Pub Date : 2017-02-13DOI: 10.1136/archdischild-2016-311497
C. Oakley, Sarita Makam, Y. Aung, S. Shebani
A boy was born at term, in good condition, with an antenatal cardiac diagnosis. The diagnosis was confirmed on echocardiography. Initial genetic bloods were taken including karyotype and fluorescence in situ hybridisation and he was discharged with outpatient follow-up. He was reviewed in clinic at 5 months of age. On examination, his saturations were 85% with a normal first heart sound, soft second heart sound and a loud ejection systolic murmur. The bloods showed a normal karyotype and 22q11 status. Following a local joint cardiac meeting he was accepted for surgical repair. Figures 1 and 2 are his preoperative and postoperative chest radiographs (CXRs). Figure 1 Preoperative chest radiograph. Figure 2 Chest radiograph taken first day postoperatively. 1. What is the most likely underlying cardiac diagnosis? 2. What potentially life-threatening presentation of this condition needs to be monitored for before surgical correction? 3. What is the most prominent complication that is seen on the postoperative CXR? 4. What are the management options for this? Answers to the questions are on page …
{"title":"Common congenital cardiac disease with uncommon postoperative complication","authors":"C. Oakley, Sarita Makam, Y. Aung, S. Shebani","doi":"10.1136/archdischild-2016-311497","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311497","url":null,"abstract":"A boy was born at term, in good condition, with an antenatal cardiac diagnosis. The diagnosis was confirmed on echocardiography. Initial genetic bloods were taken including karyotype and fluorescence in situ hybridisation and he was discharged with outpatient follow-up.\u0000\u0000He was reviewed in clinic at 5 months of age. On examination, his saturations were 85% with a normal first heart sound, soft second heart sound and a loud ejection systolic murmur. The bloods showed a normal karyotype and 22q11 status.\u0000\u0000Following a local joint cardiac meeting he was accepted for surgical repair. Figures 1 and 2 are his preoperative and postoperative chest radiographs (CXRs).\u0000\u0000\u0000\u0000Figure 1 \u0000Preoperative chest radiograph.\u0000\u0000\u0000\u0000\u0000\u0000Figure 2 \u0000Chest radiograph taken first day postoperatively.\u0000\u0000\u0000\u0000\u0000\u00001. What is the most likely underlying cardiac diagnosis?\u0000\u00002. What potentially life-threatening presentation of this condition needs to be monitored for before surgical correction?\u0000\u00003. What is the most prominent complication that is seen on the postoperative CXR?\u0000\u00004. What are the management options for this?\u0000\u0000\u0000\u0000Answers to the questions are on page …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74110624","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 : 2017-02-13DOI: 10.1136/archdischild-2016-311394
E. Allison, N. Dawson, J. Phillips, C. Lynch, Jacinta Coleman
Assessing and managing children who are underweight is an integral part of paediatric practice. Young people with anorexia nervosa (AN) are mainly cared for in the community by specialist eating disorder services. However, increasing numbers require admission to paediatric wards with medical instability due to the complications of starvation. Despite recommendations published in the junior MARSIPAN report in 2012, many paediatricians still feel poorly equipped to care for these high-risk patients. This article aims to provide a safe and structured approach to the assessment and management of children and adolescents with medically unstable AN.
{"title":"Fifteen minute consultation: A structured approach to the management of children and adolescents with medically unstable anorexia nervosa","authors":"E. Allison, N. Dawson, J. Phillips, C. Lynch, Jacinta Coleman","doi":"10.1136/archdischild-2016-311394","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311394","url":null,"abstract":"Assessing and managing children who are underweight is an integral part of paediatric practice. Young people with anorexia nervosa (AN) are mainly cared for in the community by specialist eating disorder services. However, increasing numbers require admission to paediatric wards with medical instability due to the complications of starvation. Despite recommendations published in the junior MARSIPAN report in 2012, many paediatricians still feel poorly equipped to care for these high-risk patients. This article aims to provide a safe and structured approach to the assessment and management of children and adolescents with medically unstable AN.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89379247","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 : 2017-02-08DOI: 10.1136/archdischild-2017-312641
F. Britton, A. Osei-Lah, M. Tighe
A 13-year-old girl, with a background of stage 4 thoracic neuroblastoma (diagnosed 2003) and residual spastic paraplegia with neuropathic bladder and irregular bowel habit, presented with increasing muscle fatigue and decreased exercise ability over the past 6 months. She reported symptoms including periodic slurring of speech, difficulty swallowing and the inability to smile or blink. These episodes were reported to last between 10 and 90 min. She also presented with ongoing nausea and a reduced appetite. On inspection, she had an indistinct smile and loss of the left nasolabial fold. Examination of the cranial nerves elucidated a bilateral facial weakness, decrease palate movement and bilateral reduced corneal reflexes. She had normal eye movements, no ptosis and her pupils were equal and reactive to light. Neurological examination of the upper limbs demonstrated weakness in C4–5 but otherwise she had normal power in her arms and hands. Tone, reflexes, coordination and sensation were normal. In light of her …
{"title":"Something for the weak-end? Electromyography appearances of myasthenia gravis","authors":"F. Britton, A. Osei-Lah, M. Tighe","doi":"10.1136/archdischild-2017-312641","DOIUrl":"https://doi.org/10.1136/archdischild-2017-312641","url":null,"abstract":"A 13-year-old girl, with a background of stage 4 thoracic neuroblastoma (diagnosed 2003) and residual spastic paraplegia with neuropathic bladder and irregular bowel habit, presented with increasing muscle fatigue and decreased exercise ability over the past 6 months. She reported symptoms including periodic slurring of speech, difficulty swallowing and the inability to smile or blink. These episodes were reported to last between 10 and 90 min. She also presented with ongoing nausea and a reduced appetite.\u0000\u0000On inspection, she had an indistinct smile and loss of the left nasolabial fold. Examination of the cranial nerves elucidated a bilateral facial weakness, decrease palate movement and bilateral reduced corneal reflexes. She had normal eye movements, no ptosis and her pupils were equal and reactive to light. Neurological examination of the upper limbs demonstrated weakness in C4–5 but otherwise she had normal power in her arms and hands. Tone, reflexes, coordination and sensation were normal.\u0000\u0000In light of her …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90551454","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 : 2017-02-08DOI: 10.1136/archdischild-2016-311556
Rachel C Amos, H. Jacob, W. Leith
In May 2016, the National Institute for Health and Care Excellence (NICE) published updated guidelines entitled ‘Jaundice in newborn babies under 28 days’ (box 1).1 The guideline covers diagnosis and treatment of neonates with jaundice, aiming ‘to help detect and prevent very high levels of bilirubin’. New recommendations focus on measuring and monitoring bilirubin levels and the type of phototherapy. Here, we summarise the guideline, highlighting updates and relevance to clinical practice. Box 1 ### Resources www.nice.org.uk/guidance/CG98 Link to NICE guideline and threshold table www.nice.org.uk/guidance/cg98/resources Link to treatment threshold graphs www.nice.org.uk/Guidance/cg98/evidence Link to guideline committee's discussion and evidence reviews The original NICE guideline CG98, published in May 2010, was jointly developed with the National Collaborating Centre for Women and Children's Health (now part of the National Guideline Alliance) to encourage more uniform, evidence-based practice.
{"title":"Jaundice in newborn babies under 28 days: NICE guideline 2016 (CG98)","authors":"Rachel C Amos, H. Jacob, W. Leith","doi":"10.1136/archdischild-2016-311556","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311556","url":null,"abstract":"In May 2016, the National Institute for Health and Care Excellence (NICE) published updated guidelines entitled ‘Jaundice in newborn babies under 28 days’ (box 1).1 The guideline covers diagnosis and treatment of neonates with jaundice, aiming ‘to help detect and prevent very high levels of bilirubin’. New recommendations focus on measuring and monitoring bilirubin levels and the type of phototherapy. Here, we summarise the guideline, highlighting updates and relevance to clinical practice. Box 1 \u0000### Resources\u0000\u0000www.nice.org.uk/guidance/CG98 \u0000\u0000Link to NICE guideline and threshold table\u0000\u0000www.nice.org.uk/guidance/cg98/resources \u0000\u0000Link to treatment threshold graphs\u0000\u0000www.nice.org.uk/Guidance/cg98/evidence \u0000\u0000Link to guideline committee's discussion and evidence reviews\u0000\u0000The original NICE guideline CG98, published in May 2010, was jointly developed with the National Collaborating Centre for Women and Children's Health (now part of the National Guideline Alliance) to encourage more uniform, evidence-based practice.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82436677","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 : 2017-02-08DOI: 10.1136/archdischild-2017-312618
Fahimeda Ali
Cohort study of mother–infant dyads. Setting: Canadian Healthy Infant Longitudinal Development Study. A population-based study with four contributing sites. Patients: Mothers of singleton pregnancies and their 1-year-old infants. Exposure: Maternal artificial and sugar-sweetened beverage intake from questionnaire, classified according to the number of servings per day/week/month. Outcomes: Primary outcome was infant body mass index (BMI) z-score at 1 year of age. Secondary outcome was the risk of being overweight (BMI z-score >97th centile) at 1 year of age. Follow-up period : Women recruited over 5 years (2009–2013). Infant BMI was calculated at 1 year of age. Patient follow-up : 3033 mother–infant dyads were recruited. 2682 completed follow-up of BMI and 2413 …
{"title":"Consumption of artificial sweeteners in pregnancy increased overweight risk in infants","authors":"Fahimeda Ali","doi":"10.1136/archdischild-2017-312618","DOIUrl":"https://doi.org/10.1136/archdischild-2017-312618","url":null,"abstract":"Cohort study of mother–infant dyads.\u0000\u0000Setting: Canadian Healthy Infant Longitudinal Development Study. A population-based study with four contributing sites.\u0000\u0000Patients: Mothers of singleton pregnancies and their 1-year-old infants.\u0000\u0000Exposure: Maternal artificial and sugar-sweetened beverage intake from questionnaire, classified according to the number of servings per day/week/month.\u0000\u0000Outcomes: Primary outcome was infant body mass index (BMI) z-score at 1 year of age. Secondary outcome was the risk of being overweight (BMI z-score >97th centile) at 1 year of age.\u0000\u0000Follow-up period : Women recruited over 5 years (2009–2013). Infant BMI was calculated at 1 year of age.\u0000\u0000Patient follow-up : 3033 mother–infant dyads were recruited. 2682 completed follow-up of BMI and 2413 …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90312269","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 : 2017-02-01DOI: 10.1136/archdischild-2016-312358
E. Valerio, Francesca Parata, M. Cutrone
Dermatological hand signs are common and can be benign (with or without treatment implications), linked to a change in patient's behaviour or herald more severe systemic conditions (dermatomyositis). Despite the peculiarity of underlying diseases, their visual appearances may overlap and sometimes be deceptive. It is therefore important for clinicians to be aware of the possible similarities in such diverse conditions, in order to make a correct diagnosis and target treatment. ### Which would be the most likely diagnosis for each image based on the cases below: 1. Gottron's papules 2. Psoriasis 3. Cutaneous T-cell lymphoma 4. Chewing pads 5. Knuckle calluses 6. Herpetic lesions 7. Idiopathic/familial knuckle pads 8. Cold burns (frost bites) 9. Common warts 10. Occupational lesions We evaluated a 17-year-old girl with dark phototype with an upper respiratory tract infection. Physical examination incidentally revealed plaque lesions located only at the extensor surface of her right hand, at the proximal interphalangeal joints (IJ) (figure 1A). Left hand was unharmed. The rest of the examination, apart from the concomitant respiratory infection, was negative. The girl also reported a recent school change as a current stressor. Figure 1 (A) Self-induced ‘chewing pads’, (B) Gottron’s papules, …
{"title":"Handy paediatric dermatology","authors":"E. Valerio, Francesca Parata, M. Cutrone","doi":"10.1136/archdischild-2016-312358","DOIUrl":"https://doi.org/10.1136/archdischild-2016-312358","url":null,"abstract":"Dermatological hand signs are common and can be benign (with or without treatment implications), linked to a change in patient's behaviour or herald more severe systemic conditions (dermatomyositis). Despite the peculiarity of underlying diseases, their visual appearances may overlap and sometimes be deceptive. It is therefore important for clinicians to be aware of the possible similarities in such diverse conditions, in order to make a correct diagnosis and target treatment.\u0000\u0000### Which would be the most likely diagnosis for each image based on the cases below:\u0000\u00001. Gottron's papules\u0000\u00002. Psoriasis\u0000\u00003. Cutaneous T-cell lymphoma\u0000\u00004. Chewing pads\u0000\u00005. Knuckle calluses\u0000\u00006. Herpetic lesions\u0000\u00007. Idiopathic/familial knuckle pads\u0000\u00008. Cold burns (frost bites)\u0000\u00009. Common warts\u0000\u000010. Occupational lesions\u0000\u0000We evaluated a 17-year-old girl with dark phototype with an upper respiratory tract infection. Physical examination incidentally revealed plaque lesions located only at the extensor surface of her right hand, at the proximal interphalangeal joints (IJ) (figure 1A). Left hand was unharmed. The rest of the examination, apart from the concomitant respiratory infection, was negative. The girl also reported a recent school change as a current stressor.\u0000\u0000\u0000\u0000Figure 1 \u0000(A) Self-induced ‘chewing pads’, (B) Gottron’s papules, …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77148140","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 : 2017-01-30DOI: 10.1136/archdischild-2016-311834
D. Giri, Ravi Jayaram, S. Senniappan
A 5-year-old boy was referred with a history of multiple subcutaneous nodules since infancy. He was born at 42 weeks gestation with a birth weight of 3.2 kg. At 8 months of age, he was noted to have an excessive weight gain by the health visitor and was subsequently diagnosed with primary hypothyroidism and commenced on levothyroxine 50 μg once daily. He had a normal newborn congenital hypothyroidism screen. The thyroid autoimmune antibodies were normal. By the age of 5 years, he had delayed walking, speech and learning difficulties. Mother gave a history of surgically removed calcified lesions on her back. His weight and height at presentation were 35.5 kg (+3.8 SDS) and 121.4 cm (1.6 SDS), respectively. On examination, he had multiple subcutaneous nodules over and behind the left knee, left forearm, right ankle, chest and abdomen (figures 1 and 2). Investigations revealed a …
一名5岁男童自婴儿期起就有多个皮下结节病史。他在怀孕42周时出生，出生体重为3.2公斤。8个月大时，卫生访视员注意到他体重过度增加，随后诊断为原发性甲状腺功能减退，并开始服用左旋甲状腺素50 μg，每日一次。他有一个正常的新生儿先天性甲状腺功能减退症筛查。甲状腺自身免疫抗体正常。5岁时，他出现了走路迟缓、语言和学习困难。母亲讲述了她背部手术切除钙化病灶的病史。发病时体重35.5 kg (+3.8 SDS)，身高121.4 cm (1.6 SDS)。检查发现，患者左膝、左前臂、右脚踝、胸部和腹部有多发皮下结节(图1和2)。
{"title":"Subcutaneous calcifications and hypothyroidism: Is there a missing link?","authors":"D. Giri, Ravi Jayaram, S. Senniappan","doi":"10.1136/archdischild-2016-311834","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311834","url":null,"abstract":"A 5-year-old boy was referred with a history of multiple subcutaneous nodules since infancy. He was born at 42 weeks gestation with a birth weight of 3.2 kg. At 8 months of age, he was noted to have an excessive weight gain by the health visitor and was subsequently diagnosed with primary hypothyroidism and commenced on levothyroxine 50 μg once daily. He had a normal newborn congenital hypothyroidism screen. The thyroid autoimmune antibodies were normal.\u0000\u0000By the age of 5 years, he had delayed walking, speech and learning difficulties. Mother gave a history of surgically removed calcified lesions on her back. His weight and height at presentation were 35.5 kg (+3.8 SDS) and 121.4 cm (1.6 SDS), respectively. On examination, he had multiple subcutaneous nodules over and behind the left knee, left forearm, right ankle, chest and abdomen (figures 1 and 2). Investigations revealed a …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87164140","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 : 2017-01-27DOI: 10.1136/archdischild-2016-311526
Tess Marshall-Andon, P. Heinz
Epstein-Barr virus (EBV) is a highly prevalent virus, transmitted via saliva, which often causes asymptomatic infection in children but frequently results in infectious mononucleosis in adolescents. Heterophile antibody tests, including the Monospot test, are red cell or latex agglutination assays, which detect antired cell antibodies produced as part of a polyclonal antibody response occurring during EBV infection. Heterophile antibody tests are rapid, cheap and specific tests that can be performed from the onset of symptoms of infectious mononucleosis. In adolescents, heterophile antibody tests have high specificity and sensitivity in the diagnosis of primary acute EBV infection. However, the tests have low sensitivity and low negative predictive value in young children and are not useful under the age of 4. Heterophile tests may be positive in other viral infections, autoimmune disease and haematological malignancies, but do not appear to be positive in primary bacterial infection. Virus-specific serology is required in children under the age of 4 or if an older child is heterophile negative. Virus-specific serology allows diagnosis and the pattern of positivity and negativity enables the clinician to stage the EBV infection. Virus-specific serology appears to have better sensitivity in young children, but there is cross-reaction with other herpesvirus infections, a longer turnaround time and it is more expensive to perform. Further research is needed to establish which children benefit from and hence require testing for heterophile antibodies, the cost-effectiveness of EBV investigations and whether heterophile titres have predictive value for the severity of infection and the likelihood of complications.
{"title":"How to use … the Monospot and other heterophile antibody tests","authors":"Tess Marshall-Andon, P. Heinz","doi":"10.1136/archdischild-2016-311526","DOIUrl":"https://doi.org/10.1136/archdischild-2016-311526","url":null,"abstract":"Epstein-Barr virus (EBV) is a highly prevalent virus, transmitted via saliva, which often causes asymptomatic infection in children but frequently results in infectious mononucleosis in adolescents. Heterophile antibody tests, including the Monospot test, are red cell or latex agglutination assays, which detect antired cell antibodies produced as part of a polyclonal antibody response occurring during EBV infection. Heterophile antibody tests are rapid, cheap and specific tests that can be performed from the onset of symptoms of infectious mononucleosis. In adolescents, heterophile antibody tests have high specificity and sensitivity in the diagnosis of primary acute EBV infection. However, the tests have low sensitivity and low negative predictive value in young children and are not useful under the age of 4. Heterophile tests may be positive in other viral infections, autoimmune disease and haematological malignancies, but do not appear to be positive in primary bacterial infection. Virus-specific serology is required in children under the age of 4 or if an older child is heterophile negative. Virus-specific serology allows diagnosis and the pattern of positivity and negativity enables the clinician to stage the EBV infection. Virus-specific serology appears to have better sensitivity in young children, but there is cross-reaction with other herpesvirus infections, a longer turnaround time and it is more expensive to perform. Further research is needed to establish which children benefit from and hence require testing for heterophile antibodies, the cost-effectiveness of EBV investigations and whether heterophile titres have predictive value for the severity of infection and the likelihood of complications.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89549083","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 : 2017-01-24DOI: 10.1136/archdischild-2016-312428
A. Friend, D. Roland
In patients with possible distal forearm fracture, is ultrasound scanning a reliable method of diagnosis when compared with X-ray? Design : Systematic review and meta-analysis. Data source : Medline, Web of Science, the Cochrane Library. Study inclusion criteria : Comparison of ultrasound and X-ray in patients with potential distal forearm fractures; written in English, French, German or Spanish language. A total of 16 studies involving 1204 patients with 641 fractures were included. Twelve studies involving 951 patients looked specifically at children. Included studies all used X-ray as their ‘gold standard’ for diagnosing fractures and compared ultrasound to this. Most studies …
对于可能发生前臂远端骨折的患者，与x线相比，超声扫描是一种可靠的诊断方法吗?设计:系统回顾和荟萃分析。数据来源:Medline, Web of Science, Cochrane图书馆。研究纳入标准:潜在前臂远端骨折患者的超声与x线比较;用英语、法语、德语或西班牙语书写。共纳入16项研究，涉及1204例641例骨折。涉及951名患者的12项研究专门针对儿童。所有纳入的研究都使用x光作为诊断骨折的“金标准”，并将其与超声波进行比较。大多数研究……
{"title":"Distal forearm fractures can be reliably diagnosed using ultrasound","authors":"A. Friend, D. Roland","doi":"10.1136/archdischild-2016-312428","DOIUrl":"https://doi.org/10.1136/archdischild-2016-312428","url":null,"abstract":"In patients with possible distal forearm fracture, is ultrasound scanning a reliable method of diagnosis when compared with X-ray?\u0000\u0000Design : Systematic review and meta-analysis.\u0000\u0000Data source : Medline, Web of Science, the Cochrane Library.\u0000\u0000Study inclusion criteria : Comparison of ultrasound and X-ray in patients with potential distal forearm fractures; written in English, French, German or Spanish language.\u0000\u0000A total of 16 studies involving 1204 patients with 641 fractures were included. Twelve studies involving 951 patients looked specifically at children. Included studies all used X-ray as their ‘gold standard’ for diagnosing fractures and compared ultrasound to this. Most studies …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82602606","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 : 2017-01-18DOI: 10.1136/archdischild-2016-312564
I. Wacogne
In the odd delay built into a journal like E&P, I’m writing this in the immediate aftermath of attending the Royal College of Paediatrics and Child Health Spring Conference. It’s interesting that in this age of more real print and virtual print than we can even begin to think of completing, and more resources for learning than our predecessors could have imagined, we still make the time to travel and to sit in the same room as a speaker, to hear them talk. I wonder why we do this? I suspect there are a few reasons. One of them is to do with trusting that an eminent speaker will have prepared an interesting and stimulating talk, which introduces us to a new set of ideas. Another is to listen to how people have responded to difficulties similar to our own. But I suspect that the main reason is the buzz of meeting a bunch of people, some of whom you’ve never met before, some of whom you’ve not seen for a year or two, and, well, chatting. It would be easy to create a misunderstanding here—after all, our employing bodies are often supporting us financially to attend, and I’m pretty sure they’d be reluctant to fund us to go on a general gossip. So, to clarify, it’s more than a gossip—it’s the pollination of different ideas across multiple people, and the creation of exciting new thoughts. And what about when you’re in the same room as a bad speaker? Well, these days there is always WiFi. But, that aside, I also find value in a conference where I can unfocus a little, and let the thoughts rattle around a bit. What can a journal do to recreate the best parts of a conference? Well, obviously it can’t simulate putting people in the same room. But it can bring the thoughts of some diverse people into the room you’re in— which, by some accounts, might be the littlest room in the house. This issue we’ve got lymph nodes, croup, BCG abscess, mouth ulcers, neonatal antibiotics, haemangiomas, odd X-rays, capillary refill time, pulse oximetry, and a Picket on cooling after brain injury. I reckon that’s pretty eclectic, and should, if you unfocus a little while reading, give you a few fairly diverse thoughts. My Editor’s choice is the paper on recurrent oral ulceration in children (see page 82). Esse Menson, who wrote this paper with Kirsty Le Doare, Esther Hullah and Stephen Challacombe, has been helping curate a infectious diseases subseries within the Fifteen-Minute Consultation section, so expect a lot of these over the next few months. Oral ulceration is a clinical scenario I find tricky; the range of possibilities, from idiopathic to some very serious diagnoses, and the high incidence—from 1 to 10% of children —make it important to pick the right child to investigate robustly. The authors provide a helpful table of first line investigations with the useful caveat that the absence of systemic features, you can usually avoid testing. Awhile ago I used to take copious notes in talks, convinced that I’d pore over them later, absorbing the knowledge and becoming a
我是在参加完皇家儿科学院和儿童健康春季会议之后，才写这篇文章的。有趣的是，在这个真实印刷和虚拟印刷的时代，我们甚至无法想象完成，学习资源比我们的前辈想象的要多，我们仍然有时间去旅行，和演讲者坐在同一个房间里，听他们说话。我想知道我们为什么要这样做?我怀疑有以下几个原因。其中之一是相信一位杰出的演讲者会准备一场有趣而刺激的演讲，向我们介绍一套新的思想。另一种方法是倾听人们如何应对与我们相似的困难。但我怀疑主要原因是见到一群人的兴奋，有些人你以前从未见过，有些人你已经一两年没见了，还有，嗯，聊天。这很容易造成误解——毕竟，我们的雇主经常在经济上支持我们参加，我很确定他们不愿意资助我们去八卦。所以，澄清一下，这不仅仅是闲聊——这是不同想法在多人之间的传播，以及令人兴奋的新想法的创造。当你和一个差劲的演讲者在一个房间里的时候呢?现在到处都有WiFi。但是，除此之外，我也发现了会议的价值，在那里我可以稍微分散一下注意力，让思想在周围摇摆。期刊怎样才能重现会议的精华呢?很明显，它不能模拟把人放在同一个房间里。但它可以把一些不同的人的想法带到你所在的房间——从某些方面来说，你所在的房间可能是房子里最小的房间。这期我们有淋巴结，群，卡介苗脓肿，口腔溃疡，新生儿抗生素，血管瘤，奇怪的x光片，毛细血管重新充血时间，脉搏血氧测量，以及脑损伤后冷却的问题。我认为这是相当兼收并蓄的，如果你在阅读时稍微分散一下注意力，应该会给你一些相当不同的想法。我的编辑选择是关于儿童复发性口腔溃疡的论文(见第82页)。Esse Menson，他和Kirsty Le Doare, Esther Hullah和Stephen Challacombe一起写了这篇论文，他一直在帮助策划十五分钟咨询部分的传染病子系列，所以在接下来的几个月里，我们会看到很多这样的文章。口腔溃疡是一个我觉得棘手的临床情况;从特发性到一些非常严重的诊断的可能性范围，以及从1%到10%的高发病率，使得选择合适的孩子进行强有力的调查变得非常重要。作者提供了一个有用的第一线调查表，并给出了一个有用的警告，即如果没有系统特性，通常可以避免测试。不久前，我常常在演讲中做大量的笔记，相信我以后会仔细研究它们，吸收知识，成为一名更好的医生。当然，我再也没有拿起它们，所以多年来我调整了我的风格，并试图限制自己每次演讲只讲几件事。我不再考虑“这里有什么信息”，而是考虑“因此我将采取什么行动”。在一个会议上呆上几天仍然可以给我一个比我完成的要做的事情清单，但我发现我所采取的行动，真的让我走了很长一段路。菲利帕·普伦蒂斯以这种方式出色地编辑了指南部分——确保作者给你列出要做的事情，有时更重要的是，不要做的事情。我很想知道你在看完这个月的E&P之后会做什么，或者不再做什么。只要稍微分散一下注意力，一切就都有意义了。
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