Archives of disease in childhood
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Heart murmurs are common in children, and they are often referred to a specialist for examination. A clinically innocent murmur does not need further investigation. The referral area of the University Hospital is large and sparsely populated. A new service for remote auscultation (telemedicine) of heart murmurs in children was established where heart sounds and short texts were sent as an attachment to e-mails. ⋯ Telemedical referral of patients with heart murmurs for remote assessment by a cardiologist is safe and saves time. Skilled auscultation is adequate to detect patients with innocent murmurs.
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To evaluate the predictive value of symptoms, signs, and radiographic findings accompanying presumed ventriculoperitoneal (VP) shunt malfunction, by comparing presentation with operative findings and subsequent clinical course. ⋯ Drowsiness is by far the best clinical predictor of VP shunt block. Headache and vomiting were less predictive of acute shunt block in this study. Wherever possible CT scan findings should be interpreted in the context of previous imaging. We would caution that not all cases of proven shunt blockage present with an increase in ventricle size.
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Headaches and papilloedema are key features of idiopathic (benign) intracranial hypertension (IIH). We describe three children in whom IIH was diagnosed in the absence of papilloedema. Recognition of atypical cases of IIH is important because pressure lowering treatment may be effective.
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Eight bereavement support posts in paediatrics and maternity were established using the experience of the Child Bereavement Trust (CBT). Evaluation showed that staff welcomed the informal support and teaching for themselves, as well as support for families; 67% of staff who returned questionnaires felt care for bereaved families had improved as a result of the posts. Many felt that there had been a positive effect on staff retention and stress levels.