End of life care for infants, children and young people with life limiting conditions: summary of NICE guidance

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Children and young people can have a wide range of life limiting conditions and may sometimes live with such conditions for many years. This guideline recommends that end of life care be managed as a long term process that begins at the time of diagnosis of a life limiting condition and entails planning for the future. Sometimes it may begin before the child’s birth. It is part of the overall care of the child or young person and runs in parallel with other active treatments for the underlying condition itself. Finally, it includes those aspects related to the care of the dying.

Many children receive no discharge plan after admission for severe asthma

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Children admitted to hospital with severe asthma attacks generally receive “very effective and efficient” treatment and care, but more attention must be given to asthma education and review at discharge to help prevent future attacks and readmission, says a national audit by the British Thoracic Society.

The society’s National Paediatric Asthma Audit, published on 29 November, reviewed data on more than 5500 children over the age of 1 admitted with severe asthma attacks to 153 UK hospitals in November 2015 and found that most aspects of discharge from hospital were less than optimal.

Frozen tissue service offers fertility hope to young people with cancer

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Scientists at Edinburgh University have developed a service to store testicular tissue from boys as young as 1 who are at risk of infertility because of cancer treatment. In future boys as well as girls might be able to have their fertility restored subsequent to chemotherapy.

The announcement comes after the birth of the first UK baby to be born after his mother had a transplant of her own, previously frozen, ovary tissue.

Disabled children risk further abuse after unsubstantiated referral for neglect, research finds

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Children with disabilities who have an initial unsubstantiated referral for neglect are at increased risk of being maltreated subsequently, a research letter published in JAMA has warned.

Researchers analysed data from the National Child Abuse and Neglect Data System, which collects data on children reported to child protection services in the United States and Puerto Rico. A total of 12 610 children with disabilities and 476 566 without disabilities who had first time unsubstantiated referrals for neglect in 2008 were included in the study and followed up for four years.

Reducing sugary drink intake is linked to raised HDL cholesterol levels

Children who reduce their consumption of sugar sweetened drinks by just one serving a week see improvements in their high density lipoprotein (HDL) cholesterol levels, a study published in the Journal of Nutrition has found.

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The US study used data from a multiethnic sample of 613 children aged 8 to 15 who were enrolled in a randomised double blind vitamin D supplementation trial. They self reported their intake of sugar sweetened beverages and had their fasting blood lipid concentrations measured at baseline.

Two thirds of the children were from low socioeconomic status households, almost half were overweight or obese, and 59% were from non-white or Caucasian ethnic groups. The researchers followed 380 of the children for 12 months.

Smoking ban cuts admissions for child respiratory infections

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Banning smoking in public places has cut hospital admissions for childhood respiratory infections in England by 11 000 a year, new research has estimated.

Researchers from the United Kingdom and the Netherlands said that evidence has shown that smoke-free public environments will benefit children’s health but that the exact effect on respiratory tract infections is unclear.

UK death rates in children’s heart surgery have almost halved over past decade

More children survived for at least 30 days after heart surgery at the end of the past decade than at the start, an analysis has found. The death rate fell from 4.3% to 2.6% of cases.

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The findings have prompted the researchers to call for a shift away from scrutinising short term survival to looking at the longer term effects of heart surgery in children, such as measures of ill health and the effect on functional capacity.

BMJ Learning: Vitamin D and children

BMJ Learning are looking at how vitamin D deficiency presents in children. Do you know what investigations to carry out when you suspect it? And lastly do you know how to manage vitamin D deficiency once it is diagnosed?

Quick tips: vitamin D and children

And here are our most popular modules on ophthalmology:

Glaucoma – chronic open angle glaucoma and ocular hypertension – in association with NICE

The sticky eye: diagnostic picture tests

Sticky eye: diagnostic picture tests – part 2

The red eye: diagnostic picture tests

The red eye: an update

Eyelid disorders: diagnosis and management

NHS Networks: News updates – children

Children and young people’s health report The first annual report by the Children and Young People’s Health Outcomes Forum has praised progress but also highlighted areas where more needs to be done.    Read more »

New resources for keeping children safe Public Health England has launched two new resources for local authorities on preventing accidents to children and young people in the home and on the road.   Read more »

Number of pregnant mums smoking falls to record low New figures show that only 12 percent of mothers said they were smokers at the time they gave birth, the lowest percentage in eight years of data collection.   Read more »

Antibiotics for early-onset neonatal infection A summary of selected new evidence relevant to NICE clinical guideline 149 ‘Antibiotics for early-onset neonatal infection: antibiotics for the prevention and treatment of early-onset neonatal infection’ (2012).  Read more »

BMJ Learning: Pain – June 10 2014

You see a 28 year old tennis player who has pain in his right knee. This started during a match four days ago. He twisted to hit a ball but his foot remained in the same position. What is most likely to be going on? And what tests would you do? If you are not sure then this module will help. Click on the link to complete it today:

Knee examination

And here are our most popular modules on pain:

New resource available from the Centre for Nursing Innovation

FONSCentre for Nursing Innovation

Extract from newsletter

The links below enable you to freely download and share the latest Improvement Insights, part of the FoNS Dissemination Series Improvement Insights.

Each of these one-page summaries reports on the innovative ways in which nurse-led teams across the UK have been supported by FoNS to work with patients, relatives and staff in their drive to deliver excellent care.

Volume 8 Numbers 1-10:

FoNS is committed to supporting the development of nursing and healthcare practice and one of the ways we achieve this is by providing freely accessible information. All the projects and initiatives reported on have been supported by one of FoNS’ practice based development and research programmes and have aimed to:

  • Respond to the needs of patients
  • Improve patients’ experience of care
  • Be evidence based (including practice knowledge and service users’ experience)
  • Make changes to practice
  • Share their learning

Eyes on Evidence for March

This month’s topics in NHS Eyes on Evidence:

Analysis of data from a large randomised controlled trial suggests that intensive glucose control in critically ill patients is associated with moderate to severe hypoglycaemia, and a higher risk of death.

A large scale trial examines the benefits and effectiveness of telehealth and telecare services in helping patients avoid the need for emergency hospital care.
A cross-sectional study investigating a possible link between harsh physical punishment and mental health disorders reports that reducing physical punishment may help to reduce the prevalence of mental health disorders in the general population. It suggests giving parents information about alternative discipline strategies, such as positive reinforcement.
The QIPP Collection highlights examples of local best practice, demonstrating how NHS organisations have implemented new practices that have both cut costs and improved quality. We highlight a new example:
Chair of the British HIV Association Guidelines Subcommittee, Martin Fisher, talks about the organisation’s experience of the NICE accreditation process.
Accreditation news  
At its January meeting the NICE Accreditation Advisory Committee accredited 2 guidance programmes.

Evidence Updates 
NICE recently published Evidence Updates on:

  • Strategies to prevent unintentional injuries among children and young people aged under 15
  • Hyperglycaemia in acute coronary syndromes
  • Common mental health disorders
  • Hypertension.

Better health outcomes for children and young people

Department of Health

GP_mother_and_child_380x150This pledge aims to make improvements to the health of children and young people and is part of the government’s response to the Children and Young People’s Health Outcomes Forum.
It commits signatories to put children, young people and families right at the heart of decision making and improve every aspect of health services – from pregnancy through to adolescence and beyond.

Asthma quality standard

The King’s Fund
This quality standard on the diagnosis and treatment of asthma in adults, young people and children aged 12 months and older argues that an integrated approach to services is vital. The new quality standard on asthma consists of a prioritised set of specific, concise and measurable statements that, when delivered collectively, should contribute to improving the effectiveness, quality, safety and experience of care for people with the condition.

BMJ Modules: 4 February 2013

Abdominal conditions in children are common and have a wide range of causes. In this latest module Dr Ian Wacogne outlines the common causes of various abdominal problems in children and how to recognise and manage them.

Common problems in children 2: abdominal conditions

Also here are some of BMJ’s modules on oral health. They give an important update on a range of common dilemmas.mouthulcer

Mouth cancer: recognising it and referring early

Mouth ulcers: a guide to diagnosis and management 

HIV infection: diagnostic picture tests 

Herpes simplex type 1 oral infection: a guide to diagnosis and treatment 

Neck lumps: diagnostic picture tests

Singhal, R, et al: Journal of Bone and Joint Surgery: Septic arthritis vs transient synovitis in children

Septic arthritis vs transient synovitis in children: a tertiary healthcare centre study  by R Singhal of MDGH and D PerryFN KhanD CohenHL StevensonLA JamesJS Sampath and CE Bruce

Background Establishing the diagnosis in a child presenting with an atraumatic limp can be challenging. There is particular difficulty distinguishing septic arthritis (SA) from transient synovitis (TS) and consequently clinical prediction algorithms have been devised to differentiate the conditions using the presence of fever, raised erythrocyte sedimentation rate (ESR), raised white cell count (WCC) and inability to weight bear. Within Europe measurement of the ESR has largely been replaced with assessment of C-reactive protein (CRP) as an acute phase protein. We have evaluated the utility of including CRP in a clinical prediction algorithm to distinguish TS from SA.

Method  All children with a presentation of ‘atraumatic limp’ and a proven effusion on hip ultrasound between 2004 and 2009 were included. Patient demographics, details of the clinical presentation and laboratory investigations were documented to identify a response to each of four variables (Weight bearing status, WCC >12,000 cells/m3, CRP >20mg/L and Temperature >38.5 degrees C. The definition of SA was based upon microscopy and culture of the joint fluid collected at arthrotomy.

Results 311 hips were included within the study. Of these 282 were considered to have transient synovitis. 29 patients met criteria to be classified as SA based upon laboratory assessment of the synovial fluid. The introduction of CRP eliminated the need for a four variable model as the use of two variables (CRP and weight bearing status) had similar efficacy. An algorithm that indicated a diagnosis of SA in individuals who could not weight-bear and who had a CRP >20mg/L correctly classified SA in 94.8% individuals, with a sensitivity of 75.9%, specificity of 96.8%, positive predictive value of 71.0%, and negative predictive value of 97.5%. CRP was a significant independent predictor of septic arthritis.

Spine Surgery in Children and Adolescents

Acetaminophen Improves Analgesia but does not Reduce Opioid Requirement After Major Spine Surgery in Children and Adolescents.

from Spine
Author: Hiller, Arja MD; Helenius, Ilkka MD; Nurmi, Elisa MD; Neuvonen, Pertti J. MD; Kaukonen, Maija MD; Hartikainen, Tuula RN; Korpela, Reijo MD; Taivainen, Tomi MD; Meretoja, Olli A MD

Publication Date: POST ACCEPTANCE, 11 June 2012

Long-term Reduction in Adverse Drug Events:

A multifaceted, evidence–based model for safe prescribing guideline implementation, engaging multidisciplinary clinicians, was effective in reducing medication error and harm in hospitalized children, resulting in sustained long–term improvement.
Author: Gazarian, M

Subject: Children, Medication errors, Drug toxicity , Inter disciplinary communication
Source: Pediatrics. May 2012:129(5)p.e1334 – e1342.
Published: 2012

Date added: 24/05/2012

Created by: Uma Devalapalli
Published by: East Midlands Strategic Health Authority

New UK obesity centre offers surgery to teens

A London hospital has set up the United Kingdom’s first specialist centre offering extreme weight loss surgery for children and teenagers.

Childhood obesity rates are rising fast in the UK, with latest statistics showing that a third of children aged 10-11 in England suffer from obesity or weight issues.

via New UK obesity centre offers surgery to teens – Health News – Health & Families – The Independent.

News from NHS Networks: Children with Diabetes

Every child and young person with diabetes in England can now expect an improvement in their level of care as a landmark funding agreement for paediatric diabetes services comes in to force.
The Health Education England transition team has launched its first bulletin to start providing regular updates on the development of the new organisation.

A new newsfeed: Children and Young People

Read all the latest news from the newly acquired CASH newsfeed covering Children and Young People on our Women and Children’s page.

Grateful thanks to the CASH Portal at http://www.netvibes.com/keeping-up-to-date#Home

CASH aims to keep health professionals up-to-date with new developments for the benefit of patient care and improved decision making. It is a collaborative service provided by librarians from around England who monitor and capture content from across 3 broad sectors – Primary Care, Secondary Care and Mental Health.

Eyes on Evidence: Meningitis

The Meningitis Trust

NHS Evidence provides access to more than 300,000 reliable resources from 1,300 sources. The number of evidence providers we receive information from is increasing every month.

Fact sheets from the Meningitis Trust are a recent addition to the search. The resources are primarily patient support information and cover a range of issues including developmental difficulties following meningitis, recovering after leaving hospital, entitlement to statutory benefits, and coping with bereavement. There are also fact sheets written specifically for child carers, teachers and pupils, employers, colleges and universities, and health professionals. 

The Meningitis Trust was one of the first charities to become a certified member of The Information Standard.