eLetters

1436 e-Letters

  • "Human factors matter" - Statistical analysis of performance of trigger systems misses the point

    Chapman et al (1) present a valuable evaluation of the performance characteristics of 18 commonly used paediatric early warning systems. They observed that the performance of the 12 “scoring” systems (where cumulative component values for vital signs are used to identify thresholds for escalation of care) was superior to 6 “trigger” systems (where breaching set thresholds for one or more vital signs lead to escalation without the need for adding numerical scores), based on sensitivity, specificity and area under the operating curve (AUROC). Although they do not specifically claim that this finding should be extrapolated to suggest that all scoring systems outperform trigger systems, this is the implication both in the results and discussion section. Indeed, the associated editorial by Lillitos & Maconochie confirms this implied conclusion, when they state that “In conclusion…overall, PEWS perform better than Trigger systems.” (2)

    We contend that this is an erroneous and misleading conclusion and far outstrips the scope and methodology of the study. Firstly, the findings are related to the performance of 16 specific tools and no comment can be made about whether it is the Trigger or the Score aspects which are responsible for this difference. Using the analogy of a therapeutic trial, there can be no basis to conclude that this is a “class effect” rather than specific to each tool. Secondly, the authors themselves recognise that it is the thresholds for escalation...

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  • Response to: The choking hazard of grapes: a plea for awareness

    I am a paediatric cardiothoracic surgeon who came across the article in a public account of Wechat (a popular Chinese social network app). With great interest, I tried to find and have read the full text of this paper. The reason why I am so interested in this topic is that I myself, as a father of two, experienced the same event happening to the younger sister of my children and so fortunately, I managed to have expelled the whole grape with Heimlich manoeuvre and saved her. It was an evening one year ago when my girl was 6 and a half months old. When I was having a shower in the bathroom at home, my wife suddenly screamed and cried to ask me out immediately. Her voice sounded so urgent that I could hardly have time to put on my underwear to rush out. The baby was then already drowsy, presenting with lip cyanosis and spit bubbles in the mouth. It would seem to be useless if I call medical emergency service. I had no time to think about but tried to perform Heimlich manoeuvre with hands pushing down and cephalad in her stomach, the first sets of pushes didn’t work. I rushed her to living room to check her response and did the second sets. Fortunately, the whole peel-off grape was expelled out of her mouth. Her face started to turn red and she fell asleep. The grape was peeled by my sister-in-law (as a babysitter). She intended to hold it to the baby to suck the juice. Unexpectedly, the grape was suddenly sucked deeply in by my girl! As of now, my girl is very healthy and a...

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  • Night activity Paediatric Consultant Advisory Service (PCAS) for General Practitioners in Oxfordshire: sweet-talk for healthcare & efficiency ?

    Our Paediatric Consultant Advisory Service (PCAS) was set up in 2010 as communication between Oxfordshire General Practitioners and General Paediatricians to provide a cost-saving means of reducing the numbers of outpatient face-to-face attendees. Twelve General Paediatrician Consultants rostered for Resident-oncall night duty (21.00h-09.00h) respond to email queries from Oxfordshire GPs, aiming for a standard response within 24h period. Thirty-six GP surgeries utilised this email service and Resident Paediatric Consultants responded as part of Night activity a mean of 9 emails (median 8, range 3-20) during night hours. This confirmed that between 2011-2013 there was a five fold increase of number of GP advice-seeking emails (Annual Total for [2011-2012] was 156; for [2012-2013] was 780); between 2013-2016 emails have now doubled to 1800 emails per year (5,400 emails); there were only 2 Complaints, 15 Compliments to advisory service; the complexity of questions has emerged from 1-2 line questions in 2010-2011, to paragraphs, now seeking response to a range clinical questions entailing 10-12 lines and attached clinic consultation letters.
    Quality anlaysis of a 3 month period of audit (1st September – 30th November 2013), 122 email questions arrived: of these 81 (66%) were responded to within <24hours (set standard); 15 ( 12.3%) in 24-48h; 26 (21.3%) > 48hours. 6 did not have adequate patient details so did not receive first advice response; )
    Prev...

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  • The Prevalence of ADHD is 5% in Childhood.
    Michael A. Colvin

    Professor Taylor, quoting a sound meta-analysis by Polanczyk et al published 16 years previously, declares that the prevalence of ADHD is around 5%. He appears convinced that the prevalence has not changed and does not change, and he explains that rates which differ from around 5% are either due to over-diagnosis or under-diagnosis.

    I hope I am not being impudent in suggesting that the professor has a rather in...

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  • Re: What we may have missed
    Eric Taylor

    Thanks to Dr Colvin for his interest. I should like to clarify that an "unspoken assumption" of genetic determinism did not underlie my review. I agree with his points on the aetiology: the balance of genetic and environmental influences and their interaction deserve much more study. The aetiology, however, is an issue rather separate from prevalence. Even if countries did differ in their actual rates (rather than just...

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  • Conclusions not justified by findings
    Charlotte M Wright
    It is encouraging to see a clinical service making an effort to examine the patterns of growth found in their condition. However the conclusions drawn from their data seem greatly overstated. They describe a pattern of 'progressive growth failure' in nearly a quarter of children with ataxia telangiectasia (AT), yet there is an average decline across all children of less than half a centile space over 3 years. These children are...
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  • Integrated services for infants, children and young people
    Elaine P Lockhart

    This article helps us think about how we would like to provide services to infants, children and young people (ICYP) in response to changing needs, financial constraints and a push for multi-agency integrated working. We propose that paediatric services should have integrated mental health expertise in primary care, community and hospital based services. This would allow for prevention and early intervention, development...

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  • The lost children
    brian mcnicholl

    Wright and Wales highlight the issues of childhood obesity but there is a lack of clear guidance on who should deal with it. The suggestion to " opportunistically discuss a childs weight" is easier said than done. Whose responsibility is it ? There is little immediate consequence if it is not done. Obesity is rarely the presenting complaint to a doctor. So tackling obesity, in addition to the primary complaint is two co...

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  • Re:Bruising in children with bleeding disorders - Limitations
    Peter Collins

    Dear Editors

    We thank Drs Chakraborty and Morris for their interest in our study. We acknowledge that the children without bleeding disorders were only recruited in south Wales whilst those with bleeding disorders were recruited in centres around the UK. Given the data available we are not able to comment on whether children are likely to bruise differently dependent on where they live.

    We agree that...

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  • What we may have missed
    Michael A. Colvin

    Two alternative explanations are given by Professor Taylor for the global problem with ADHD diagnosis, but he overlooks one interesting possibility- perhaps the reported prevalences are about right. That is, perhaps the rates really do vary considerably between populations and are rising in the USA and in other countries.

    Professor Taylor recognises some obvious facts. Firstly, there is a large unmet need. Seco...

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