111 results
Search Results
2. Are antihistamines effective in children? A review of the evidence.
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De Bruyne, Pauline, Christiaens, Thierry, Boussery, Koen, Mehuys, Els, and Van Winckel, Myriam
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ANTIHISTAMINES ,ANTIALLERGIC agents ,DRUG efficacy ,OFF-label use (Drugs) ,DRUG side effects ,SEROTONIN antagonists ,ANTIPSYCHOTIC agents ,PHENOTHIAZINE ,DRUG labeling ,MEDICAL prescriptions ,EVIDENCE-based medicine ,DRUG approval ,TREATMENT effectiveness ,THERAPEUTICS - Abstract
Background and Aims: During the last decades, much attention has been paid to off-label and unlicensed prescriptions in paediatrics. However, on-label prescribing can also cause health issues. In this paper, the case of first-generation H1-antihistamines is investigated, notably the range of indications for which products are licensed in different European countries and the evidence base (or lack thereof) for each indication, as well as reported adverse drug reactions.Methods: Review of the Summary of Product Characteristics of first-generation H1-antihistamines with a focus on paediatric use. This is plotted against the evidence available in the literature.Results: This investigation shows a large variability in labelled indications and licensing ages when compared in five different European countries. Moreover, most of the indications are not based on clinical trials evaluating efficacy and safety of these drugs in children.Conclusions: Many of the licensed indications of first-generation antihistamines do not appear to be evidence based. [ABSTRACT FROM AUTHOR]- Published
- 2017
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3. Children's palliative care in low- and middle-income countries.
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Downing, Julia, Powell, Richard A., Marston, Joan, Huwa, Cornelius, Chandra, Lynna, Garchakova, Anna, and Harding, Richard
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PALLIATIVE treatment ,MEDICAL care ,CHILDREN'S health ,MIDDLE-income countries ,LOW-income countries ,MEDICAL care standards ,CHILD health services ,DEVELOPING countries ,MANAGEMENT ,POVERTY ,EVIDENCE-based medicine - Abstract
One-third of the global population is aged under 20 years. For children with life-limiting conditions, palliative care services are required. However, despite 80% of global need occurring in low- and middle-income countries (LMICs), the majority of children's palliative care (CPC) is provided in high-income countries. This paper reviews the status of CPC services in LMICs--highlighting examples of best practice among service models in Malawi, Indonesia and Belarus--before reviewing the status of the extant research in this field. It concludes that while much has been achieved in palliative care for adults, less attention has been devoted to the education, clinical practice, funding and research needed to ensure children and young people receive the palliative care they need. [ABSTRACT FROM AUTHOR]
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- 2016
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4. Health policy research: successes and challenges.
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Lemer, Claire, Cheung, C. Ronny, Viner, Russell, and Wolfe, Ingrid
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HEALTH policy ,EVIDENCE-based medicine ,PHYSICIAN practice patterns ,RESEARCH funding ,NATIONAL health services ,GOVERNMENT policy - Abstract
This review seeks to explore and explain what health policy research is and why it matters, through pooling the evidence and providing case examples. Alongside examining the types of research involved, and their rationale the paper identifies the challenges taking part in this sort of research may create. Finally the paper suggests how to make clinical research more accessible to policy makers. [ABSTRACT FROM AUTHOR]
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- 2015
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5. Towards evidence-based medicine for paediatricians.
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Phillips, Bob
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EVIDENCE-based medicine ,PEDIATRICIANS ,INFLAMMATORY bowel diseases - Published
- 2022
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6. Towards evidence-based medicine for paediatricians.
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Sevenoaks, Laura and Tulloh, Robert
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MUCOCUTANEOUS lymph node syndrome ,EVIDENCE-based medicine ,MEDICAL personnel ,DISEASE risk factors ,PEDIATRICIANS - Published
- 2020
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7. Drug treatment of inborn errors of metabolism: a systematic review.
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Alfadhel M, Al-Thihli K, Moubayed H, Eyaid W, and Al-Jeraisy M
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- Dose-Response Relationship, Drug, Humans, Randomized Controlled Trials as Topic, Evidence-Based Medicine methods, Metabolism, Inborn Errors drug therapy
- Abstract
Background: The treatment of inborn errors of metabolism (IEM) has seen significant advances over the last decade. Many medicines have been developed and the survival rates of some patients with IEM have improved. Dosages of drugs used for the treatment of various IEM can be obtained from a range of sources but tend to vary among these sources. Moreover, the published dosages are not usually supported by the level of existing evidence, and they are commonly based on personal experience., Methods: A literature search was conducted to identify key material published in English in relation to the dosages of medicines used for specific IEM. Textbooks, peer reviewed articles, papers and other journal items were identified. The PubMed and Embase databases were searched for material published since 1947 and 1974, respectively. The medications found and their respective dosages were graded according to their level of evidence, using the grading system of the Oxford Centre for Evidence-Based Medicine., Results: 83 medicines used in various IEM were identified. The dosages of 17 medications (21%) had grade 1 level of evidence, 61 (74%) had grade 4, two medications were in level 2 and 3 respectively, and three had grade 5., Conclusions: To the best of our knowledge, this is the first review to address this matter and the authors hope that it will serve as a quickly accessible reference for medications used in this important clinical field.
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- 2013
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8. Principles of evidence based medicine.
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Akobeng AK
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- Child, Humans, Information Storage and Retrieval, Randomized Controlled Trials as Topic, Research, Child Welfare, Evidence-Based Medicine methods
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Health care professionals are increasingly required to base clinical decisions on the best available evidence. Evidence based medicine (EBM) is a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values. This paper explains the concept of EBM and introduces the five step EBM model: formulation of answerable clinical questions; searching for evidence; critical appraisal; applicability of evidence; evaluation of performance. Subsequent articles will focus on the principles and critical appraisal of randomised controlled trials, systematic reviews, and meta-analyses, and provide a practical demonstration of the five step EBM model using a real life clinical scenario.
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- 2005
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9. Towards evidence-based medicine for paediatricians.
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Lowry, Christopher, McAlister, Peter, Wallace, Fiona, Fallis, Richard, and Mullen, Stephen
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POSTOPERATIVE nausea & vomiting ,EVIDENCE-based medicine ,PEDIATRICIANS ,CHILDREN'S injuries ,MEDICAL sciences ,BRAIN injuries - Published
- 2021
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10. Current evidence-based recommendations on investigating children with global developmental delay.
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Mithyantha, Renuka, Kneen, Rachel, McCann, Emma, and Gladstone, Melissa
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DEVELOPMENTAL delay ,CHILDREN ,BRAIN abnormalities ,GENETIC testing ,GENETIC disorders ,DIAGNOSIS of developmental disabilities ,EVIDENCE-based medicine - Abstract
Introduction: Global developmental delay (GDD) affects 1%-3% of the population of children under 5 years of age, making it one of the most common conditions presenting in paediatric clinics; causes are exogenous, genetic (non-metabolic) or genetic (metabolic). Recent advances in biotechnology and genetic testing mean that the investigations available to perform for children under 5 years are increasing and are more sensitive than previously. This change in availability and type of testing necessitates an update in the recommendations for investigating GDD.Methods: We conducted a review of the literature from 2006 to 2016 to identify articles with evidence relating to the investigation of developmental delay in children under the age of 5 years. We collated the evidence into first-line and second-line investigations and, where available, on their yield and cost implications.Results: We have provided up-to-date guidance for first-line and second-line investigations for children with GDD under the age of 5 years. Recent evidence demonstrates that genetic testing for all children with unexplained GDD should be first line, if an exogenous cause is not already established. Our review of the literature demonstrates that all patients, irrespective of severity of GDD, should have investigations for treatable conditions. Evidence demonstrates that the yield for treatable conditions is higher than previously thought and that investigations for these metabolic conditions should be considered as first line. Additional second-line investigations can be led by history, examination and developmental trajectories.Discussion: We may need to update present recommendations in the UK for investigation of developmental delay. This would include microarray testing as first line and a more thorough approach to investigations for metabolic disorders that can be treated. Clinical assessment remains vital for guiding investigations. [ABSTRACT FROM AUTHOR]- Published
- 2017
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11. Towards evidence-based medicine for paediatricians.
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Phillip, Bob
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EVIDENCE-based medicine ,PEDIATRICIANS ,NEONATAL intensive care units - Published
- 2023
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12. Towards evidence-based medicine for paediatricians.
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Phillips, Bob
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EVIDENCE-based medicine ,PEDIATRICIANS ,COVID-19 pandemic ,RESEARCH grants - Published
- 2020
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13. Towards evidence-based medicine for paediatricians.
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LYMPHOBLASTIC leukemia ,CHILD patients ,JUVENILE diseases ,EVIDENCE-based medicine ,ACUTE leukemia - Published
- 2024
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14. Evidence-based practice in cognitive-behavioural therapy.
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Stallard, Paul
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EMOTIONAL problems of children ,PSYCHOLOGICAL distress ,CHRONIC diseases ,CHILDREN'S health ,PROFESSIONAL practice ,EVIDENCE-based medicine ,TREATMENT effectiveness - Abstract
Cognitive-behavioural therapy (CBT) is a practical, goal-focused approach that helps children understand the relationship between their thoughts, feelings and behaviours. The aim is to identify the dysfunctional and distorted cognitions associated with their psychological problems and to create more functional and balanced cognitive patterns that create less emotional distress and more helpful behaviours. CBT has strong evidence as an effective intervention for children and adolescents with emotional problems. The benefits for children with physical health and chronic conditions appear promising, although further research is required to substantiate these gains. [ABSTRACT FROM AUTHOR]
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- 2022
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15. Improving access to care for children with mental disorders: a global perspective.
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Patel, Vikram, Kieling, Christian, Maulik, Pallab K., and Divan, Gauri
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CHILD psychopathology ,DEVELOPMENTAL disabilities ,CHILD psychology ,MENTAL health ,EVIDENCE-based medicine ,HEALTH programs ,MIDDLE-income countries - Abstract
Developmental disabilities, emotional disorders and disruptive behaviour disorders are the leading mental health-related causes of the global burden of disease in children aged below 10 years. This article aims to address the treatment gap for child mental disorders through synthesising three bodies of evidence: the global evidence base on the treatment of these priority disorders; the barriers to implementation of this knowledge; and the innovative approaches taken to address these barriers and improve access to care. Our focus is on low-resource settings, which are mostly found in low- and middle-income countries (LMIC). Despite the evidence base on the burden of child mental disorders and their long-term consequences, and the recent mental health Gap Action Programme guidelines which testify to the effectiveness of a range of pharmacological and psychosocial interventions for these disorders, the vast majority of children in LMIC do not have access to these interventions. We identify three major barriers for the implementation of efficacious treatments: the lack of evidence on delivery of the treatments, the low levels of detection of child mental disorders and the shortage of skilled child mental health professionals. The evidence based on implementation, although weak, supports the use of screening measures for detection of probable disorders, coupled with a second-stage diagnostic assessment and the use of nonspecialist workers in community and school settings for the delivery of psychosocial interventions. The most viable strategy to address the treatment gap is through the empowerment of existing human resources who are most intimately concerned with child care, including parents, through innovative technologies, such as mobile health, with the necessary skills for the detection and treatment of child mental disorders. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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16. Towards evidence-based medicine for paediatricians.
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Phillips, Bob
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URINARY tract infections ,EVIDENCE-based medicine ,PEDIATRICIANS ,MEDICAL personnel - Published
- 2021
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17. Towards evidence-based medicine for paediatricians.
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Phillips, Bob
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EVIDENCE-based medicine ,PEDIATRICIANS ,DATA libraries - Published
- 2024
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18. Towards evidence-based medicine for paediatricians.
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Levene, Ilana and Phillips, Bob
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EVIDENCE-based medicine ,SYMPATHY ,PEDIATRICIANS ,ADOPTED children - Published
- 2021
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19. Should bubble baths be avoided in children with urinary tract infections?
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Modgil, G. and Baverstock, A.
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URINARY tract infections in children ,BATHING of infants ,BATHS ,EVIDENCE-based medicine ,PEDIATRICIANS ,DISEASE risk factors - Abstract
The article presents an evidence-based answer to a question on the use of bubble baths in children with urinary tract infections (UTI). There is a lack of conclusive evidence supporting the advice of general pediatricians to avoid the use of bubble bath to prevent UTI. However, the common sense approach is advised. The enjoyment of bubble baths outweighs the limited evidence of their supposed harm.
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- 2006
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20. Towards evidence-based medicine for paediatricians.
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Paddock, Michael, Ruffle, Amy, Beattie, George, Prasai, Amit, Jeanes, Annmarie, and Phillips, Bob
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EVIDENCE-based medicine ,LYMPHADENITIS ,PEDIATRICIANS ,COLOR Doppler ultrasonography ,NEEDLE biopsy - Published
- 2020
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21. Should teenage girls with anorexia nervosa be offered oestrogen treatment to reduce later risk of osteoporosis?
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Zadeh, Pooneh and Etheridge, Lucinda
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EVIDENCE-based medicine ,PEDIATRICIANS ,BONE density ,ADOLESCENCE ,ANOREXIA nervosa ,OSTEOPOROSIS - Published
- 2020
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22. How has research in the past 5 years changed my clinical practice?
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Nicholas Mann
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Service (systems architecture) ,Pediatrics ,medicine.medical_specialty ,Biomedical Research ,Public domain ,Field (computer science) ,Congenital Hypothyroidism ,Albuminuria ,Humans ,Mainstream ,Medicine ,Child ,Publication ,Evidence-Based Medicine ,Notice ,business.industry ,Infant, Newborn ,Professional Practice ,Public relations ,Urinary Tract Infections ,Pediatrics, Perinatology and Child Health ,business ,Tourette Syndrome ,Medical literature - Abstract
Research leads to changes in our clinical practice, but all doctors have different approaches to tackling the constant barrage of information and new evidence. However, those practitioners who are constantly changing treatments once they come across some new theory or research data may not necessarily be doing their patients a service. For example, most paediatricians will take more notice of a randomised controlled trial about blood transfusion in a mainstream journal such as BMJ rather than a single case report found in an obscure transfusion journal. Teaching is another useful method of keeping up to date as it encourages one to investigate the latest developments. Furthermore, junior doctors import new helpful techniques and ideas from other units where they have previously worked. The peer review process helps to weed out the majority of poorly constructed papers and those with serious statistical or ethical problems, but such systems are far from perfect. For example, on occasion an editor may be tempted to by-pass peer review on the grounds that a paper contains important data that should be in the public domain as soon as possible. The world output of medical literature is vast and expands at an exponential rate, and most of us who are busy clinicians do not have the time to read more than a few journals on a regular basis. It is therefore easy to miss important papers that may be relevant to one’s own area of practice. Review papers in journals by experts are helpful in pulling together relevant information and are an efficient use of our precious time. Hopefully, the editor will pick a clinician who knows their field well, can write clearly and is able to give a balanced view. Another technique adopted by editors is to publish an editorial or commentary by an expert …
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- 2008
23. Licensed medicines, off-label use or evidence-based. Which is most important?
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Bonati, Maurizio, Jacqz-Aigrain, Evelyne, and Choonara, Imti
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ANTIBIOTICS ,CHLORAMPHENICOL ,OFF-label use (Drugs) ,EVIDENCE-based medicine ,PHARMACEUTICAL industry ,DRUG labeling ,MEDICAL prescriptions ,DRUG approval - Published
- 2017
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24. Fluid resuscitation in paediatric burns: how do we get it right? A systematic review of the evidence.
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Stutchfield, Christopher, Davies, Anna, and Young, Amber
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META-analysis ,FLUID therapy ,RESUSCITATION ,DATABASE searching ,BURNS & scalds ,COMPARATIVE studies ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,SYSTEMATIC reviews ,EVIDENCE-based medicine ,EVALUATION research ,TREATMENT effectiveness - Abstract
Background: Optimal fluid resuscitation in children with major burns is crucial to prevent or minimise burn shock and prevent complications of over-resuscitation.Objectives: To identify studies using endpoints to guide fluid resuscitation in children with burns, review the range of reported endpoint targets and assess whether there is evidence that targeted endpoints impact on outcome.Design: Systematic review.Methods: Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials databases were searched with no restrictions on study design or date. Search terms combined burns, fluid resuscitation, endpoints, goal-directed therapy and related synonyms. Studies reporting primary data regarding children with burns (<16 years) and targeting fluid resuscitation endpoints were included. Data were extracted using a proforma and the results were narratively reviewed.Results: Following screening of 777 unique references, 7 studies fulfilled the inclusion criteria. Four studies were exclusively paediatric. Six studies used urine output (UO) as the primary endpoint. Of these, one set a minimum UO threshold, while the remainder targeted a range from 0.5-1.0 mL/kg/hour to 2-3 mL/kg/hour. No studies compared different UO targets. Heterogeneous study protocols and outcomes precluded comparison between the UO targets. One study targeted invasive haemodynamic variables, but this did not significantly affect patient outcome.Conclusions: Few studies have researched resuscitation endpoints for children with burns. Those that have done so have investigated heterogeneous endpoints and endpoint targets. There is a need for future randomised controlled trials to identify optimal endpoints with which to target fluid resuscitation in children with burns. [ABSTRACT FROM AUTHOR]- Published
- 2019
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25. Should levetiracetam rather than phenobarbitone be the first-line treatment for neonatal seizures?
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Giva, Sheiniz, Boyle, Michael A., and Gorman, Kathleen M.
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CEREBRAL anoxia-ischemia ,EVIDENCE-based medicine ,NEONATAL surgery ,PEDIATRICIANS ,MEDICAL personnel ,MEDICAL sciences ,NEURODEVELOPMENTAL treatment for infants - Published
- 2021
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26. Should vitamin D supplementation routinely be prescribed to children receiving antiepileptic medication?
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Scott, Maura, Corrigan, Neil, Bourke, Thomas, Thompson, Andrew, and Mallett, Peter
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EVIDENCE-based medicine ,PEDIATRICIANS ,DIETARY supplements ,VITAMIN D deficiency ,VITAMIN D metabolism - Published
- 2021
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27. Health policy research: successes and challenges
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C Ronny Cheung, Ingrid Wolfe, Claire Lemer, and Russell M Viner
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Biomedical Research ,Evidence-Based Medicine ,business.industry ,Health Priorities ,Health Policy ,Interprofessional Relations ,Pooling ,Public relations ,Health services ,Pediatrics, Perinatology and Child Health ,sort ,Medicine ,Humans ,business ,Policy Making ,Health policy - Abstract
This review seeks to explore and explain what health policy research is and why it matters, through pooling the evidence and providing case examples. Alongside examining the types of research involved, and their rationale the paper identifies the challenges taking part in this sort of research may create. Finally the paper suggests how to make clinical research more accessible to policy makers.
- Published
- 2014
28. Question 3 Ketamine or midazolam: does it matter which?
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Elisabeth Jameson
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Male ,medicine.medical_specialty ,Midazolam ,Sedation ,Conscious Sedation ,MEDLINE ,Cochrane Library ,Lacerations ,medicine ,Humans ,Hypnotics and Sedatives ,Ketamine ,Child ,Evidence-Based Medicine ,Sutures ,business.industry ,General surgery ,Forearm Injuries ,Evidence-based medicine ,Emergency department ,Search terms ,Anesthesia ,Pediatrics, Perinatology and Child Health ,medicine.symptom ,business ,medicine.drug - Abstract
A 7-year-old boy presents to the emergency department having sustained a laceration to his forearm after playing pirates with his brother using kitchen knives. He has no other injuries but the laceration requires suturing. He is, unsurprisingly, not keen on the idea of stitches and is very upset and won't co-operate. Midazolam and ketamine are commonly used sedative agents; which would be preferable in this emergency room scenario? In children with simple lacerations requiring suturing [patient], is midazolam [intervention] more effective than ketamine [comparison] in achieving adequate sedation [outcome]? ### Primary sources MEDLINE was searched from 1950 to November 2008 and EMBASE from 1980 to week 51 2008 via the OVID interface. The advanced search mode was used with the terms (‘midazolam’ and ‘ketamine’) and (‘suturing’ or ‘laceration’). Limits were: MEDLINE, ‘all child 0–18 years’ and EMBASE, ‘child ‘. ### Secondary sources The Cochrane Library was searched using the search terms ‘midazolam’ and ‘ketamine’. ### Outcome The search of MEDLINE revealed 15 papers, three of which were relevant. EMBASE yielded 24 articles with one additional relevant article. No other papers were identified in The Cochrane Library, but all four relevant papers were listed on the Cochrane register of trials (see table 1). Emergency departments are often presented with children requiring minor …
- Published
- 2010
29. Question 2: Would systemic steroids be useful in the management of Stevens-Johnson syndrome?
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Geetha Anand and Fenella Corrick
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Male ,Pathology ,medicine.medical_specialty ,Evidence-Based Medicine ,Erythema ,business.industry ,Incidence (epidemiology) ,Mucocutaneous zone ,Disease ,Evidence-based medicine ,medicine.disease ,Dermatology ,Toxic epidermal necrolysis ,Treatment Outcome ,Adrenal Cortex Hormones ,Stevens-Johnson Syndrome ,Pediatrics, Perinatology and Child Health ,medicine ,Etiology ,Humans ,Erythema multiforme ,medicine.symptom ,business ,Child - Abstract
An 8-year-old patient is admitted with severe mucocutaneous erythema and fever. He looks acutely ill, with haemorrhagic crusting on his lips and complains of burning pain. He is diagnosed with Stevens-Johnson Syndrome (SJS) and supportive measures are commenced. You wonder if in this scenario systemic steroids would be useful. You decide to look at the evidence. In children with SJS (patient) do systemic steroids (intervention) reduce morbidity or mortality (outcome)? PubMed and Scopus databases were searched using search terms: Stevens-Johnson syndrome AND steroids AND (management OR treatment OR therapy). Inclusion criteria were: children included in study population, article in English, evidence level 2 or higher (using Oxford Centre for Evidence-based Medicine criteria1). Altogether, 189 papers were found in Pubmed, of which 186 were irrelevant or of insufficient quality. Three hundred and ten papers were found in Scopus, of which one was a further relevant paper. All relevant papers are summarised in table 1. View this table: Table 1 Summary of included papers SJS (also known as Lyell's disease) and toxic epidermal necrolysis (TEN) are severe, sometimes life-threatening skin reactions that present with mucocutaneous epidermal detachment.2 Classically considered drug reactions, other aetiological factors include viral infections, M pneumoniae , vaccines and some neoplastic and autoimmune conditions.3 There are no universally accepted diagnostic criteria and confusion over nomenclature between SJS, TEN and erythema multiforme has been only partially resolved. Bastuji-Garin et al in 19934 and Roujeau in 19945 published a consensus definition distinguishing erythema multiforme as a distinct entity, with SJS and TEN variants of severity in a spectrum of the same disease process. Estimates of incidence vary widely, perhaps reflecting the use of varying classification systems, from 0.4 to 1.2 and 1.2 to 6 …
- Published
- 2013
30. Burden of child and adolescent obesity on health services in England.
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Viner, Russell M., Kinra, Sanjay, Nicholls, Dasha, Cole, Tim, Kessel, Anthony, Christie, Deborah, White, Billy, Croker, Helen, Wong, Ian C. K., and Saxena, Sonia
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ADOLESCENT obesity ,MEDICAL care ,EVIDENCE-based medicine ,BODY mass index ,COMORBIDITY - Published
- 2018
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31. Highlights from this issue.
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Platt, Martin Ward and Ward Platt, Martin
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TRIGGER warnings ,COGNITIVE therapy ,PREMATURE infant diseases ,MIGRAINE ,HEADACHE treatment ,EVIDENCE-based medicine - Published
- 2017
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32. 'The Score Matters': wide variations in predictive performance of 18 paediatric track and trigger systems.
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Chapman, Susan M., Wray, Jo, Oulton, Kate, Pagel, Christina, Ray, Samiran, and Peters, Mark J.
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TRIGGER warnings ,PEDIATRICS ,EVIDENCE-based medicine ,CHILDREN'S hospitals ,CARDIAC arrest ,CATASTROPHIC illness ,CRITICAL care medicine ,HOSPITAL care ,INTENSIVE care units ,PHARMACOKINETICS ,PROGNOSIS ,RISK assessment ,PREDICTIVE tests ,RETROSPECTIVE studies ,SEVERITY of illness index ,DISEASE progression ,PATIENT readmissions - Abstract
Objective: To compare the predictive performance of 18 paediatric early warning systems (PEWS) in predicting critical deterioration.Design: Retrospective case-controlled study. PEWS values were calculated from existing clinical data, and the area under the receiver operator characteristic curve (AUROC) compared.Setting: UK tertiary referral children's hospital.Patients: Patients without a 'do not attempt resuscitation' order admitted between 1 January 2011 and 31 December 2012. All patients on paediatric wards who suffered a critical deterioration event were designated 'cases' and matched with a control closest in age who was present on the same ward at the same time.Main Outcome Measures: Respiratory and/or cardiac arrest, unplanned transfer to paediatric intensive care and/or unexpected death.Results: 12 'scoring' and 6 'trigger' systems were suitable for comparative analysis. 297 case events in 224 patients were available for analysis. 244 control patients were identified for the 311 events. Three PEWS demonstrated better overall predictive performance with an AUROC of 0.87 or greater. Comparing each system with the highest performing PEWS with Bonferroni's correction for multiple comparisons resulted in statistically significant differences for 13 systems. Trigger systems performed worse than scoring systems, occupying the six lowest places in the AUROC rankings.Conclusions: There is considerable variation in the performance of published PEWS, and as such the choice of PEWS has the potential to be clinically important. Trigger-based systems performed poorly overall, but it remains unclear what factors determine optimum performance. More complex systems did not necessarily demonstrate improved performance. [ABSTRACT FROM AUTHOR]- Published
- 2017
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33. Immunotherapy for arterial ischaemic stroke in childhood: a systematic review.
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Edwards, Hannah B., Mallick, Andrew A., and O'Callaghan, Finbar J. K.
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IMMUNOTHERAPY ,PEDIATRIC therapy ,ISCHEMIA treatment ,STROKE treatment ,NEUROLOGICAL disorders ,THERAPEUTIC use of glucocorticoids ,DISEASE relapse prevention ,CEREBRAL ischemia ,STROKE ,SYSTEMATIC reviews ,EVIDENCE-based medicine ,CENTRAL nervous system infections ,INTRACRANIAL arterial diseases ,DISEASE complications - Abstract
Background: There is little evidence about either prevention or treatment of childhood arterial ischaemic stroke (AIS). However, drugs that regulate the immune and inflammatory response could theoretically prevent occurrence or recurrence of AIS. Additionally, as an acute treatment, they may limit the neurological damage caused by AIS. Here, we systematically review the evidence on the use of immunotherapy in childhood AIS.Design: A systematic review of publications in databases Embase and Medline from inception. All types of evidence were included from trials, cohorts, case-control and cross-sectional studies and case reports.Results: 34 reports were included: 32 observational studies and 2 trials. Immunotherapy was used in two key patient groups: arteriopathy and acute infection. The majority were cases of varicella and primary angiitis of the central nervous system. All three cohorts and 80% of the case studies were treated with steroids. Recurrence rates were low. Analytical studies weakly associated steroids with lower odds of new stroke and neurological deficits, and better cognitive outcomes in the context of Moyamoya disease and tuberculosis.Conclusions: Immunotherapies are used in children with AIS, mainly as steroids for children with arteriopathy. However, there is currently little robust evidence to either encourage or discourage this practice. There is weak evidence consistent with the hypothesis that in certain children at risk, steroids may both reduce the risk of occurrent/recurrent stroke and enhance neurological outcomes. As the potential benefit is still uncertain, this indicates that a trial of steroids in childhood AIS may be justified. [ABSTRACT FROM AUTHOR]- Published
- 2017
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34. Developing a paediatric drug formulary for the Netherlands.
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van der Zanden, Tjitske M., de Wildt, Saskia N., Liem, Yves, Offringa, Martin, de Hoog, Matthijs, and Dutch Paediatric Pharmacotherapy Expertise Network NKFK (Nederlands Kenniscentrum voor Farmacotherapie bij Kinderen)
- Subjects
EVIDENCE-based medicine ,DRUG development ,PEDIATRICS ,MEDICATION safety ,DRUG efficacy ,CONSENSUS (Social sciences) ,DRUG administration ,MEDICAL prescriptions ,DRUG approval ,KNOWLEDGE base - Abstract
As many drugs in paediatrics are used off-label, prescribers face a lack of evidence-based dosing guidelines. A Dutch framework was developed to provide dosing guidelines based on best available evidence from registration data, investigator-initiated research, professional guidelines, clinical experience and consensus. This has clarified the scientific grounds of drug use for children and encouraged uniformity in prescribing habits in the Netherlands. The developed framework and the current content of the Dutch Paediatric Formulary could be used as basis for similar initiatives worldwide, preferably in a concerted effort to ultimately provide children with effective and safe drug therapy. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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35. Towards evidence-based medicine for paediatricians.
- Author
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Phillips, Bob
- Subjects
EVIDENCE-based medicine ,PREMEDICATION ,PEDIATRICIANS - Published
- 2023
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36. Prerequisites to support high-quality clinical trials in children and young people
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Jenny M. Kindblom, Florian B. Lagler, and Steven Hirschfeld
- Subjects
Medical education ,medicine.medical_specialty ,business.industry ,Process (engineering) ,Information quality ,Evidence-based medicine ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,Resource (project management) ,Incentive ,030225 pediatrics ,Pediatrics, Perinatology and Child Health ,Medicine ,030212 general & internal medicine ,Outcomes research ,business ,Competence (human resources) - Abstract
Children have the right to treatment based on the same quality of information that guides treatment in adults. Without the proper evaluation of medicinal products and devices in paediatric clinical trials that are designed to meet the rigorous standards of the competent authorities, children are discriminated from advances in medicine. There are regulatory, scientific and ethical incentives to address the knowledge gap regarding efficacy and safety of medicines in the paediatric population. High-quality clinical trials involving children of all ages can generate data that will ultimately close the knowledge gaps and support decision making.For clinical trials that enrol children, the needs are specialised and often resource intensive. Prerequisites for successful paediatric clinical trials are personnel with training in both paediatrics and neonatology and expertise in clinical trials in these populations. Moreover, national and international networks for efficient collaboration, dissemination of information, and sharing of resources and expertise are also needed, together with competent, efficient and high-quality local infrastructure with effective processes. Monitoring and oversight bodies with the relevant competence, including expertise in paediatrics, is also an important prerequisite for paediatric clinical trials. Compromise in any of these components will compromise the downstream results.This paper discusses the structures and competences needed in order to perform effective, high-quality paediatric clinical trials with the ultimate goal of better medicines and treatments for children. We propose a model of examining the process as a series of components that each has to be optimised, then all the components are actively optimised to function together as an ecosystem, and the resulting ecosystem functions well with the general research system and the healthcare delivery system.
- Published
- 2020
37. Testing our understanding of tests
- Author
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Marie Westwood and Bob Phillips
- Subjects
Pediatrics ,medicine.medical_specialty ,Evidence-Based Medicine ,Evidence-based practice ,business.industry ,MEDLINE ,Probabilistic logic ,Evidence-based medicine ,Sensitivity and Specificity ,Test (assessment) ,Comprehension ,Pre- and post-test probability ,Data Interpretation, Statistical ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Medical physics ,Clinical Competence ,business ,Categorical variable ,Diagnostic Techniques and Procedures - Abstract
Doctors have a prime role as diagnosticians and are encouraged to practise evidence based medicine (EBM). The classic Bayesian formulation of evidence based diagnostic testing1 relies on the estimation of a pretest probability, modified by the probabilistic estimate of test accuracy to produce a post-test probability. If this is high enough to cross a “treatment threshold”, then therapy is commenced. Alternatively, if it is low enough, then one disregards the possibility of the diagnosis. This probability modifying philosophy of diagnosis isn’t the only approach currently practiced in medicine. Other diagnostic traditions exist such as the “anatomical” (the neurologist asking, “What level is the spinal cord lesion at?”), the “criterion based” (“Do they score enough for Kawasaki disease?”) and the “categorical” (a histopathologist asking, “Do those cells in that pattern looks like graft rejection?”) and are useful at other times and in other ways.2 But, when you try to break things down like this, you soon see that each is a simplification. Using estimates of accuracy for a single test to quantify the way that probability of disease changes underestimates how it is actually used. Many tests provide far more information about the patient and their condition than the simple presence or absence of disease (eg, the location of a tumour and its risk of complications) and diagnostic tests are often pieced together in a chain of information in order to arrive at the underlying problem. What the paper by Sox3 in this issue of the Archives suggests is that we’re actually very poor at understanding the arithmetic components of diagnosis. This might have been predictable. The paper sits alongside a series of studies from the last 30 years which have demonstrated how poor – on average – doctors are at using test performance descriptors. And it doesn’t …
- Published
- 2009
38. QUESTION 1: Are paediatric oncology patients at risk of transfusional iron overload?
- Author
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Rompola, Melpomeni
- Subjects
LYMPHOBLASTIC leukemia in children ,BLOOD transfusion ,BIOPSY ,RED blood cell transfusion ,TUMOR treatment ,ANTINEOPLASTIC agents ,BLOOD transfusion reaction ,IRON in the body ,RISK assessment ,EVIDENCE-based medicine - Abstract
The article presents a case study of a three-year-old girl who was treated for acute lymphoblastic leukaemia (ALL). Topics discussed include the risk of transfusional iron overload (IO), the packed red blood cell (PRBC) transfusions, and the use of liver biopsy to diagnose IO. Information regarding the management and monitoring of IO is also provided.
- Published
- 2016
- Full Text
- View/download PDF
39. Steroid-sensitive nephrotic syndrome: an evidence-based update of immunosuppressive treatment in children.
- Author
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Larkins, Nicholas, Siah Kim, Craig, Jonathan, Hodson, Elisabeth, and Kim, Siah
- Subjects
ADRENOCORTICAL hormones ,HORMONE therapy ,NEPHROTIC syndrome in children ,NEPHROTIC syndrome treatment ,IMMUNOSUPPRESSIVE agents ,DISEASE relapse ,THERAPEUTICS ,THERAPEUTIC use of glucocorticoids ,GLUCOCORTICOIDS ,NEPHROTIC syndrome ,EVIDENCE-based medicine - Abstract
Nephrotic syndrome is one of the most common paediatric glomerular diseases, with an incidence of around two per 100,000 children per year. Corticosteroids are the mainstay of treatment, with 85%-90% of children going into remission with an 8-week course of treatment. Unfortunately, nephrotic syndrome follows a relapsing and remitting course in the majority, with 90% relapsing at least once. About half will progress to frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS). Different initial steroid regimens have been evaluated since the first trials in Europe and America in the 1960s. Most trials have been designed to evaluate the optimal duration of the initial therapy, rather than different cumulative doses of corticosteroid, or the management of relapses. Until recently, these data suggested that an initial treatment duration of up to 6 months reduced the number of children developing a relapse, without evidence of increased steroid toxicity. Recently, three large, well-designed randomised control trials were published, which demonstrated no significant reduction in risk of relapse or of developing FRNS by extended treatment compared with 2 or 3 months. While there are few trial data to guide the treatment of individual relapses in steroid-sensitive nephrotic syndrome (SSNS), there is some evidence that a short course of corticosteroid therapy during upper respiratory tract infection may prevent relapse. In patients with FRNS or SDNS who continue to relapse despite low-dose alternate-day steroids a number of non-corticosteroid, steroid-sparing immunosuppressive agents (cyclophosphamide, ciclosporin, tacrolimus, mycophenolate mofetil, levamisole, rituximab) have been shown to reduce the risk of relapse and of FRNS. However, there are limited head-to-head data to inform which agent should be preferred. In this article, we review recent data from randomised trials to update paediatricians on the current evidence supporting interventions in SSNS. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
40. What are the indications for using probiotics in children?
- Author
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Szajewska, Hania
- Subjects
PROBIOTICS ,DIETARY supplements ,CHILD nutrition ,RANDOMIZED controlled trials ,PREBIOTICS ,THERAPEUTIC use of probiotics ,PEDIATRICS ,EVIDENCE-based medicine - Abstract
The health benefits of probiotics have been the subject of extensive research. Still, some questions are being repeatedly asked: should one use or not use probiotics? If yes, how and when should probiotics be used? The purpose of this review is to summarise current evidence on specific probiotics' efficacy and safety to help healthcare professionals make evidence-based decisions on the indications for using specific probiotic strains or combinations in children. To identify relevant data, searches of MEDLINE and the Cochrane Library databases were performed in July 2015 to locate randomised controlled trials or their meta-analyses published in the last five years. The MEDLINE database also was searched for evidence-based clinical practice guidelines, developed by scientific societies. Considering that probiotics have strain-specific effects, the main focus was on data on individual probiotic strains, not on probiotics in general. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
41. Tools for 'safety netting' in common paediatric illnesses: a systematic review in emergency care.
- Author
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de Vos-Kerkhof, Evelien, Geurts, Dorien H. F., Wiggers, Mariska, Moll, Henriette A., and Oostenbrink, Rianne
- Subjects
EMERGENCY medical services ,PEDIATRICS ,PHYSICIANS ,FEVER in children ,DYSPNEA ,CHILD health services ,HOSPITAL emergency services ,LONG-term health care ,SYSTEMATIC reviews ,EVIDENCE-based medicine ,DISCHARGE planning ,PATIENT readmissions - Abstract
Context: Follow-up strategies after emergency department (ED) discharge, alias safety netting, is often based on the gut feeling of the attending physician.Objective: To systematically identify evaluated safety-netting strategies after ED discharge and to describe determinants of paediatric ED revisits.Data Sources: MEDLINE, Embase, CINAHL, Cochrane central, OvidSP, Web of Science, Google Scholar, PubMed.Study Selection: Studies of any design reporting on safety netting/follow-up after ED discharge and/or determinants of ED revisits for the total paediatric population or specifically for children with fever, dyspnoea and/or gastroenteritis. Outcomes included complicated course of disease after initial ED visit (eg, revisits, hospitalisation).Data Extraction: Two reviewers independently assessed studies for eligibility and study quality. As meta-analysis was not possible due to heterogeneity of studies, we performed a narrative synthesis of study results. A best-evidence synthesis was used to identify the level of evidence.Results: We summarised 58 studies, 36% (21/58) were assessed as having low risk of bias. Limited evidence was observed for different strategies of safety netting, with educational interventions being mostly studied. Young children, a relevant medical history, infectious/respiratory symptoms or seizures and progression/persistence of symptoms were strongly associated with ED revisits. Gender, emergency crowding, physicians' characteristics and diagnostic tests and/or therapeutic interventions at the index visit were not associated with revisits.Conclusions: Within the heterogeneous available evidence, we identified a set of strong determinants of revisits that identify high-risk groups in need for safety netting in paediatric emergency care being related to age and clinical symptoms. Gaps remain on intervention studies concerning specific application of a uniform safety-netting strategy and its included time frame. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
42. Towards evidence based medicine for paediatricians.
- Author
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Phillips, Bob
- Subjects
EVIDENCE-based medicine ,PEDIATRICIANS ,PEDIATRICS - Abstract
Focuses on pediatricians' use of evidence-based medicine. Integration of highest quality scientific evidence with clinical expertise; Management of diseases in children.
- Published
- 2003
- Full Text
- View/download PDF
43. Screening for coeliac disease: what evidence is required before population programmes could be considered?
- Author
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E H Young and N J Wareham
- Subjects
medicine.medical_specialty ,education.field_of_study ,Pathology ,Health professionals ,business.industry ,Population ,Alternative medicine ,Evidence-based medicine ,medicine.disease ,Coeliac disease ,Harm ,Family medicine ,Pediatrics, Perinatology and Child Health ,medicine ,business ,education ,Preclinical stage ,Mass screening - Abstract
Commentary on the paper by Tommasini et al In the traditional doctor-patient consultation, the patient initiates a visit and the physician’s imperative is to respond to the best of his or her ability. However, in a screening programme, the initiation comes from health professionals, and many commentators have argued that this poses different ethical challenges.1 In particular it is argued that the level of evidence concerning the balance of overall benefit and harm from the screening programme must be much greater than that for a traditional therapeutic intervention. Although screening may intuitively be logical for a particular condition which is prevalent and detectable in the preclinical stage, intuition is not an appropriate basis for commencing a screening programme. A number of criteria have been described that allow the evidence for screening programmes to be more formally evaluated.2 Calls are regularly made for the introduction of population screening programmes, such as that for coeliac disease (CD) in the paper by Alberto et al in this issue.3 These screening criteria form the basis for evaluating the strength of the evidence supporting that call. They also highlight key uncertainties, which could be the subject of future research. This process has been undertaken for screening for type 2 diabetes in adults,4 and the history of the debate on …
- Published
- 2004
44. Interventions to reduce acute paediatric hospital admissions: A systematic review
- Author
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Abdul-Kareem Abdul-Rahman, Alice E Martin, Andrew Collinson, Ken Stein, Rebecca Whear, Stuart Logan, Jo Thompson Coon, and Kate Boddy
- Subjects
medicine.medical_specialty ,Evidence-Based Medicine ,genetic structures ,business.industry ,Child Health Services ,Psychological intervention ,MEDLINE ,Length of Stay ,medicine.disease ,Hospitalization ,Patient Admission ,Emergency medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Medical emergency ,Emergencies ,business ,Child ,Hospital Units ,Algorithms - Abstract
To compare the effectiveness of interventions aimed at reducing the rate of acute paediatric hospital admissions.Systematic review.Medline, Embase, PsychINFO, The Cochrane Library, Science Citation Index Expanded from inception to September 2010; hand searches of the reference lists of included papers and other review papers identified in the search.Controlled trials were included. Articles were screened for inclusion independently by two reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary.Seven papers were included. There is some evidence to suggest that short stay units may reduce admission rates. However, there is a general lack of detail in the reporting of interventions and the methods used in their evaluation which precludes detailed interpretation and extrapolation of the results. The authors found no evidence that the use of algorithms and guidelines to manage the admission decision was effective in reducing acute admission rates. Furthermore, the authors were unable to locate any eligible papers reporting the effects on admission rates of admission decision by paediatric consultant, telephone triage by paediatric consultant or the establishment of next day emergency paediatric clinics.There is little published evidence upon which to base an optimal strategy for reducing paediatric admission rates. The evidence that does exist is subject to substantial bias. There is a pressing need for high quality, well conducted research to enable informed service change.
- Published
- 2012
45. Question 1 How common is co-existing meningitis in infants with urinary tract infection?
- Author
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Nigel Curtis, Anastasia Pantazidou, and Marc Tebruegge
- Subjects
Pediatrics ,medicine.medical_specialty ,Evidence-Based Medicine ,medicine.diagnostic_test ,business.industry ,Lumbar puncture ,Urinary system ,Infant, Newborn ,MEDLINE ,Infant ,Aseptic meningitis ,Meningoencephalitis ,Cochrane Library ,medicine.disease ,Spinal Puncture ,Meningitis, Bacterial ,Bacteremia ,Urinary Tract Infections ,Pediatrics, Perinatology and Child Health ,Humans ,Medicine ,business ,Intensive care medicine ,Meningitis - Abstract
You are asked to review a febrile 2-month-old infant who presented to the accident and emergency department. The urine analysis carried out before your arrival is suggestive of urinary tract infection (UTI) (urine dipstick: positive for nitrites and white blood cells (WBCs); microscopy: 220 WBCs per high powered field). On examination the infant appears well and has no signs suggestive of meningitis. However, you recall a senior colleague stating that young infants with UTI should always have a full septic workup to rule out co-existing bacterial meningitis. You wonder if there is any evidence to support routinely performing a lumbar puncture in this setting? In an infant with UTI [patient], is a lumbar puncture [test] indicated to rule out co-existing bacterial meningitis [outcome]? Search of the Cochrane Library database using the terms ‘Urinary Tract Infection’ and ‘pyelonephritis’ retrieved 18 Cochrane reviews, none of which were relevant. Medline was searched using the PubMed interface (1950—to date/no limits set): (1) a keyword search using (Urinary Tract Infection OR pyelonephritis OR cystitis) AND (meningitis OR meningoencephalitis OR lumbar puncture) AND (neonat* OR infant) retrieved 507 publications, of which 11 were relevant,1,–,11 and (2) a search using the MeSH terms (‘Infant, Newborn’ OR ‘Infant’) AND ‘Urinary Tract Infections’ AND ‘Central Nervous System Infections’ retrieved 172 publications, but no further relevant papers were identified. Search of the ISI Web of Science (1900—to date), EMBASE (1980—to date) and Scopus (1900—to date) using the same keyword strategy as above yielded 106, 328 and 163 matches, respectively, among which no, two12 13 and one12 further relevant paper(s) were identified. Publications that described a group of fewer than 30 infants with UTI and …
- Published
- 2011
46. Community acquired pneumonia
- Author
-
George Russell
- Subjects
Male ,medicine.medical_specialty ,Pediatrics ,Evidence-based practice ,Scrutiny ,Leading Article ,Sister ,law.invention ,Randomized controlled trial ,Community-acquired pneumonia ,law ,Humans ,Medicine ,Child ,Set (psychology) ,Evidence-Based Medicine ,business.industry ,Infant ,Pneumonia ,Evidence-based medicine ,Guideline ,medicine.disease ,Community-Acquired Infections ,Child, Preschool ,Family medicine ,Practice Guidelines as Topic ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
We live in an era when medical practice is increasingly regulated by guidelines and protocols. Ideally, such guidance should be evidence based, and in particular it is generally recommended that advice on medical treatment should be based on the results of adequately powered, double blind, placebo controlled trials or, some would say, better still, a meta-analysis of several such trials. Unfortunately, evidence of this standard is often lacking, and many guidelines amount to little more than the opinions of the authors. This is not to say that opinion based guidelines are valueless—the opinions of experienced clinicians may be better than no opinion at all. Thus, a significant proportion of the advice contained in the first edition of the British Thoracic Society Guidelines on asthma management1 was opinion, rather than evidence based, yet its publication was followed by a fall in childhood asthma admissions. This fall might have reflected some unknown benign environmental influence, but was much more likely to have resulted from improved management of asthma in the community as the guidelines gradually changed clinical practice. Moreover, guidelines that indicate areas where supporting evidence is lacking can point the way to future research. The publication of the asthma guidelines was followed by various papers presenting evidence that had hitherto been lacking, for instance in relation to the use of intravenous aminophylline in acute asthma.2 This month sees the publication in our sister journal Thorax of a new set of Guidelines,3 this time on the management of community acquired pneumonia in children. In preparing these Guidelines, the authors have followed a well trodden path. An extensive literature review was followed by close scrutiny of apparently relevant papers. Those of us who have sat on guideline working parties will appreciate how this process, which can involve the review …
- Published
- 2001
47. Optimal management of allergic rhinitis.
- Author
-
Scadding, Glenis K.
- Subjects
HAY fever in children ,DIAGNOSTIC errors ,QUALITY of life ,ASTHMA risk factors ,EVIDENCE-based medicine ,IMMUNOTHERAPY ,THERAPEUTICS - Abstract
Allergic rhinitis (AR), the most common chronic disease in childhood is often ignored, misdiagnosed and/or mistreated. Undertreated AR impairs quality of life, exacerbates asthma and is a major factor in asthma development. It can involve the nose itself, as well as the organs connected with the nose manifesting a variety of symptoms. Evidence-based guidelines for AR therapy improve disease control. Recently, paediatric AR guidelines have been published by the European Academy of Allergy and Clinical Immunology and are available online, as are a patient care pathway for children with AR and asthma from the Royal College of Paediatrics and Child Health. Management involves diagnosis, followed by avoidance of relevant allergens, with additional pharmacotherapy needed for most sufferers. This ranges, according to severity, from saline sprays, through non-sedating antihistamines, oral or topical, with minimally bioavailable intranasal corticosteroids for moderate/severe disease, possibly plus additional antihistamine or antileukotriene. The concept of rhinitis control is emerging, but there is no universally accepted definition. Where pharmacotherapy fails, allergen-specific immunotherapy, which is uniquely able to alter long-term disease outcomes, should be considered. The subcutaneous form (subcutaneous immunotherapy) in children has been underused because of concerns regarding safety and acceptability of injections. Sublingual immunotherapy is both efficacious and safe for grass pollen allergy. Further studies on other allergens in children are needed. Patient, carer and practitioner education into AR and its treatment are a vital part of management. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
48. Psychological interventions for mental health disorders in children with chronic physical illness: a systematic review.
- Author
-
Bennett, Sophie, Shafran, Roz, Coughtrey, Anna, Walker, Susan, and Heyman, Isobel
- Subjects
CHILD psychopathology ,COGNITIVE therapy ,TREATMENT of depression in children ,ANXIETY in children ,EVIDENCE-based medicine ,SYSTEMATIC reviews ,PREVENTION ,THERAPEUTICS - Abstract
Background: Children with chronic physical illness are significantly more likely to develop common psychiatric symptoms than otherwise healthy children. These children therefore warrant effective integrated healthcare yet it is not established whether the known, effective, psychological treatments for symptoms of common childhood mental health disorders work in children with chronic physical illness. Methods: EMBASE, MEDLINE, PsycINFO and CINAHL databases were searched with predefined terms relating to evidence-based psychological interventions for psychiatric symptoms in children with chronic physical illness. We included all studies (randomised and non-randomised Design:s investigating interventions aimed primarily at treating common psychiatric symptoms in children with a chronic physical illness in the review. Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality analysis. Results: Ten studies (209 children, including 70 in control groups) met the criteria for inclusion in the review. All studies demonstrated some positive outcomes of cognitive behavioural therapy for the treatment of psychiatric symptoms in children with chronic physical illness. Only two randomised controlled trials, both investigating interventions for symptoms of depression, were found. Conclusions: There is preliminary evidence that cognitive behavioural therapy has positive effects in the treatment of symptoms of depression and anxiety in children with chronic physical illness. However, the current evidence base is weak and fully powered randomised controlled trials are needed to establish the efficacy of psychological treatments in this vulnerable population. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
49. StaR Child Health: developing evidence-based guidance for the design, conduct and reporting of paediatric trials.
- Author
-
van't Hoff, William and Offringa, Martin
- Subjects
CHILDREN'S health ,CLINICAL trials ,EVIDENCE-based medicine ,EXPERIMENTAL design ,RESEARCH ,HEALTH policy ,STANDARDS - Abstract
There has been a huge upsurge in clinical research in children in the last decade, stimulated in England by dedicated research infrastructure and support through the National Institute for Health Research. This infrastructure offering research design, expert review, trial management, research nurse, data support and dedicated facilities enables paediatricians to conduct more and better research. The challenge is how to design and conduct trials that will make a real difference to children's health. Standards for Research (StaR) in Child Health was founded in 2009 to address the paucity and shortcomings of paediatric clinical trials. This global initiative involves methodologists, clinicians, patient advocacy groups and policy makers dedicated to developing practical, evidence-based standards for enhancing the reliability and relevance of paediatric clinical research. In this overview, we highlight the contribution of StaR to this agenda, describe the international context, and suggest how StaR's future plans could be integrated with new and existing support for research. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
50. Moving beyond prevalence studies: screening and interventions for children with disabilities in low-income and middle-income countries.
- Author
-
Yousafzai, Aisha K., Lynch, Paul, and Gladstone, Melissa
- Subjects
CHILDREN with disabilities ,LOW-income countries ,MIDDLE-income countries ,DISEASE prevalence ,MEDICAL screening ,EVIDENCE-based medicine - Abstract
Research understanding the lives of children with disabilities in low-income and middle-income countries has predominantly focused on prevalence studies with little progress on evidence-based service development. At the same time, global attention in child health has shifted from child survival strategies to those that bring child survival and development together. This review examines whether intervention research can be better aligned with current theoretical constructs of disability and international guidelines that advocate for the realisation of rights for children with disabilities and inclusive early childhood development. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
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