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The article discusses the development and implementation of clinical practice guidelines (CPGs) for pediatric care in Australia. The Royal Children's Hospital (RCH) in Melbourne has been involved in creating CPGs since 1996, with the aim of improving the quality of care for children and young people. The process involves reviewing available evidence, consulting with specialists, and presenting a final draft at a committee meeting. The CPGs are concise and focused, highlighting key points and red flags. The article also mentions the formation of the Paediatric Improvement Collaborative (PIC) in 2018, which aims to adapt and expand the CPGs for use in multiple states. The PIC CPGs are currently being evaluated, and plans are underway to make them available nationally. The article emphasizes the importance of reducing variation in care and ensuring that the guidelines are applicable to local contexts. [Extracted from the article]

Aim: Asthma is a major contributor to direct and indirect health-care costs and resource use. In May 2015, the Royal Children's Hospital (RCH) amended its clinical practice guideline for acute asthma management from discharging patients if the anticipated salbutamol requirement was every 3-4 h to discharging patients who were clinically well at 1 h after initial treatment. Our objective was to examine the impact of the new discharge recommendation on emergency department (ED) length of stay (LOS), rates of admission and representation.Methods: We retrospectively audited the case notes of children presenting with mild or moderate asthma to the RCH ED over the equivalent 2-week periods in winter 2014 (pre-implementation of the new guideline) and 2015 (post-implementation).Results: A total of 105 patients in 2014 and 92 patients in 2015 were included. In both years, all patients who initially presented with mild or moderate asthma either improved or stayed within the same severity classification at the 1-h assessment. For patients who were clinically well by the 1-h assessment, there was a significant reduction in admissions between 2014 and 2015 (40 vs. 10%, P = 0.001). There was also a reduction for these patients in median LOS from 3 h 13 min in 2014 to 2 h 31 min in 2015 (P = 0.03). In both years, all patients who were moderate at 1 h were admitted. There was no difference in the rate of representation or subsequent deterioration in those patients who were discharged at 1 h between the 2 years.Conclusion: Early discharge of patients who are clinically well 1 h after initial therapy may be associated with a reduction in LOS and admission rate without an apparent compromise in patient safety. Further evaluation of this intervention is required to determine whether this is a true causal relationship. [ABSTRACT FROM AUTHOR]

The treatment of Mycobacterium abscessus complex (MABSC) pulmonary infections is an emerging challenge in patients with cystic fibrosis (CF). Multidrug therapy for prolonged durations is required and carries the significant burden of drug-related toxicity, cost and selective pressure for multiresistant bacteria. International guidelines acknowledge that clinical and in vitro data to support treatment regimens are limited, particularly in children. As part of a collaboration between the infectious diseases and respiratory units at our institution, we have developed a modified treatment guideline that aims to balance the aims of MABSC eradication and slowing disease progression with minimising drug toxicity and resistance. The outcomes of this treatment approach will be monitored and reported. In this manuscript, we discuss the available evidence for treatment choices and present our treatment guideline for paediatric patients with CF and MABSC infection. [ABSTRACT FROM AUTHOR]

Questions: How have tree growth and growth trends varied in structurally complex old‐growth forests? What determines this variation and how this differs among species? Location: Natural boreal old‐growth forests, northern Finland. Methods: We sampled trees over 10‐cm diameter on 48 randomly located 0.1‐ha plots in three landscapes and compiled a data set of 1,565 trees including all three main species, and a full range of sizes and competitive states in northern boreal old‐growth forests. We extracted tree ring samples from every tree and used ring widths to reconstruct tree sizes and their neighbourhood for the past 50 years for Pinus sylvestris and Picea abies, and 30 years for Betula pubescens. We used mixed‐effects models to study variation in tree growth. In the models, we used annually varying environmental variables, forest and tree structural variables and site variables as predictors. We also measured soil hydraulic properties for a water balance model to specifically include soil moisture deficits as predictors. Results: Tree growth rates had increased during the analysis period for all three species, with the highest increases for P. sylvestris and B. pubescens. All three species grew well during warm summers, but P. sylvestris and P. abies growth was also negatively influenced by soil moisture deficits. Competition in these sparse forests had a small influence on growth. However, its influence increased over time. Conclusions: The trees showed positive growth trends, but the increasing competition means that such strong positive trends are unlikely to continue over the long term. For year‐to‐year variability, negative influence of droughts implied that increasing temperatures are not only beneficial to tree growth even in these high‐latitude forests. Overall, the findings demonstrate the site‐ and species‐dependent complexity in tree responses to environmental and structural changes we may expect in the future. Tree growth rates in the northern boreal old‐growth forests in Finland showed increasing trends in the recent decades. However, at annual resolution, droughts negatively influenced the growth of Norway spruce and Scots pine, implying that even in these high latitude (67°N) forests the benefits of increasing temperatures to tree growth are limited. [ABSTRACT FROM AUTHOR]

Many advances and challenges have occurred in the field of paediatric infectious diseases during the past 50 years. It is impossible to cover all of these in a short review, but a few highlights and lowlights will be covered. These include virtual disappearance of some infectious diseases, emergence of new ones, infections in the immunocompromised, antimicrobial resistance, development of new and improved antimicrobials, improved diagnostic tests and the Human Microbiome Project. [ABSTRACT FROM AUTHOR]

The paediatric aspects of travel medicine can be complex, and individual advice is often required. Nonetheless, children are much more likely to acquire common infections than exotic tropical diseases whilst travelling. Important exceptions are malaria and tuberculosis, which are more frequent and severe in children. Overall, travellers' diarrhoea is the most common illness affecting travellers. This review discusses vaccines and medications that may be indicated for children who are travelling overseas. It focuses on immunizations that are given as part of the routine schedule, as well as those that are more specific to travel. Malaria and travellers' diarrhoea are also discussed. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 14‐year‐old girl who was suffering from painful lumps on her lower legs and occasional associated knee pain. It states that a presumptive diagnosis of erythema nodosum (EN) was made, the patient had had a sore throat prior to the appearance of first lesions and biopsies should be considered for patients with atypical course or atypical distribution. It mentions that anti‐inflammatory drugs can help relieve pain and bed rest may decrease rash.

The author talks about fever, cited to account for up to 30% of visits to emergency departments (EDs). Topics discussed include the huge impact of the introduction of conjugate vaccines on the epidemiology of fever in children between 3 months and 3 years of age, what causes the reduction in rates of occult bacteraemia in febrile infants younger than 3 months, and how combining clinical and laboratory features can help identify children who are at risk of serious bacterial infection (SBI).

The article discusses recommendations for the use of antiviral agents in the treatment and prevention of the H1N1 influenza virus. It notes that diagnostic tests can be used for targeted antiviral treatment at the early stage of the pandemic, but H1N1 testing is generally not recommended for patients who live in areas that have already been established with community transmission. The section cites that antiviral treatments can reduce the duration of symptoms and the incidence of lower respiratory tract infections.

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. [ABSTRACT FROM AUTHOR]

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in children is increasingly common and can be associated with dissemination and life-threatening complications. Empiric therapy for presumed severe Staphylococcus aureus infection should be reviewed. Four children with severe invasive CA-MRSA infection causing osteomyelitis and pneumonia complicated by pulmonary embolus and deep venous thrombosis are described. The literature is reviewed and recommendations for management are provided. [ABSTRACT FROM AUTHOR]

The authors reflect on the rapid occurrence of innovations in paediatric emergency medicine (PEM) and mentions some articles within the issue. They also discuss the origins of emergency medicine, the development of hospital emergency as an independent medical specialty since the 1950s, and the important differences of PEM from its adult counterpart. An overview of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network, founded in 2004, is also presented.