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Paediatric Practice (paediatric + practice)
Selected AbstractsAssessing quality of life in paediatric clinical practiceJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2010Angela M Morrow The rising prevalence of children with chronic conditions has made quality of life an increasingly important outcome measure in paediatric practice. The discrepancy between doctors' and patients' perceptions of quality of life makes formal assessment necessary. In this paper we use a case scenario to answer commonly asked questions. What is quality of life and who can assess it? Why assess quality of life in the clinical setting? Is it feasible to measure in routine clinical practice? How is quality of life formally assessed? We provide a basic outline of the language and methods of quality of life assessment and use the case scenario to discuss the process of choosing an appropriate instrument. We conclude that quality of life assessment in clinical practice is feasible and provides benefits for both patients and doctors. The benefits include better informed doctors, improved patient doctor communication and a means to effectively monitor quality of life as a treatment outcome. [source] Developmental assessment of children: A survey of Australian and New Zealand paediatriciansJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 8 2005Sean Beggs Objectives: To determine the current practice for developmental assessment of children by Australian and New Zealand paediatricians. To determine factors associated with higher levels of self-reported confidence and expertise in developmental paediatrics and factors associated with better practice. Methods: A cross-sectional postal survey of Australian and New Zealand paediatricians conducted in 2003, enquiring about their training in developmental paediatrics and their practice for evaluating development. Results: Of 811 questionnaires sent, 590 (73%) were returned. Ninety-one respondents indicated that they did not see children with developmental issues leaving 499 surveys for analysis. The overwhelming majority of paediatricians felt that more training was required in developmental paediatrics (88%) and that there was a need to be taught a formal developmental assessment tool (83%). Higher self-ratings of confidence and expertise in developmental paediatrics were associated with a period of formal developmental training (OR (95% CI) 2.7 (1.6,4.4), 3.4 (2.0,5.8), respectively), and being taught a formal developmental assessment tool (OR (95% CI) 2.0 (1.2,3.2), 2.2 (1.3,3.7), respectively). Predictors of paediatricians performing a formal developmental assessment included formal developmental training (OR (95% CI) 2.0 (1.1,3.8)) being taught an assessment tool (OR (95% CI) 2.8 (1.5,5.2)) and mandatory training (OR (95% CI) 2.4 (1.4,4.1)). Conclusions: Developmental paediatrics is a significant and important part of paediatric practice. This survey suggests, however, that paediatric training and continuing education should have not reflected this practice. The overall method and content of developmental training including whether formal assessment tools should be taught needs to be reviewed and revised. [source] Isolated minimal renal pelvic dilatation detected antenatally in a non-tertiary setting is an uncommon predictor of significant vesicoureteric refluxJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2003GJ Rennick Objectives: To study in a non-tertiary centre the prevalence and grade of vesicoureteric reflux detected postnatally in infants already identified antenatally with isolated minimal renal pelvic dilatation. Methods: Retrospective review over the years 1998,2000 inclusive of a central computerized database in the single paediatric practice within Albury Wodonga. Results: Ninety-three (65 male) infants detected antenatally with isolated renal pelvic dilatation (,3 mm at 18 weeks gestation, ,5 mm at 32 weeks gestation,<10 mm dilatation at any gestation) had a Micturating Cystourethrogram result. Thirteen infants (seven male) had vesicoureteric reflux detected, with a total of 18 refluxing renal units. Of these 13 infants five had bilateral vesicoureteric reflux (two male), and eight had unilateral vesicoureteric reflux. The median reflux grade was 2.0, with significant vesicoureteric reflux (greater than grade II) occurring in 5.4% (5/93). Conclusions: Significant vesicoureteric reflux (greater than grade II) occurred in only 5.4% (5/93) of infants. It is concluded that isolated minimal renal pelvic dilatation detected antenatally is a poor screening test for clinically significant vesicoureteric reflux. [source] Vasopressin in paediatric practicePEDIATRIC ANESTHESIA, Issue 7 2008ANDREW WOLF No abstract is available for this article. [source] The braun thermoscan thermometer: validation of normal ranges in a paediatric practicePEDIATRIC ANESTHESIA, Issue 9 2002C.A. Streets Introduction Pyrexia is a common cause of operative cancellation in paediatric practice, and so the accurate determination of temperature is of paramount importance. Recently the Braun ThermoScan infrared aural thermometer has been introduced to Derriford Hospital as a safe and non-invasive technique for measuring temperature. Initially the published upper limits of normal for this technique appeared to be higher than expected. Initial experiences with the thermometer in Derriford Hospital produced high temperature readings in children who were otherwise clinically well. The aim of this study was to compare the manufacturer's published normal ranges with those obtained from a general paediatric population. Methods Ethics Committee approval was obtained. The study was conducted between July and November 2001. Patients less than 16 years of age, and admitted to either the Day Surgical Unit or the general paediatric wards for elective surgery were included. Each child had its temperature measured on admission using the Braun ThermoScan aural thermometer. The ages and temperatures were recorded, and the values compared with the manufacturer's normal ranges using standard error of the means. Results Preliminary data are reported from 248 children: 1,2 years (n = 30), 3,10 years (n = 159), and 11,15 years (n = 59). The table demonstrates that there is no significant statistical difference between the manufacturer's ranges and those of the Derriford Hospital paediatric elective surgical population. Discussion The Braun ThermoScan infrared aural thermometer is considered to be a safe, hygienic, and convenient technique for measuring temperature. Despite initial misgivings that a temperature approaching 38°C could not be considered normal, this study has confirmed that the manufacturer's published normal ranges are indeed compatible with those obtained from a district general hospital paediatric population. Conclusion This study validates the manufacturer's published normal range for the Braun ThermoScan thermometer. This therefore leaves a clinical dilemma , does a child with a temperature of 37.9°C have a pyrexia or not? [source] Is epidural analgesia associated with an improved outcome following open Nissen fundoplication?PEDIATRIC ANESTHESIA, Issue 1 2001G.A.M. Wilson FRCA Postoperative epidural analgesia is increasingly popular in paediatric practice, although evidence of its benefit is scarce. We performed a retrospective analysis of a series of 104 consecutive open Nissen fundoplications, to determine whether mode of analgesia, epidural (n=65) or opioid infusion (n=39), influenced certain outcome measures, including intensive care utilization, duration of hospital stay, morbidity and mortality. The two groups were similar in terms of demographic characteristics and associated pathologies. Overall, morbidity and mortality (2%) rates were low. Mean duration of hospital stay was significantly greater for the opioid group, compared to those receiving epidural analgesia (13 vs. 8 days, P < 0.05). The number of patients who remained in hospital for more than 7 days was also significantly greater in the opioid group. Accepting the limitations of a retrospective study, these data suggest that epidural analgesia might be associated with an improved outcome following Nissen fundoplication and this merits a prospective study. [source] Remifentanil in paediatric anaesthetic practiceANAESTHESIA, Issue 3 2009D. F. Marsh Summary Remifentanil is a synthetic opioid, first introduced into clinical practice in 1996. Its unique pharmacokinetic profile has resulted in a gradual increase in its popularity in paediatric anaesthesia. It is an opioid of high potency and rapid clearance, consequently lacking problems of accumulation. These characteristics give it a high degree of predictability and it has become an attractive choice for a wide variety of anaesthetic challenges, from premature neonates to the elderly. Neonates and infants have a higher clearance than older children and, as a result, remifentanil has additional benefits in this group. Remifentanil can be described as the only consistently predictable opioid in paediatric practice. [source] Interpretation of ,clear fluids' in paediatric practiceANAESTHESIA, Issue 5 2004L. Ng No abstract is available for this article. [source] Temperature monitoring in paediatric practiceANAESTHESIA, Issue 7 2000C. Macdonald No abstract is available for this article. [source] Neonatal hyperinsulinaemic hypoglycaemia and monogenic diabetes due to a heterozygous mutation of the HNF4A geneAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2009Jennifer J. CONN Recent research has demonstrated that mutations of the hepatocyte nuclear factor 4-alpha (HNF4A) gene are associated with neonatal hyperinsulinaemic hypoglycaemia. Mutations of this gene also cause one of the subtypes of monogenic diabetes, a form of diabetes formerly known as maturity-onset diabetes of the young. This article describes a family discovered to have a novel frame-shift mutation of the HNF4A gene in the setting of early-onset maternal diabetes and severe neonatal hyperinsulinaemic hypoglycaemia. The implications of a diagnosis of HNF4A gene mutation for obstetric and paediatric practice are discussed. [source] Clinical detection of caries in the primary dentition with and without bitewing radiographyAUSTRALIAN DENTAL JOURNAL, Issue 1 2009B Newman Abstract Background:, Inadequate detection of caries in the primary dentition due to non-use of bitewing radiography is commonly encountered in paediatric practice. The present study investigated the increased benefits of using bitewing radiography in addition to the visual-tactile examination technique for detection of primary dentition caries in a non-fluoridated community, and determined the prevalence of "hidden" occlusal caries in the primary dentition. Methods:, Primary teeth were scored for caries at the restorative threshold using a visual-tactile technique followed by bitewing radiographic examination in a sample of 611 schoolchildren aged 6.4 ± 0.5 yrs to 12.1 ± 0.8 yrs residing in a non-fluoridated city. Results:, Overall, at the restorative threshold, the visual-tactile technique could detect 62 per cent of occlusal caries compared to 74 per cent for bitewing radiography (p < 0.001). The prevalence of "hidden" occlusal caries was 12 per cent. In contrast, for primary molar proximal surface caries, the visual-tactile technique could detect only 43 per cent of caries compared with 91 per cent for bitewing radiography (p < 0.001). Conclusions:, In the primary dentition, use of bitewing radiography increases the detection rate of proximal surface caries substantially. It is recommended that bitewing radiography be included as part of the routine examination of children with proximal surfaces that cannot be visualized. [source] Physiological skin conditions of preterm and term neonatesCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 4 2010F. S. Afsar Summary Skin problems in children during the first few weeks of life can raise concern, even for experienced neonatologists and paediatric dermatologists. The skin of preterm and term newborn babies has distinct differences from juvenile and adult skin. An understanding of the nature of neonatal skin, the physiological and nonphysiological skin conditions of preterm and term neonates, and skin care are essential in paediatric practice. This article discusses the nature of the neonatal skin and its physiological phenomena. [source] | ||||||||||