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Tertiary Paediatric Hospital (tertiary + paediatric_hospital)
Selected Abstracts27 years of croup: An update highlighting the effectiveness of 0.15 mg/kg of dexamethasoneEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2009Milana Dobrovoljac Abstract Objective: To update an earlier observational study (1980,1995) documenting dramatic improvements in the management of croup with the mandatory use of a single oral dose of dexamethasone and to ascertain whether a reduction from a dose of 0.6 to 0.15 mg/kg in 1995 maintained these improved outcomes over the next 11 years. Methods: We evaluated retrospectively the experience of children with croup in Princess Margaret Hospital for Children, the only tertiary paediatric hospital in Western Australia, over the subsequent 11 year period from 1996 to 2006 inclusive. Data were updated from ED, general hospital and the intensive care unit records to show the numbers of children presenting to the hospital, admitted, transferred to intensive care and intubated. We also recorded the length of hospital stay and representation rate of all cases within 7 days. Results: The dramatic improvements in outcomes for croup, including reduced admission rates, length of stay, transfers to the intensive care unit, intensive care unit days and number of intubations as reported in our earlier paper, were maintained using 0.15 mg/kg dexamethasone. Admission rates for croup have fallen from 30% in the early 1990s to less than 15% in recent years, whereas the representation rate has risen slightly. Conclusion: The improved outcomes for children with croup presenting to our paediatric ED have been maintained with a reduced, single oral dose of 0.15 mg/kg of dexamethasone. [source] Investigation of the rate of meningitis in association with urinary tract infection in infants 90 days of age or youngerEMERGENCY MEDICINE AUSTRALASIA, Issue 5 2007Peter J Vuillermin Abstract Objective: To test the hypothesis that urinary tract infections (UTI) in young infants are rarely associated with meningitis. Methods: We undertook a review of the laboratory results from 322 infants, 90 days of age or younger, with an admission or discharge diagnosis of UTI or meningitis. The study was conducted in a tertiary paediatric hospital. The primary outcome measure was the incidence of coexisting urinary tract and cerebrospinal fluid sepsis. Results: In total, 161 of the 322 (50%) infants with an admission or discharge diagnosis of UTI or meningitis were subsequently shown to have a culture-proven UTI. Of the children with a culture-proven UTI, 75 (47%) had cerebrospinal fluid obtained. We detected one case of probable bacterial meningitis in association with UTI. Conclusion: UTI is rarely associated with meningitis in infants 90 days of age or younger. [source] Monitoring nutritional status accurately and reliably in adolescents with anorexia nervosaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2009Andrew C Martin Aim: Accurate assessment of nutritional status is a vital aspect of caring for individuals with anorexia nervosa (AN) and body mass index (BMI) is considered an appropriate and easy to use tool. Because of the intense fear of weight gain, some individuals may attempt to mislead the physician. Mid-upper arm circumference (MUAC) is a simple, objective method of assessing nutritional status. The setting is an eating disorders clinic in a tertiary paediatric hospital in Western Australia. The aim of this study is to evaluate how well MUAC correlates with BMI in adolescents with AN. Methods: Prospective observational study to evaluate nutritional status in adolescents with AN. Results: Fifty-five adolescents aged 12,17 years with AN were assessed between January 1, 2004 and January 1, 2006. MUAC was highly correlated with BMI (r = 0.79, P < 0.001) and individuals with MUAC ,20 cm rarely required hospitalisation (negative predictive value 93%). Conclusions: MUAC reflects nutritional status as defined by BMI in adolescents with AN. Lack of consistency between longitudinal measurements of BMI and MUAC should be viewed suspiciously and prompt a more detailed nutritional assessment. [source] Discussing withdrawing and withholding of life-sustaining medical treatment in a tertiary paediatric hospital: A survey of clinician attitudes and practicesJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2008Tom Forbes Aim: To better understand current attitudes and practices relating to discussions concerning the withholding and withdrawing of life-sustaining medical treatment (WWLSMT) among medical staff in the paediatric setting. Methods: An anonymous online survey of paediatricians (senior medical staff , SMS) and paediatric trainees (junior medical staff , JMS) likely to be involved in the care of children with life limiting illness. Results: A total of 162 responses were obtained (response rate 42%). SMS indicated feeling more comfortable with their abilities to discuss WWLSMT than JMS. Barriers to discussing WWLSMT were numerous and included clinician concerns about family readiness for the discussion, prognostic uncertainty, family disagreement with the treating team regarding the child's prognosis/diagnosis and concerns about how to manage family requests for treatments that are not perceived to be in the child's best interests. Fifty-eight per cent of JMS and 35.8% of SMS reported receiving no specific communication training regarding WWLSMT. Most learned through experience and by observing more senior colleagues. There was a high level of support for additional training in this area and for the provision of resources such as discussion guidelines and a structured form for documenting the outcomes WWLSMT discussions. Conclusion: The majority of JMS feel less comfortable with their abilities to facilitate these discussions than their senior colleagues. The results of this study suggest that although confidence correlates with experience, junior and senior clinicians are eager to improve their skills through ongoing professional development and the provision of resources. The education needs of JMS and SMS appear to be different. [source] Use of the Internet by parents of paediatric patientsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2006Brynn K Wainstein Aim: We aimed to determine the rate of Internet use for obtaining medical information by health-care patients at a tertiary paediatric hospital, whether the Internet may influence patients' attitudes to health-care services and health-care providers and whether patients would prefer the assistance of a professional informatics officer. Methods: An anonymous questionnaire randomly distributed to 450 subjects at Sydney Children's Hospital, Sydney, Australia. Results: A total of 294 (65%) questionnaires were returned. Overall Internet use for medical information was 64% (189/294). Most (97%; 183/189) respondents reported ,wanting to know more' as the reason they sought information on the Internet. Eighty-eight per cent (167/189) of respondents reported that they trust their doctor more than the Internet. Twenty-one per cent (39/189) had presented their doctor with information about which he/she was unaware and 18% (34/189) had altered a health-care decision because of information found on the Internet. The Internet had influenced questions asked of doctors in 83% (156/189). Eighty-six per cent (252/294) of all respondents were in favour of professional assistance to obtain medical information. Conclusion: A large number of patients use the Internet to find information that influences their attitudes to health care. The services of a medical informatics professional would likely benefit both patients and doctors. [source] Obesity and under-nutrition in a tertiary paediatric hospitalJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5-6 2004J O'Connor Objective: (i) To determine the prevalence of over- and under-nutrition in both inpatients and outpatients in a tertiary paediatric hospital; (ii) to compare the prevalence of over-nutrition with that in the Australian community and (iii) to determine whether nutritional status has an impact on length of stay in hospital. Methods: Patients aged over 12 months were proportionately sampled from medical and surgical wards and outpatient clinics. Data were collected for 245 inpatients (54% male) and 272 outpatients (55% male). Children's height, weight and body mass index (kg/m2) were measured. Overweight, obesity and under-nutrition were defined according to international criteria. Prevalence of overweight and obesity was compared with that in the 1995 Australian National Nutrition Survey (NNS). Results: Similar proportions of inpatients and outpatients were underweight (6%) and wasted (4%). The prevalence of overweight and obesity in inpatients (22%) was similar to the NNS but was significantly higher in outpatients (32%, P < 0.0001). In a regression model to predict inpatient length of stay, nutritional status (P = 0.004) and the interaction between age and nutritional status (P = 0.009) were significant predictors. For over-nourished inpatients, length of stay increased significantly with age. For normally nourished and under-nourished inpatients, length of stay was relatively constant, regardless of age. Conclusions: There is a high prevalence of over-nutrition in paediatric patients, and increased length of stay for older over-nourished inpatients. These issues need to be addressed in terms of opportunities for intervention and impact on hospital resources. [source] Transition in chronic illness: Who is going where?JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2008Katharine S Steinbeck Aim: With increasing survival rates for chronic childhood illness, there has been an increasing focus on the transition of clinical care from paediatric to adult services. Data regarding patient numbers are essential for strategic planning and for optimal management. We report on a data collection exercise from the New South Wales Greater Metropolitan Clinical Taskforce Transition Program. Methods: Data were collected between August 2004 and October 2005 through face-to-face interviews with over 200 clinicians in 68 clinical services in tertiary paediatric hospitals in New South Wales, providing information on approximately 4200 patients. Results: Sixty-eight services kept a database on patients with chronic illness but less than half were electronic. Eight services (12%) could specifically identify patients in the active phase of transition on their databases. The five most prevalent clinical groups requiring transition to adult specialist health care (excluding cerebral palsy and developmental disability) were diabetes, other endocrinology, neurology, spina bifida and gastroenterology. Conclusions: There are large numbers of young people with chronic illness and disability who need effective transition to long-term adult care. This study has enabled the identification of paediatric aspects of the transition process that require attention. [source] | ||||||||||