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prognosis

Q: Caffeine and prematurity

4 Jan, 10 | by Bob Phillips

Bulgarian coffee saying 'Happy Life'Now, it’s been a while since I scared myself by visiting a NICU, but I do recall the liberal use of caffeine by the resident medical and nursing staff, both for themselves and their tiny patients. There have been may things said about the delightful methylxanthine (including this, this and this) but did you ever think it could protect neonatal brains as well as keeping them breathing?

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When do strawberry naevi go away?

2 Jun, 09 | by Bob Phillips

Summer’s here in Yorkshire, and the fruit of the season is strawberries. But strawberry naevi can be troublesome, and cause lots and lots of worries for parents. So how well do we know their natural history? Resolution of 50% at 5 years, 70% at 7 years and 90% at 9 years?

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Risk vs. prognostic factors

9 Mar, 09 | by Bob Phillips

Gold stars to the first to spot the linkThe separation of ‘risk’ factors and ‘prognostic’ factors at first seems the sort of obsessive fine detail that gives epidemiologists and statisticians a bad name. Sadly, the difference is actually worth understanding for any clinician that’s going to try to cut through an observational study and understand what it might be truthfully telling us. (This isn’t the true of the difference between a Peto odds ratio meta-analysis and a DerSimion & Laird random effects meta-analysis. That is a pointlessly academic difference.) Fortunately, the difference between risk and prognostic factors is straight forward. ‘Risk’ factors are those which as associated with causing a condition (like smoking for lung cancer, being premature for chronic lung disease, or soft light and wine for falling in love). more…

Confused by confounding.

13 Feb, 09 | by Bob Phillips

Abdominal radiographSometimes we are in situations where we think that something causes problems, and we can’t do a trial randomising one group to get something which we think causes problems! How do we then go about finding out – how to we avoid the problems of ‘confounding’ – and what is that anyway? For example, think about necrotising enterocolitis. Which babies develop NEC? more…

Q: Portacath or Hickman Line, madam?

7 Dec, 08 | by Bob Phillips

PortacathA 6 year old girl with Acute Lymphoblastic Leukaemia presents with another episode of febrile neutropenia with positive blood culture from her Hickman line. On a ward round, her parents discuss that they would like her to have a Portacath device inserted so that she can go swimming and is more comfortable around her friends. They are worried that she will be more susceptible to infection as the device is just below the skin and would like to avoid further hospital admissions. They ask if the portacath will increase her risk of infection during her remainder of her treatment? more…

Q: Does nephrocalcinosis mean problems for neonates?

25 Jun, 08 | by Bob Phillips

USS of nephrocalcinosisWhat do you do if, accidentally, you scan the abdomen of a neonate and find nephrocalcinosis? Book them in for a transplant in a couple of years? Annual serum electrolytes, blood pressure & isotopic GFR measurement? Pretend you hadn’t seen it?

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Leave appendiceal masses alone.

27 Feb, 08 | by Bob Phillips

Acute appendicitisA 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.

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Crystal balls

7 Jan, 08 | by Bob Phillips

Crystal BallIt’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 that presented with mild nausea, and ask ‘Why didn’t we predict that?”. more…

Unanswered Question: What is the long term outcome for antenatally drug exposed children?

11 Jul, 07 | by BMJ

Whilst attending the adoption panels it has become clear that many of the prospective parents ask about the antenatal drug exposure of the babies and what that means for the future for these children. They are given fairly vague advice and told that we can’t be sure of the outcome and so are left with some uncertainty. Is it possible to give them better and clearer advice?

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