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, […]
Category: archimedes
But at what cost?
It’s uncommon for us, as paediatricians, to be asked about how cost-effective our treatments are. Glancing at the media shows health stories about the new wonder drugs in adult cancer, or in Alzheimer’s disease, and how they are being restricted by a heartless and miserly health system. Where do these statements about ‘cost-effectiveness’ come from? […]
MRI-brain for microcephaly?
A 7-year-old boy was referred for medical assessment as part of the process of producing a statement of special educational needs. There had been no medical concerns in the past and there was no family history of note. On examination, the boy was noted to be micro cephalic with head circumference on the 0.4th centile, […]
Leave appendiceal masses alone.
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 […]
Q: FRAX testing for Autistic Boys?
You diagnose a 5-year-old with Autistic spectrum disorder. His examination is unremarkable and there is no family history of learning difficulties. Should you perform a molecular genetic screen for FMR1 mutations (fragile X)? […]
No dental antibiotic prophylaxis for VP shunts.
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 […]
Disease spectrum vs disease prevalence
In examining a diagnostic test, we make the assumption that the characteristics of the test – its sensitivity and specificity (or likelihood ratios, the way I prefer to think) – will stay constant across different populations, although the positive and negative predictive values will change * . This is sort of true, and sort of […]
Irritating hip or rotting femur?
A 3 year old boy presents to the Emergency Department with a limp. He has been reluctant to weight bear on his right leg during the day and has a temperature of 37.9°C. Hip examination is painful. What clinical or laboratory tests could help discriminate between septic arthritis and transient synovitis? Of course, you could […]
Question: Melatonin for ADHD?
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 […]
Crystal balls
It’s a great sport of journalists and commentators to look back at predictions of the future from decades past, and see just how badly they have gone astray. We do this as clinicians too, but with a sense of guilt … looking back to an unexpected relapse of a low-risk tumour, or a fulminant hepatitis […]