Преимущества и недостатки велосипедного движения

ntroduction Community-acquired pneumonia (CAP) is a common indication for antibiotic treatment in young children. Data are limited regarding the ideal dose and duration of amoxicillin, leading to practice variation which may impact on treatment failure and antimicrobial resistance (AMR). Community-Acquired Pneumonia: a randomIsed controlled Trial (CAP-IT) aims to determine the optimal amoxicillin treatment strategies for CAP in young children in relation to efficacy and AMR.Methods and analysis The CAP-IT trial is a multicentre, randomised, double-blind, placebo-controlled 2×2 factorial non-inferiority trial of amoxicillin dose and duration. Children are enrolled in paediatric emergency and inpatient environments, and randomised to receive amoxicillin 70–90 or 35–50 mg/kg/day for 3 or 7 days following hospital discharge. The primary outcome is systemic antibacterial treatment for respiratory tract infection (including CAP) other than trial medication up to 4 weeks after randomisation. Secondary outcomes include adverse events, severity and duration of parent-reported CAP symptoms, adherence and antibiotic resistance. The primary analysis will be by intention to treat. Assuming a 15% primary outcome event rate, 8% non-inferiority margin assessed against an upper one-sided 95% CI, 90% power and 15% loss to follow-up, 800 children will be enrolled to demonstrate non-inferiority for the primary outcome for each of duration and dose.Ethics and dissemination The CAP-IT trial and relevant materials were approved by the National Research Ethics Service (reference: 16/LO/0831; 30 June 2016). The CAP-IT trial results will be published in peer-reviewed journals, and in a report published by the National Institute for Health Research Health Technology Assessment programme. Oral and poster presentations will be given to national and international conferences, and participating families will be notified of the results if they so wish. Key messages will be constructed in partnership with families, and social media will be used in their dissemination.Trial registration number ISRCTN76888927, EudraCT2016-000809-36

What are you looking at?

Above all the practice of medicine is a discipline of direct contact; diagnosis is built on history and examination. In paediatrics there may only be a second-hand narrative so the art of recognising illness from observation alone makes it an even more appealing but challenging career. Medical education has previously concerned itself with teaching the clinical signs of illness (e.g. chest retractions) or abnormal postures or positions adopted (i.e. in a child with a dystonia) or the sounds made (i.e. stridor in upper airways instruction). Furthermore clinically important visual or auditory patterns are not always found by directly looking at the patient. For example, it is also important to teach how to recognize the waveforms of abnormal electrical traces representing breathing (capnography) or cardiac patterns (asystole). Medical pedagogy has traditionally centred on teaching how to determine normal from abnormal by teaching what students needed to look at. The advent of accessible technology to adequately determine the direction of gaze has opened up a new paradigm of educational investigation in understanding where a person is looking and for how long, therefore helping us understand how to look at patients

Have the UK Pediatric Trauma Protocols resulted in a reduction in chest computed tomography imaging for children presenting with major blunt trauma?

Objectives To observe variation in imaging requests after publication of the Royal College of Radiologists UK Paediatric Trauma Protocols in 2014, recommending limited use of thoracic computed tomography (CT) to appropriately clinically risk stratified children. Method A retrospective observational study using data from the Trauma Audit & Research Network in the United Kingdom, for children (0–16 years of age) for the years 2012–2021. Percentages were calculated to facilitate comparison between year groups (under 1 year of age, 1–10 years of age, 11–15 years of age), and CT imaging categories reviewed: (1) whole-body CT (WBCT); (2) abdominopelvic CT (CTAP) with chest radiograph (CXR); (3) chest, abdomen, and pelvic CT (CTCAP) with CXR; (4) CTCAP without CXR; and (5) other imaging. Results Increased use of the recommended protocol (CXR with CTAP) was observed after guidance publication but was not sustained: infants under 1 year old, 0.0% in 2012, 7% in 2017, 0.0% in 2021; 1–10-year-olds, 4% in 2012, 13.9% in 2017, 5.5% in 2021; 11–15-year-olds, 7.1% in 2012, 10.2% in 2017, 6.6% in 2021. Requests for WBCT increased from 2012–2021 (all age groups, 2.4%, 2012, to 5.3%, 2021) and requests for CTCAP were consistently at a higher level than that of the recommended protocol. Conclusion The increased use of CXR with CTAP after publication of the guidelines, was not sustained with a decreasing trend observed from ∼2017, raising concern for the ionizing radiation burden in this population.</p

Reclaiming the systems approach to paediatric safety

Prior to the emergence of the patient safety movement as a distinct science, it was assumed that the safety of patients was an outcome of good professional acumen, and that if healthcare providers could individually perform well then their patients would remain safe at all times. It is now 20 years since the publication of To Err is Human,1 the first major review of healthcare safety in the USA. In the UK, the publication Organisation with a Memory 2 in 2000 supported the view that patient safety required a wider system approach. Both documents reframed safety and error in healthcare as an organisational or system issue rather than one of individual error, whether of omission or of commission. Over the past 20 years, there has been major progress in the understanding of patient safety and the complexity of the systems involved in providing healthcare. In a recent review of the state of patient safety in 2018, Bates and Singh3 conclude that ‘Highly effective interventions have since been developed and adopted for hospital-acquired infections and medication safety, although the impact of these interventions varies because of their inconsistent implementation and practice’. Within paediatrics, the National Patient Safety Agency made the first attempt in the UK to detail the extent of healthcare-derived harm among children.4 The problems identified remain a challenge—namely communication, deterioration, delayed or missed diagnosis, infections and medication harm. This is despite well-tested theories and interventions being available for many of these. In this paper, we explore the theories of patient safety and provide principles to tackle the challenge ahead

Time to improve the diversity of paediatric skin images

Although significant progress has been made in the last decade, there is still clear evidence of thenegative impact of racism on health and well-being, through implicit and explicit biases,institutional structures, and interpersonal relationships (1). It is remarkable that in 2020 we stillface such a situation within our healthcare systems. The time has come for physicians andresearchers to act and make change to these inequalities in health. The impact of the lack ofdiversity of skin tone representation in medical resources on the ability of healthcare workers torecognise childhood skin and genetic conditions, however, has never been established. This isdespite the American Academy of Pediatrics clearly advocating for rigorous research thatexamines, amongst others, “the impact of policy changes and community-level interventions onreducing the health effects of racism and other forms of discrimination on youth development” (1).This represents a significant gap in the literature that needs to be urgently addressed. Work hasstarted on trying to address these challenges with medical student Malone Makwende creating theresource “mind the gap”[2] to specifically highlight skin conditions on black and brown skin. [Opening paragraph]</div

A cross-sectional description of open access publication costs, policies and impact in emergency medicine and critical care journals

Introduction: Finding journal open access information alongside its global impact requires access to multiple databases. We describe a single, searchable database of all emergency medicine and critical care journals that include their open access policies, publication costs, and impact metrics. Methods: A list of emergency medicine and critical care journals (including citation metrics) was created using Scopus (Citescore) and the Web of Science (Impact Factor). Cost of gold/hybrid open access and article process charges (open access fees) were collected from journal websites. Self-archiving policies were collected from the Sherpa/RoMEO database. Relative cost of access in different regions were calculated using the World Bank Purchasing Power Parity index for authors from the United States, Germany, Turkey, China, Brazil, South Africa and Australia. Results: We identified 78 emergency medicine and 82 critical care journals. Median Citescore for emergency medicine was 0.73 (interquartile range, IQR 0.32–1.27). Median impact factor was 1.68 (IQR 1.00–2.39). Median Citescore for critical care was 0.95 (IQR 0.25–2.06). Median impact factor was 2.18 (IQR 1.73–3.50). Mean article process charge for emergency medicine was $2243.04, SD =$1136.16 and for critical care $2201.64, SD =$1174.38. Article process charges were 2.24, 1.75, 2.28 and 1.56 times more expensive for South African, Chinese, Turkish and Brazilian authors respectively than United States authors, but neutral for German and Australian authors (1.02 and 0.81 respectively). The database can be accessed here: http://www.emct.info/publication-search.html. Conclusions: We present a single database that captures emergency medicine and critical care journal impact rankings alongside its respective open access cost and green open access policies

In reply.

We appreciate the opportunity to respond to Dr. Pelaccia’s letter,1 which sought to draw some important conclusions for the field of emergency medicine decision making from our recent article.

OC26 - Parents of young children in research: informants, consultants and collaborators.

Theme: ETHICAL ISSUES: dignity and humanity. INTRODUCTION: Patient and public involvement in research is recognised as best practice in the UK, as services developed with service users are more likely to meet their needs. In child health this often means engaging with parents of young children. AIM: To share experiences of engaging with parents of young children in research projects at varying levels of participation. METHODS: Methods include parents as participants, as parent panels and as research team members reflecting various steps on the participation ladder (Hart 1992). RESULTS: Parents report personal benefits and a range of different challenges when engaging in child health research which impact the management/delivery of research projects. CONCLUSION: Key elements of working with parents include time to plan involvement, building respect/mutual understanding, equal access to project activities, continual support for parents, reward and recognition. Research projects need to cost and plan for parents' engagement in research for it to be successful

Risk factors for asthma attacks and poor control in children: a prospective observational study in UK primary care

Objective To identify risk factors for asthma attacks and poor asthma control in children aged 5–16 years. Methods Prospective observational cohort study of 460 children with asthma or suspected asthma from 10 UK general practices. Gender, age, ethnicity, body mass index, practice deprivation decile, spirometry and fraction of exhaled nitric oxide (FeNO) were recorded at baseline. Asthma control scores, asthma medication ratio (AMR) and the number of asthma attacks were recorded at baseline and at 6 months. The above independent variables were included in binary multiple logistic regression analyses for the dependent variables of: (1) poor symptom control and (2) asthma attacks during follow-up. Results Poor symptom control at baseline predicted poor symptom control at 6 months (OR 4.4, p=0.001), while an increase in deprivation decile (less deprived) was negatively associated with poor symptom control at 6 months (OR 0.79, p=0.003). Higher FeNO levels (OR 1.02, p A decrease in AMR was also associated with an increased OR for future asthma attacks (OR 2.99, p=0.003) when included as an independent variable. Conclusions We identified risk factors for poor symptom control and asthma attacks in children. Routine assessment of these factors should form part of the asthma review to identify children at an increased risk of adverse asthma-related events.</p

Letter in response to letter by Diba Behzad-Noori & Gurdas Singh in response to "Prescribing in a paediatric emergency".

We thank Behzad-Noori D & Singh G for their letter to the editor (1) commenting on our recent publication (2). We are pleased to see medical students interested in academic endeavour and note their multiple previous letters to other journals about survey design and validity