Archives of disease in childhood
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The term "safeguarding" is widely used but its meaning and its relationship to child protection have not been precisely defined. It is a more inclusive concept than child protection and emphasises not only the diagnosis and management of child abuse as conventionally understood but also the importance of recognising children in distress and intervening where possible to prevent a range of adverse outcomes. Achieving these goals will depend in part on greater awareness and more extensive training in psychosocial issues and the mental health of children and young people, and their parents.
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Randomized Controlled Trial
Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial.
Acute otitis media (AOM) is common in children, yet the optimal management of ear pain associated with AOM has not been well studied. We set out to determine the efficacy of topical aqueous 2% lignocaine eardrops compared with a placebo (saline) for pain relief of AOM in children. ⋯ This study suggests that topical aqueous 2% lignocaine eardrops provide rapid relief for many young children presenting with ear pain attributed to AOM. The concurrent use of simple oral analgesia is a likely contributor to effective management of this painful childhood condition.
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A subgroup of children with special health care needs (CSHCN) have chronic and complex medical conditions and frequently attend the emergency department (ED). Some of these ED visits could be prevented through appropriate clinician advice or, if an ED visit is unavoidable, the management time could be decreased. We set out to determine whether an ED-based advice and coordination programme was feasible and could prevent or accelerate ED care for these patients. METHODS, SETTING AND PATIENTS: We identified CSHCN who frequently attended the ED at a large tertiary children's hospital. These patients were enrolled in an ED-based coordination programme, the Accelerated Care through Emergency (ACE) programme providing 24-hour mobile-phone access to experienced ED nurses. We prospectively tracked usage patterns and determined the rate of ED visits after receiving phone advice and the waiting time for patients to be seen in ED. Parental satisfaction and cost of the programme were also assessed. ⋯ We have developed a coordinated approach towards the provision of healthcare for a group of families with diverse severe chronic medical conditions who frequently present to the ED. Through a comprehensive programme including the development of patient-care plans, care coordination and 24-hour mobile-phone access we were able to enhance families' capacities to manage their children's conditions in the community.
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The increased presence of consultant staff should theoretically lead to better outcomes in emergency departments (EDs). A retrospective observational study was conducted in a tertiary paediatric emergency department (PED) over a 10-year period documenting trends in percentage of children admitted, complaints to the department and average waiting times. Consultant numbers increased from 2.6 to 6.2 full time equivalent staff between 2000 and 2004. ⋯ The percentage of children admitted decreased by 27%, complaints fell by 41% and the average waiting time by 15%. The yearly cost of an additional 3.6 consultants (2005) was $A1,003,490 with net saving to the hospital of over $A9.48 million. The provision of additional consultant medical staff in a PED coincided with a decrease in the percentage of children admitted, complaints to the department and average waiting times, and was cost effective.