13 Feb, 09 | by Bob Phillips
If you were offered a choice of medication to treat an ailment you were suffering from, and you’d asked about how effective they were (and there’s a huge chunk of the population that wouldn’t, and would be happy to just do as they are told), then what information would you like? more…
9 Feb, 09 | by Bob Phillips
That’s it really - it’s a very simple question. Does the time, effort and printing resources we use in creating asthma action plans have a measurable benefit in terms of stopping the kids getting as poorly? Or is it a job-creation scheme for these financially strapped times?
22 Dec, 08 | by Bob Phillips
Does oral aciclovir improve clinical outcome in immunocompetent children with primary herpes simplex gingivostomatitis?
A 3 year old previously well boy presents with a fever of 38.6ºc and several ulcers and erosions extending from his lips, along the tongue and cheek, to the back of the throat. The lesions have all appeared within the last 2 days. He has been crying inconsolably over the past 24 hours and is refusing food and drink. Is the use of oral aciclovir is indicated for primary herpes gingivostomatitis in children?
7 Dec, 08 | by Bob Phillips
When I was doing neonates, it was considered good practice to get little babies spliced away from their Mother, given oxygen to breathe and wrapped up warm, all pretty damn quickly. I keep hearing rumours from my neonatally biased friends that perhaps there are other, better ways of doing things.
So - how long do you advise waiting until clamping the umbilical cord after delivery? Two, three minutes (where the baby can chill & develop polycythaemia?) or as little time as it takes you to get hold of a clamp (so the child can be deprived of the last few teaspoons of good fetal blood?).
8 Oct, 08 | by Bob Phillips
It’s my own question, this time, and throws up lots of annoying little things.
The problem is straightforward: I’m a paediatric oncologist in my spare time, and was asked about the use of LifeMel honey to prevent infections.
Now, being both an EBMer and a Physician, I said I didn’t know, but didn’t think it could do, but might cause problems. (Remember we’re not supposed to give honey to infants ’cause of botulinism? Same concerns.)
12 Sep, 08 | by Bob Phillips
It’s simple really - Autumn is approaching and most paediatricians are gathering their Virally Protective Hankies to ward off the germs they know they’ll be assaulted by. There’s heavy training in many departments for the new docs — “if it’s bronchiolitis clinically, don’t X-ray them, don’t bleed them, don’t IV them and don’t give them a ‘trial’ of bronchodilators: accept it - there’s nothing you can do and the nurses will get them better with feeds, oxygen and cups of tea”.
But what about the really poorly one, that makes you think “I wish I was next door to PICU” .. surely you’re wanting just to wander down to SCBU and borrow that spare CPAP machine .. that has to work .. doesn’t it ..?
2 May, 08 | by BMJ Group
A 13 year old boy with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) comes to the clinic with his mother for a review. He was started on atomoxetine 6 weeks prior to this visit for hyperactive/impulsive symptoms and poor concentration. The boy was admitted in the hospital one week ago for changed behaviour, disorientation, irrelevant speech and self-harming behaviour. He was reported as very aggressive and hostile towards other children and adults. In past use of stimulant medication was not considered because of the risk of abuse and drug diversion. Mother correlates this hospitalization due to side effect of atomoxetine. She asks your opinion about increased aggression and hostility related to atomoxetine .
27 Feb, 08 | by Bob Phillips
A 5 year old boy was admitted to a rural New Zealand hospital with 10 day history of abdominal pain. The pain was localised to the RIF with guarding and examination revealed a palpable mass in the RIF. He had previously presented with a 1 day history of severe abdominal pain and fever and had been discharged the following day with a diagnosis of gastroenteritis. He was transferred to the tertiary hospital and a diagnosis was made on ultrasound scan of appendiceal mass with abscess. His condition was stable. He was commenced on conservative management and supportive care with intravenous (iv) antibiotics followed by a 2 week course of oral antibiotics. He responded well to conservative management and was scheduled for appendectomy after an interval of 6-8 weeks. You wonder whether it is necessary, now he is well, for him to have an appendectomy.
12 Feb, 08 | by Bob Phillips
During a routine clinic follow-up, a patient with an indwelling ventriculo-peritoneal shunt enquires whether prophylactic antibiotics are necessary prior to routine dental hygiene work. He produces a letter from his dentist enquiring the same.
Dr Max Nathan of Morriston Hospital, Swansea, UK has had this happen … has it happened to you? And what did you do?
11 Jan, 08 | by Bob Phillips
Does melatonin improve sleep pattern in children with Attention Deficit Hyperactivity Disorder?
Adam is an 8 year old boy with Attention Deficit Hyperactivity Disorder (ADHD) who you see with his mother in your paediatric outpatient clinic. She explains that life is being made increasingly stressful for the whole family as Adam is having difficulty getting off to sleep. It often takes him several hours to calm down and go to sleep, and the day after he gets angry and seems to be tired all the time. She has seen a recent TV programme that suggested that melatonin may be helpful for children with ADHD.
Are the television producers correct? If melatonin is prescribed for Adam, will it be harmful or helpful in improving his sleep?
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