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FAST TRACKING IMPORTANT ARTICLES
In general it has been weekly, rather than monthly, peer reviewed journals that have championed rapid publication of articles. Today we publish an article that was submitted in September. We will continue to be alert to important and topical papers. This original research article, from the Centre for Paediatric Pharmacy Research, University of London, describes the use of antidepressants in children and adolescents in the UK between 1992 and 2001. Over this time period, the use of tricyclic antidepressants declined by 30% and the use of selective serotonin reuptake inhibitors (SSRIs) increased 10 fold. Most SSRIs were prescribed for depression. This article places in context the 2003 recommendation by the Committee on Safety of Medicines to withdraw the use of venlafaxine and all SSRIs (except fluoxetine) for children with major depression disorders because of the concern that these drugs increase the risk for suicidal behaviour.
See page 1098
NURSERY RHYMES OR TELEVISION: WHICH IS MORE VIOLENT?
The increasing amount of violence in numerous countries, particularly in the US, has led to renewed interest in the origins of aberrant behaviour. Dr Davies and colleagues from Bristol compare violent scenes in current British television and the most popular audiotapes of nursery rhymes, including Jack and Jill, Six in a Bed, and Simple Simon. Surprisingly the violent content of these two media are not similar—it takes about 12 minutes to encounter a violent episode on television but only about 1 minute in popular nursery rhymes. For centuries, nursery rhymes (and children’s literature) have contained depictions of murder, bullying, abject poverty, monsters, abduction, fighting, and stealing. However, at least for most young children, parents or other adults are often engaged with children when they are exposed to these disturbing episodes in audiotapes and books. This is not true for television, movies, the Internet, or video and computer games. In these more recent technological advances there is usually no parental mediation. Children and teenagers are left alone to explore the violent content with their friends or on their own. It is not likely that any single technological advance or change in the content of television and movies is responsible for the increased amount of violence in society, but it is possible that the accumulative effect of these exposures desensitises children to the implications of their acts.
See page 1103
EDUCATIONAL RESEARCH – AN IMPORTANT ROLE FOR ADC
We continue to enhance ADC by ensuring that its content reflects the numerous and varied issues that are important in contemporary medicine. In this issue there are two articles that focus on the evaluation of medical students and special registrars. How to ensure that physicians are competent has become increasingly important because of the dramatic increase in medical knowledge. We now recognise that traditional medical education must include curricula about ethics, cultural competency, and issues related to quality of care and evidence based medicine. Dr Tsai summarises what is known about the use of children as standardised patients (SPs) in objective, structured clinical examinations. His conclusions—the use of children as SPs is practical, reliable, and valid, but it is important to limit the use of children to situations where there are no other effective teaching techniques. Drs Davies and Howells review the principles of assessment of special registrars and novel tools for performance assessment, including peer ratings, patient and parent feedback, chart stimulated recall, and structured observation of a clinical encounter by a senior faculty member. Our hope is that in the future we can bring you the results of original research that focuses on educational issues.
See pages1089 and 1117
ENTERTAINING AND INFORMATIVE ARTICLES
This issue brings some unique and we hope entertaining pieces to ADC. Dr Flores writes of the role of physicians, and specifically paediatricians, in the movies. He provides us with his top 10 lists of the best, funniest, and most useful movies in medical education. Red Beard directed by Akira Kurosawa in 1965 gets his nod as the best movie, M*A*S*H* directed by Robert Altman as the most humorous, and The Doctor by Ed Rosenbaum as the most useful. Professor Lindemann explores the true meaning of the word “piglet,” having found that investigators often use the term piglet, newborn piglet, and newborn pig, interchangeably. His evidence based approach to this question is much appreciated.
See pages1084 and 1130
FOLLOWING YOUR OWN ADVICE
At numerous research meetings, presenters often conclude with a set of recommendations based upon their study. It is the wise observer who asks, “those are wonderful recommendations – can you tell me what’s happening at your own institution.” In a similar vein, researchers from Alder Hey audited their paediatric audits. Not surprisingly, most were judged incomplete, and more importantly, re-auditing was the exception rather than the rule. Re-auditing is a critical step in assuring that clinical practice has changed and improved, reflecting, presumably, why the audit was done in the first place. I fear that we have made significant intellectual and financial commitments to quality improvement, at least in measuring variation, but continue to struggle with implementation.
See page 1128
SEASONS GREETINGS ONE AND ALL
I would be remiss not to wish our readers good cheer during this holiday season and good health for the year to come. May we find contentment in our lives, and may the health and well being of children everywhere improve.