Journal of paediatrics and child health
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The Fluid Expansion as Supportive Therapy (FEAST) trial in an African setting without intensive care facilities found that bolus fluid therapy for severe infections (including malaria and viral infections) resulted in a significantly higher mortality than those not given a bolus. This was a high-quality study of 3170 children with 48 h mortality as the primary outcome. ⋯ Some have tried to attack the ethics of the study, but this is unjustified. The implications for paediatric practice in Africa are that intravenous fluids need to be monitored more closely, and the practice of giving boluses to every 'query septic infant and child' needs to be examined more critically.
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J Paediatr Child Health · Jun 2012
Targeted oxygen therapy in special care nurseries: is uniformity a good thing?
There is wide variation in the commencement of inspired oxygen (FiO2) and the oxygen saturation (SpO(2) ) targets set in special care nurseries (SCNs). Evidence supports minimising unnecessary oxygen exposure. Does the introduction of a protocol advocating the uniform approach of commencing FiO2 at 30% and targeting SpO2 of 94-96% for infants ≥ 33 weeks gestation with respiratory distress reduce oxygen exposure? ⋯ Introduction of a uniform oxygen protocol in SCNs for infants ≥ 33 weeks gestation with respiratory distress reduces the number of infants receiving oxygen and, in term infants, the duration of oxygen exposure.
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J Paediatr Child Health · Jun 2012
Changes in anticonvulsant prescribing for Australian children: implications for Quality Use of Medicines.
The evidence-base guiding choices between newer versus established anticonvulsants in children is limited. Inappropriate use exposes children to potentially ineffective and/or harmful medicines. Our objective is to describe recent anticonvulsant prescribing patterns in the Australian paediatric population, evaluating overall trends and extent of off-label prescribing of newer agents. ⋯ The substantial reduction in carbamazepine use and corresponding increase in newer anticonvulsant prescribing, including off-label uses, raises questions about potentially suboptimal Quality Use of Medicines. Such major changes in prescribing may have important clinical and economic consequences. Further study to better understand paediatric prescribing choices and outcomes is needed.
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J Paediatr Child Health · Jun 2012
Paediatric resuscitation training: is e-learning the answer? A before and after pilot study.
To determine whether an e-learning resuscitation programme was able to improve the knowledge and competence of doctors and nurses in providing cardiopulmonary resuscitation to children in a simulated cardiac arrest. ⋯ E-learning does improve both the knowledge and competence of doctors and nurses in providing cardiopulmonary resuscitation to children in the simulation environment.
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The complexity and cost of health care, along with a greater need for accountability calls for a new style of clinical leadership. The new clinical leader will lead reform by putting the needs of the patient first and foremost, looking at current and planned services from the patient's point of view as well as the clinician's. ⋯ The new clinical leaders will understand the importance of consulting widely and engaging colleagues in creating change to improve patient care. They will develop trusting and mutually respectful relationships with health service management and be able to negotiate the delicate balance between clinical judgement, resource constraints and personal loyalties by keeping the best outcome for the patient at the forefront of their thinking.