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Aim: To evaluate changes in in‐hospital mortality rate following implementation of a comprehensive electronic medical record (EMR) system. Methods: Before and after study of 355,709 hospital discharges, over an 8‐year period, at a paediatric teaching hospital. The major outcome measures were crude number of in‐hospital deaths, deaths per 1000 discharges, and standardised mortality ratio. Results: Primary analysis of data from 2 years before and 2 years after EMR go‐live showed a reduction in absolute mortality of 33 deaths, a reduction in the mortality rate of 0.48 per 1000 discharges (95% CI 0.09, 0.88 per 1000): and a relative 22% decrease (95% CI: 4%, 36%, P = 0.02) in deaths per 1000 discharges from 2.20 to 1.72. There was also a reduction in standardised mortality ratio of 47% (95% CI: 18%, 66%, P = 0.004). Post‐hoc analysis of mortality rates for an additional 2‐year pre‐intervention period indicated that these changes in the mortality rate were not part of a pre‐existing downward trend. Further analysis of an additional 20‐month post‐intervention period suggests that the reduced mortality rate has been sustained. Conclusion: We documented evidence of a clinically important decrease in in‐hospital mortality rate following the implementation of a modern comprehensive EMR system in an Australian paediatric teaching hospital. The study does not prove a causal relationship, and it is possible that other factors explain some, or all, of this difference, but no changes in the hospital population or other major interventions were identified as alternative explanations for this observed change. [ABSTRACT FROM AUTHOR]

A study involving scope in the condensation reaction of phenylsulfonylacetic acid with a series of carbonyl derivatives has been conducted. Reactivity trends favor formation of the corresponding vinyl sulfones when working with aryl aldehydes. Electron-deficient aryl aldehydes outperform electron-rich aryl aldehydes. Negligible differences were noted when using electron-rich and electron-deficient arylsulfonylacetic acid derivatives. Post-run analyses of the reaction mixture reveal formation of a minor product which resulted from methylidene transfer onto the carbonyl derivative. Support of a Knoevenagel-type condensation followed by decarboxylation is provided. [ABSTRACT FROM PUBLISHER]

Children with frequent or recurrent infections commonly present to medical practitioners in both primary and secondary care. Here we provide a structured approach to the consultation of the infant under 2 years of age with frequent infections. The key is a focused history and examination to elicit red flags to an underlying diagnosis, while at the same time seeking benign explanations for the frequency of infections, which account for the majority of children, thereby avoiding unnecessary investigations. [ABSTRACT FROM AUTHOR]

Studies from multiple countries report that most hospitalized children, especially the youngest and sickest, experience pain that is often severe yet inadequately treated. Evidence suggests this can lead to immediate and lifelong consequences affecting children, families, and communities. Partnership and shared decision-making by children, families, and clinicians is the ideal pediatric healthcare model and can improve care quality and safety, including pain care. A growing evidence base demonstrates that inpatient portals (electronic personal health record applications linked to hospital electronic medical or health records) can improve child and family engagement, outcomes, and satisfaction during hospitalization. This study examined the perspectives of caregivers of hospitalized children and of hospitalized youth about using an inpatient portal to support their engagement in pain care while in hospital. A qualitative descriptive study design was used and 20 participants (15 caregivers and 5 youth) with various painful conditions in one pediatric hospital participated in semistructured interviews. The authors applied a reflexive content analysis to the data and developed 3 broad categories: (1) connecting and sharing knowledge about pain, (2) user-centred designs, and (3) preserving roles. These findings outlined caregiver and youth recommendations for portal configurations that deeply engage and empower children and families in pain care through multidirectional knowledge sharing, supporting caregiver and clinicians' roles without burdening, or replacing human interaction implicit in family-centered pain care. Further research should measure the impact of portals on pain-related outcomes and explore the perspectives of clinicians. [ABSTRACT FROM AUTHOR]

The authors discuss the advantages and disadvantages of using antibiotics in recurrent urinary tract infection (UTI) prevention. They mention that the benefits of long-term antibiotics in reducing the risk of repeat symptomatic UTI in susceptible children is small, and that its relation to the increased risk of microbial resistance must also be considered. Moreover, they say that the benefits of using long-term antibiotics is greater from children with vesicoureteric reflux (VUR).

Aim: To determine (i) the proportion of doctors who recommend parent-initiated oral corticosteroids (PIOCS) for acute asthma; and (ii) the proportion of parents who have received this advice. Methods: (i) An internet-based survey of doctors involved in the care of children with asthma; and (ii) a questionnaire-based survey of parents of children aged 4–13 years who were identified from a random sample of primary schools within the Barwon region of Victoria. Results: Eight-five per cent (95% confidence interval 80.0–89.1%) of responding doctors reported recommending PIOCS to parents of children with asthma. However, only 16.5% (95% confidence interval 14.2–18.7%) of parents of children with recent asthma symptoms report that they have received such advice. Conclusion: The majority of responding doctors involved in the care of children with asthma report recommending PIOCS to parents. By contrast, a minority of parents of children with asthma report that they have received such advice. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. User-centred electronic medical record designs that support biopsychosocial conceptualizations of pain and safeguard high-risk practices are critical to improving outcomes for hospitalized children and families. Most hospitalized children experience pain that is often inadequately assessed and undertreated. Exposure to undertreated childhood pain is associated with negative short-term and long-term outcomes and can detrimentally affect families, health services, and communities. Adopting electronic medical records (EMRs) in pediatric hospitals is a promising mechanism to transform care. As part of a larger program of research, this study examined the perspectives of pediatric clinical pain experts about how to capitalize on EMR designs to drive optimal family-centered pain care. A qualitative descriptive study design was used and 14 nursing and medical experts from 5 countries (United States, Canada, United Kingdom, Australia, and Qatar) were interviewed online using Zoom for Healthcare. We applied a reflexive content analysis to the data and constructed 4 broad categories: "capturing the pain story," "working with user-friendly systems," "patient and family engagement and shared decision making," and "augmenting pain knowledge and awareness." These findings outline expert recommendations for EMR designs that facilitate broad biopsychosocial pain assessments and multimodal treatments, and customized functionality that safeguards high-risk practices without overwhelming clinicians. Future research should study the use of patient-controlled and family-controlled interactive bedside technology to and their potential to promote shared decision making and optimize pain care outcomes. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Teleconference etiquette," by D. Isaacs in the 2012 issue.

The article comments on the current use of nebulised epinephrine in croup to achieve immediate clinical improvement. As stated, epinephrine is associated with clinically and statistically significant transient reduction of symptoms of croup 30 minutes posttreatment. It states that nebulized epinephrine may be used to treat obstructive airway symptoms associated with moderate to severe croup.

Presents the case of generalized colonic seizures in a new born baby. Pyridoxine overdose by the mother during pregnancy; Temporal relationship between seizures and pyridoxine therapy; The overdose of the vitamin and the abrupt withdrawal as the cause of the seizures.

The article presents the case study of a boy of four years who is diagnosed with periorbital cellulitis and is treated later.

Background. Use of hypotonic intravenous fluid to maintain hydration in children in hospital has been associated with hyponatraemia, leading to neurological morbidity and mortality. We aimed to assess whether use of fluid solutions with a higher sodium concentration reduced the risk of hyponatraemia compared with use of hypotonic solutions. Methods. We did a randomised controlled double-blind trial of children admitted to The Royal Children’s Hospital (Melbourne, VIC, Australia) who needed intravenous maintenance hydration for 6 h or longer. With an online randomisation system that used unequal block sizes, we randomly assigned patients (1:1) to receive either isotonic intravenous fluid containing 140 mmol/L of sodium (Na140) or hypotonic fluid containing 77 mmol/L of sodium (Na77) for 72 h or until their intravenous fluid rate decreased to lower than 50% of the standard maintenance rate. We stratified assignment by baseline sodium concentrations. Study investigators, treating clinicians, nurses, and patients were masked to treatment assignment. The primary outcome was occurrence of hyponatraemia (serum sodium concentration <135 mmol/L with a decrease of at least 3 mmol/L from baseline) during the treatment period, analysed by intention to treat. The trial was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN1260900924257. Findings. Between Feb 2, 2010, and Jan 29, 2013, we randomly assigned 690 patients. O f these patients, primary outcome data were available for 319 who received Na140 and 322 who received Na77. Fewer patients given Na140 than those given Na77 developed hyponatraemia (12 patients [4%] vs 35 [11%]; odds ratio [OR] 0⋅31, 95% Cl 0⋅16-0⋅61; p=0 001). No clinically apparent cerebral oedema occurred in either group. Eight patients in the Na140 group (two potentially related to intravenous fluid) and four in the Na77 group (none related to intravenous fluid) developed serious adverse events during the treatment period. One patient in the Na140 had seizures during the treatment period compared with seven who received Na77. Interpretation Use of isotonic intravenous fluid with a sodium concentration of 140 mmol/L had a lower risk of hyponatraemia without an increase in adverse effects than did fluid containing 77 mmol/L of sodium. An isotonic fluid should be used as intravenous fluid for maintenance hydration in children. Funding National Health and Medical Research Council, Murdoch Childrens Research Institute, The Royal Children’s Hospital, and the Australian and New Zealand College of Anaesthetists. [ABSTRACT FROM AUTHOR]

Background: Bacille Calmette-Guérin (BCG) vaccination has beneficial off-target effects that may include protecting against non-mycobacterial infectious diseases. We aimed to determine whether neonatal BCG vaccination reduces lower respiratory tract infections (LRTI) in infants in the Melbourne Infant Study: BCG for Allergy and Infection Reduction (MIS BAIR) trial.Methods: In this investigator-blinded trial, neonates in Australia were randomized to receive BCG-Denmark vaccination or no BCG at birth. Episodes of LRTI were determined by symptoms reported in parent-completed, 3-month questionnaires over the first year of life. Data were analyzed by intention-to-treat using binary regression.Results: A total of 1272 neonates were randomized to the BCG vaccination (n = 637) or control (n = 635) group. The proportion of participants with an episode of LRTI in the first year of life among BCG-vaccinated infants was 54.8% compared to 58.0% in the control group, resulting in a risk difference of -3.2 (95% confidence interval, -9.0 to 2.6) after multiple imputation. There was no interaction observed between the primary outcome and sex, maternal BCG, or the other prespecified effect modifiers.Conclusions: Based on the findings of this trial, there is insufficient evidence to support the use of neonatal BCG vaccination to prevent LRTI in the first year of life in high-income settings. [ABSTRACT FROM AUTHOR]

Aims: To test the hypothesis that the salivagram is frequently positive in those at high risk of aspiration but negative in individuals at low risk of aspiration lung disease. Methods: We studied 63 individuals with spastic quadriparetic cerebral palsy (CP), aged 14 months to 16 years (31 females and 32 males), and 20 able-bodied young adult volunteers, aged 19–29 years (17 female and three males) using the salivagram. Twenty millilitres of 99mTc-sulphur colloid in saline was instilled into the pharynx of each subject over 1 h. Aspiration was characterised by the appearance of activity in either lung field. Results: Aspiration was demonstrated by salivagram in 56% of children with CP (95% confidence interval 43% to 68%), compared to 0% of young adults (97.5% one-sided confidence interval 0% to 17%). The difference in frequency is highly significant ( P < 0.0006). Conclusions: The salivagram is frequently positive in those at high risk of aspiration, but frequently negative in those at low risk of aspiration. It may be a useful investigation for the demonstration of aspiration. [ABSTRACT FROM AUTHOR]

Aim: Intermittent wheezing illnesses, which include viral-associated wheeze and asthma, are among the most common reasons for children to present urgently to a doctor. The objectives of this systematic review were to assess the benefits and harmful effects of parent-initiated oral corticosteroids (PIOCS) in the management of intermittent wheezing illness in children. Methods: The Cochrane Airways Group Specialised Register, The Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE, LILACS, Web of Science and Dissertation Abstracts were searched. Only randomised clinical trials studying patients aged between 1 and 18 years, with an intermittent wheezing illness were included. Results: From 572 original citations, a total of two randomised clinical trials (303 randomised participants) were included. The quality of the included trials was high; however, marked clinical heterogeneity precluded a meta-analysis. The two trials did not find evidence that PIOCS are associated with a benefit in terms of hospital admissions, unscheduled medical reviews, symptoms scores, or bronchodilator use. Conclusion: Limited current evidence is available and it is inconclusive regarding the benefit from PIOCS therapy in the treatment of intermittent wheezing illnesses in children. Oral corticosteroids have a clearly defined role in the management of acute asthma in the hospital setting. Therefore, it is reasonable for clinicians to recommend PIOCS when (i) the child has a history of severe acute asthma; and (ii) the parents are able to assess asthma status. However, widespread use of PIOCS cannot be recommended until the benefits and harms can be clarified further. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 has radically changed the delivery of healthcare in Australia. Central to a tertiary paediatric institution's (The Royal Children's Hospital Melbourne (RCH) response was a digital health approach comprising a broad suite of informatics and technology solutions including optimising a fully integrated electronic medical record (EMR).Methods: This comprehensive approach spanned all patient care areas and encompassed a broad range of hospital operations. They included patient triage, registration, COVID-19 screening clinic operations, electronic ordering, prescribing and documentation, telehealth, reporting and analytics and research.Discussion: This paper outlines key aspects of our COVID-19 digital health strategy, highlighting the rapid transition to telehealth and the development of a remote "virtual telehealth" strategy for clinicians which proved popular and allowed true "working from home".Conclusion: COVID-19 has inadvertently focussed the spotlight on the utility of digital health for clinical care. The speed and uptake of digital health within this pandemic has been remarkable and unprecedented in both an Australian and global setting. Whilst many of these changes have been beneficial, some may have been rushed or forced with minimal consideration of ongoing governance. Key stakeholders and enablers should be identified for post-pandemic consideration in future digital health implementation and adoption strategies. [ABSTRACT FROM AUTHOR]

Background: Individualised Action Plans (APs) are a key management tool for paediatric asthma, allergy, anaphylaxis and eczema. They provide salient care instructions for patients and caregivers and are thought to improve disease outcomes, albeit with minimal supporting evidence. Whilst the provision of an AP has become a widely measured healthcare quality marker, the content of the plans provided has been relatively neglected. The Royal Children's Hospital, Melbourne (RCH) implemented an AP generation tool integrated within its Electronic Medical Record (EMR) in 2017. This case study aims to exhibit the potential benefits of a hospital-wide integrated AP tool, assess its uptake and usage at our institution and demonstrate quality and user interface issues detected through audit of APs provided.Methods: A retrospective observational analysis of all APs created within the RCH EMR for patients aged 0-18 years between January 1 and December 31, 2018 was conducted. For each AP, automatically populated and clinician entered fields were extracted and analysed.Results: 2637 APs were completed during the study period. The most used AP was for asthma. Omission rates of critical information were low but could be improved. Depending on clinical condition, there was variation in both the location of completion (ED vs clinic/hospital visit) and role of clinician completing the AP (consultant vs junior medical staff).Conclusion: There was considerable uptake of an EMR-integrated AP tool across our institution. An electronic AP allowed for qualitative evaluation of usage and audit of AP content and will guide further system and user interface improvements to improve AP quality. [ABSTRACT FROM AUTHOR]

Aim: Low-value care (LVC) is common. We aimed, using infants presenting to a major tertiary paediatric hospital with bronchiolitis between April 2016 and July 2018, to: (i) assess rates of chest X-ray (CXR) and medication use; (ii) identify associated factors; and (iii) measure the harm of not performing these practices.Methods: We extracted data from the electronic medical record for all children aged 1-12 months given a diagnosis of bronchiolitis in the emergency department. Factors potentially associated with LVC practices were extracted, including patient demographics, ordering physician characteristics, order indication, medications prescribed and admission ward. To assess for harm, a radiologist, blinded to CXR indication, reviewed all CXRs ordered over the winter of 2017 for infants with bronchiolitis.Results: A CXR was ordered for 439 (11.2%) infants, most commonly to rule out consolidation and collapse (65%). CXRs were more likely to be ordered for admitted infants (40.9% admitted to the general medical ward), and 62% were ordered by emergency department staff. Salbutamol was prescribed for 9.3% (n = 199). Amongst those who had a CXR, 28% were prescribed an antibiotic compared to 2.1% for those who did not. In an audit of 98 CXRs ordered over the winter of 2017, there were no CXR findings that meaningfully affected patient outcomes.Conclusion: Using electronic medical record data, we found that CXR and medication use in bronchiolitis were higher than expected given our hospital guideline advice. Future research needs to understand why and develop interventions to reduce LVC. [ABSTRACT FROM AUTHOR]

A 2-week-old female infant was transferred from a regional hospital for mechanical ventilation after developing severe respiratory distress. Stridor had been present since the age of 1 week and was complicated by coryzal illness. Mechanical ventilation was difficult with marked inspiratory and expiratory flow obstruction recorded by the ventilator. Echocardiogram showed a normal heart. Flexible bronchoscopy revealed mid-tracheal extrinsic compression (unchanged with positive end-expiratory pressure) and advancement of the endotracheal tube by 2 cm completely corrected the flow obstruction. Repeat echocardiogram showed a double aortic arch. This case report emphasizes the importance of clinical history, examination findings and interpretation of the ventilator waveforms in the differential diagnosis of a difficult-to-ventilate infant with bronchiolitis. [ABSTRACT FROM AUTHOR]

Background: There are no medications known that improve the outcome of infants with bronchiolitis. Studies have shown the management of bronchiolitis to be varied. Objectives: To describe medication use at the seven study hospitals from a recent multi-centre randomised controlled trial on hydration in bronchiolitis (comparative rehydration in bronchiolitis [CRIB]). Methods: A retrospective analysis of extant data of infants between 2 months (corrected for prematurity) and 12 months of age admitted with bronchiolitis identified through the CRIB trial. CRIB study records, medical records, pathology and radiology databases were used to collect data using a standardised form and entered in a single site database. Medications investigated included salbutamol, adrenaline, steroids, ipratropium bromide, normal saline, hypertonic saline, steroids and antibiotics. Results: There were 3456 infants available for analysis, of which 42.0% received at least one medication during hospitalisation. Medication use varied by site between 27.0 and 48.7%. The most frequently used medication was salbutamol (25.5%). Medication use in general, and salbutamol use in particular, increased by 8.2 and 9.3%, respectively, per month after 4 months of age; from 22.9 and 3.6% at 4 months to 81.4 and 68.8% at 11 months. In infants admitted to the intensive care unit (ICU) compared with those not admitted to ICU 81.6 and 39.5%, respectively, received medication at one point during the hospital stay. Conclusions: Medication was used for infants with bronchiolitis frequently and variably in Australia and New Zealand. Medication use increased with age. Better strategies for translating evidence into practice are needed. [ABSTRACT FROM AUTHOR]

Background: Clinical medical handover between doctors forms a critical part of the patient care process. However, with the evolution of junior medical staff (JMS) working conditions, time pressure and increasing clinical and administrative loads mean that quality clinical handover is increasingly important yet more challenging to achieve. This study evaluated the impact of a newly integrated electronic handover tool on JMS adoption and usage of the tool, as well as impacts on the quality (accuracy and redundancy) of handover data, JMS perceived workflow (time management and communication) and JMS satisfaction.Findings: The majority of JMS surveyed used the tool at 1 (87.0%) and 3 (67.4%) months post implementation. After the introduction of the electronic handover tool, 67.5% of users spent less than 15min updating handover data in the electronic handover tool, compared to just 6.7% prior to the introduction. 28.3% of respondents noted that there was >25% redundant data, compared to more than half (52.2%) prior to introduction of the electronic tool. Overall JMS satisfaction with their handover process was significantly higher post implementation of the integrated electronic handover report (17.4% pre, 80.4% at 1 month, 67.4% at 3 months).Conclusion: A newly introduced integrated electronic medical record handover tool had a high uptake amongst JMS, and resulted in improvement in perceived handover efficiency, a reduction in redundant data entry and improved JMS handover satisfaction. [ABSTRACT FROM AUTHOR]

Aim: We aimed to examine the impact of weather on hospital admissions with bronchiolitis in Australia and New Zealand.Methods: We collected data for inpatient admissions of infants aged 2-12 months to seven hospitals in four cities in Australia and New Zealand from 2009 until 2011. Correlation of hospital admissions with minimum daily temperature, wind speed, relative humidity and rainfall was examined using linear, Poisson and negative binomial regression analyses as well as general estimated equation models. To account for possible lag between exposure to weather and admission to hospital, analyses were conducted for time lags of 0-4 weeks.Results: During the study period, 3876 patients were admitted to the study hospitals. Hospital admissions showed strong seasonality with peaks in wintertime, onset in autumn and offset in spring. The onset of peak incidence was preceded by a drop in temperature. Minimum temperature was inversely correlated with hospital admissions, whereas wind speed was directly correlated. These correlations were sustained for time lags of up to 4 weeks. Standardised correlation coefficients ranged from -0.14 to -0.54 for minimum temperature and from 0.18 to 0.39 for wind speed. Relative humidity and rainfall showed no correlation with hospital admissions in our study.Conclusion: A decrease in temperature and increasing wind speed are associated with increasing incidence of bronchiolitis hospital admissions in Australia and New Zealand. [ABSTRACT FROM AUTHOR]

Objectives To describe the rate of intensive care unit (ICU) admission, type of ventilation support provided and risk factors for ICU admission in infants with bronchiolitis. Design Retrospective review of hospital records and Australia and New Zealand Paediatric Intensive Care (ANZPIC) registry data for infants 2-12 months old admitted with bronchiolitis. Setting Seven Australian and New Zealand hospitals. These infants were prospectively identified through the comparative rehydration in bronchiolitis (CRIB) study between 2009 and 2011. Results Of 3884 infants identified, 3589 charts were available for analysis. Of 204 (5.7%) infants with bronchiolitis admitted to ICU, 162 (79.4%) received ventilation support. Of those 133 (82.1%) received non-invasive ventilation (high flow nasal cannula [HFNC] or continuous positive airway pressure [CPAP]) 7 (4.3%) received invasive ventilation alone and 21 (13.6%) received a combination of ventilation modes. Infants with comorbidities such as chronic lung disease (OR 1.6 [95% CI 1.0-2.6]), congenital heart disease (OR 2.3 [1.5-3.5]), neurological disease (OR 2.2 [1.2-4.1]) or prematurity (OR 1.5 [1.0-2.1]), and infants 2-6 months of age (OR 1.5 [1.1-2.0]) were more likely to be admitted to ICU. Respiratory syncitial virus positivity did not increase the likelihood of being admitted to ICU (OR 1.1 [95% CI 0.8-1.4]). HFNC use changed from 13/53 (24.5% [95% CI 13.7-38.3]) patient episodes in 2009 to 39/91 (42.9% [95% CI 32.5-53.7]) patient episodes in 2011. Conclusion Admission to ICU is an uncommon occurrence in infants admitted with bronchiolitis, but more common in infants with comorbidities and prematurity. The majority are managed with non-invasive ventilation, with increasing use of HFNC. [ABSTRACT FROM AUTHOR]

Objective Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospitalisation. We aimed to assess whether intravenous hydration ( IVH) was more cost-effective than nasogastric hydration ( NGH) as a planned secondary economic analysis of a randomised trial involving 759 infants (aged 2-12 months) admitted to hospital with a clinical diagnosis of bronchiolitis and requiring non-oral hydration. No Australian cost data exist to aid clinicians in decision-making around interventions in bronchiolitis. Methods Cost data collections included hospital and intervention-specific costs. The economic analysis was reduced to a cost-minimisation study, focusing on intervention-specific costs of IVH versus NGH, as length of stay was equal between groups. All analyses are reported as intention to treat. Results Intervention costs were greater for IVH than NGH ($113 vs $74; cost difference of $39 per child). The intervention-specific cost advantage to NGH was robust to inter-site variation in unit prices and treatment activity. Conclusion Intervention-specific costs account for <10% of total costs of bronchiolitis admissions, with NGH having a small cost saving across all sites. [ABSTRACT FROM AUTHOR]

A correction for the article "Changing Epidemiology of Respiratory Syncytial Virus in Australia—Delayed Re-Emergence in Victoria Compared to Western Australia/ New South Wales" is presented, which is published in the September–October 2020 issue of the periodical.

Aim: The newly formed Australian Paediatric Research Network (APRN) aims to facilitate general paediatricians' participation in research in secondary care settings. This (its first) project aimed to identify Australian paediatricians' top research priorities and preferred research designs. Methods: All Australian general paediatricians were invited into a national Delphi process survey. In Stage 1, they were asked ‘T hinking about your clinical practice, what are the most important research questions which need addressing?’. Using qualitative methods, a ‘top 20’ list of the most common, feasible research questions was generated. In Stage 2, respondents prioritised these ‘top 20’ research questions in terms of perceived importance to their practice, and rated their interest in participating in various types of research. Results: A total of 685 (68%) of 1006 paediatricians completed the baseline survey, with 209 paediatricians contributing 430 Stage 1 research questions. Of these, 128 (30%) had not been addressed in the literature and were researchable in the secondary care outpatient setting. The top five questions ranked in Stage 2 by 348 paediatricians were obesity management (two questions), long-term ADHD educational outcomes, autism spectrum outcomes, and prophylactic antibiotics in preventing urinary tract infections. Paediatricians were willing to participate in research designs, including longitudinal research (75%) and randomised trials (64%). Conclusions: Australian paediatricians are interested in research, and their ideas can provide direction for APRN and potentially other networks in Australia. Many of the questions generated could not be easily answered by traditional biomedical and clinical research methods, highlighting the potential benefit of practice-based research networks. [ABSTRACT FROM AUTHOR]

Objective: The use of complementary and alternative medicine (CAM) within the Australian community is common. The objective of this study was to determine the prevalence and pattern of CAM usage in children attending a tertiary children's hospital. Methods: We conducted a cross-sectional survey of children attending the Royal Children's Hospital, Melbourne. Children were identified by consecutive acute admissions and attendance at outpatient clinics. A structured questionnaire with items about the use of CAM in the preceding year was administered by means of a face-to-face interview. Results: Based on the 503 children surveyed, 51% reported CAM use in the preceding year. Forty-three percent had used at least one CAM medication. The most common medicinal CAM used were multivitamins, vitamin C, herbal remedies and homeopathic treatments. Non-medicinal CAM was used by 23% of the participants. The most commonly used therapies were chiropractic, naturopathy, aromatherapy, therapeutic massage and dietary restriction. The main reasons stated for CAM usage included promotion of general health and treatment of colds. Sixty-three percent of those reporting CAM use had not discussed this with their treating doctor. Conclusion: The use of CAM by children is common. Complementary and alternative medicine is particularly used for the treatment of common illnesses and conditions of childhood. Importantly, use is not always conveyed to treating physicians. Given the potential risk of adverse events associated with the use of CAM or interactions with conventional management, doctors should ask about their use as a part of routine history taking. [ABSTRACT FROM AUTHOR]