163 e-Letters

published between 2011 and 2014

  • At the threshold
    Ross J. Langley

    The question asks would a rapid PCR test on blood alter management in a febrile infant by way of discontinuing antibiotic therapy if found to be negative.

    The multiplex PCR offered would not alter management in a "hot, grumpy, 2 month old" even if it offered 100% certainty that the infant did not have bacteraemia. Bacteraemia implies bacterial infection directly in the blood and is only one of a number of potentia...

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  • Malawi trial is included
    Indi Trehan

    The second paragraph of this brief note is entirely incorrect, as the trial from Malawi is indeed included in the BMJ meta-analysis. It is included as reference #34 and mentioned explicitly by name in Tables 1 and 2 and Figures 2 and 3. That trial in fact provided approximately 2/3 of the participants included in the meta-analysis.

    Conflict of Interest:

    None declared

  • Re: Cultural awareness; small volumes of blood for culture cause under-detection of invasive infections
    Shamez Ladhani

    We support Drs. Munro and Flanagan's recommendations to increase awareness of the need for larger volumes of bloods for culturing in children,1 and additionally recommend larger volumes of cerebrospinal fluid during lumbar puncture, given the increasing availability of molecular diagnostic tests for viruses causing meningitis. However, we believe that the findings of their recent audit identifying similar blood volumes...

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  • Epidemiology of Paediatric Firearm Injuries
    Hannah K Murch

    We were interested in the paper by Srinivasan and colleagues1 as it brings into focus the differences in the epidemiology of firearm injuries in children and young people between the USA and the United Kingdom and the importance that gun control has had in child and adolescent safety here. Through the Child Death Review in Wales we have previously reviewed deaths from firearm injuries in the UK. This followed the death i...

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  • Interveening in childrens' health
    Richard G. Wilson

    Mitch Blair's article is an important commentary on the relationship between academic enquiry and changes which affect child health, and justifies some amplification. The two examples he relies on are very different and obscure a third. The benefit of antenatal steroids in reducing R.D.S. was based on research but occurred as a result of a steady increase in collaboration of paediatricians (responsible for treatment of R....

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  • Evidence based medicine and research activities in the developing world
    Sascha Meyer

    Dear Sir, We read with interest the work by Duke et Fuller (1) demonstrating an increase in the publication of randomized controlled trial (RCT); total: 1553) in 76 low- and middle income countries (LMIC) over a 11-year period. Of note, studies of nutrition (366 publications, 23.6%) and malaria (336 publications, 21%) predominated. Trials of infectious diseases - most importantly malaria involved a comprehensive range of...

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  • Sleep duration for children with autism spectrum disorders: longitudinal study
    Tomoyuki Kawada

    Humphreys et al. investigated a prospective longitudinal study of sleep duration in 73 children with autistic spectrum disorder (ASD) by setting controls (1). Sleep data were collected by questionnaire survey from parents. Although there was no significant difference in total sleep duration in infancy, shortening of night sleep duration became predominant in children with ASD from 30 months of age, which was caused by lat...

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  • Re: The value of Child Death Overview Panels (CDOP) remains unproven
    Dr Luke Allen

    Value for money

    We endorse the sentiments expressed by Mecrow and O'Connor, and acknowledge the concerns they raise. As emphasised in our paper, there is currently a lack of evidence for the efficacy, efficiency and effectiveness of the child death review process. However, we would argue that the value of the CDOP process is not predicated on a demonstrable reduction in mortality alone.

    While demons...

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  • Cultural awareness; small volumes of blood for culture cause under-detection of invasive infections
    Alasdair P.S Munro

    We read with interest your article demonstrating surprisingly low levels of culture-confirmed invasive bacterial infections in children.[1] Whilst we agree better strategies are needed for separating low risk, febrile children from those with invasive-infections, we believe there is another significant factor contributing to their apparent low rates.

    Large studies demonstrate that blood-culture volumes are frequ...

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  • The value of Child Death Overview Panels (CDOP) remains unproven
    ian k Mecrow

    Allen et al (1) are to be congratulated in reporting the first attempt to quantify the efficacy and impact of Child Death Overview Panels (CDOP) in the UK. They note that Paediatricians contributing to the workings of the panel are of the view that the panels function well with 71% of responders agreeing or agreeing strongly that they offer good value. However, the nature of the study may have involved significant bias as...

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