Journal of paediatrics and child health
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J Paediatr Child Health · Apr 2014
Comparative StudyRetrospective review of 200 children hospitalised with acute asthma. Identification of intervention points: a single centre study.
Indigenous Australians with asthma have higher morbidity and mortality compared with non-Indigenous Australians. In children hospitalised with acute asthma, we aimed to (i) determine if acute severity, risk factors and management differed between Indigenous and non-Indigenous children; and (ii) identify intervention points to reduce morbidity and mortality of asthma. ⋯ Unlike other common respiratory diseases requiring hospitalisation, biological factors are unlikely major contributors to the known gap in asthma outcomes between Indigenous and non-Indigenous children. Intervention points include better identification, documentation and management of tobacco smoke exposure, delivery of salbutamol and discharge planning (including education and utilisation of asthma action plans).
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J Paediatr Child Health · Apr 2014
Immunisation coverage among a birth cohort of Aboriginal infants in an urban community.
The aim of this study is to examine the age-appropriate immunisation coverage and the factors associated with this in a cohort of Aboriginal infants in an outer urban Sydney community in comparison with non-Aboriginal infants in this community. ⋯ Immunisation rates in this population of Aboriginal infants are comparable to those of non-Aboriginal infants except for delay in immunisation at 4 and 6 months. Identified risk factors for both Aboriginal and non-Aboriginal infants may be amenable to intervention. Strategies to ensure timely compliance with immunisation schedules in this outer urban community have achieved reasonable immunisation coverage for Aboriginal and non-Aboriginal infants.
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J Paediatr Child Health · Apr 2014
Varicella in a Paediatric Intensive Care Unit: 10-year review from Starship Children's Hospital, New Zealand.
Varicella is now a vaccine-preventable disease but is generally considered benign, making it a low priority for a funded universal immunisation scheme. We aimed to increase the knowledge of the severity, morbidity and mortality caused by varicella, by a review of cases requiring paediatric intensive care in New Zealand where vaccine is available but not funded. ⋯ Varicella, or its secondary complications, requiring paediatric intensive care, carries high mortality, particularly for immunocompromised patients, and long-term morbidities, mostly affecting previously healthy children.
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J Paediatr Child Health · Apr 2014
Route less travelled? Ambulance use for children with high-acuity acute illness.
Ambulance transportation offers important supportive care and treatment en route to definitive treatment. However, children may be at risk of under-utilising ambulance transportation, where private vehicle is possible. This study aims to determine how many of the sickest children present to hospitals in Auckland via ambulance and whether certain population groups are lower users of ambulance services. ⋯ A significant proportion of acutely unwell children presenting to hospital were not transported by ambulance, particularly those aged less than 1 year. This has the potential to result in worse health outcomes. There were no identified associations with patient demographics, and further research is required to better understand this problem and develop solutions.
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Errors in clinical reasoning continue to account for significant morbidity and mortality, despite evidence-based guidelines and improved technology. Experts in clinical reasoning often use unconscious cognitive processes that they are not aware of unless they explain how they are thinking. Understanding the intuitive and analytical thinking processes provides a guide for instruction. ⋯ Competence in clinical reasoning is acquired by supervised practice with effective feedback. Clinicians must recognise the common errors in clinical reasoning and how to avoid them. Trainees can learn clinical reasoning effectively in everyday practice if teachers provide guidance on the cognitive processes involved in making diagnostic decisions.