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In Kipling’s seminal novel ‘Kim’, the central premise (literal and metaphorical) is the wresting for power in fin de (19th) siècle South Asia. This attritional confrontation became popularly known as the Great Game and, though ostensibly a children’s book, is really more complex. At its core, it is an examination of conflict at multiple levels, part of course of the ‘human condition’. The book, is as apposite now as it was in the Bombay and Kabul of Kipling’s youth and the theme underpins several of this month’s broad ranging papers
Though one might debate the relative contributions to the change, no one would refute the fact that, as starkly highlighted by the global terrorism index, the world is becoming less stable. Though human beings may always have had this propensity, technological changes have altered the means of expressing this phenotype on both a personal and national scale. Sadly, children are often (literally) caught in the crossfire and we would be doing them a disservice by being underprepared for either terrorism or natural disasters. The terrorist attacks in France in 2015 and 2016 (in Paris and Nice respectively) led to the development of the ORSAF-AMAVI network: Organisation de la Réponse du Système de Santé en Situations Sanitaires Exceptionnelles-Afflux Massif de Victimes. Motarmet and colleagues examined the state of preparedness in French paediatric centres 2 years on from the pivotal episodes. The results were mixed: they found excellent intensive care coverage, but patchier in-house surgical cover and incomplete teaching and simulation and, in places, unclear logistical arrangements. How would other centres perform: if unprepared, then why? In the editorial by Bank and Plotchnik (p…), these findings are extrapolated and methods of teaching discussed on a local and international scale. Any paediatrician not directly involved in emergency care or trauma surgery on a day to day basis is, by definition, inexperienced. This (inexperience) is allowed: being unprepared by dint of a lack of teaching surely is not. See pages 320 and 322.
Improving communication might be a well-worn mantra but is still surprisingly badly practised. So much conflict between families and even colleagues is attributable to breakdown in this area and, once entrenched, can be near impossible to eradicate. The conflict management framework is a tool designed to enable identification and prevent escalation before stances become factionalised. Forbat’s paper describes the way in which it can be applied in the invariably highly charged environment of a paediatric oncology ward. After induction and implementation, incidence of events dropped markedly (by 64%) with qualitative improvement in staff morale. A common source of vexation ‘family micromanaging’ the authors identified is important: easy to fall into this pattern, hard to break. See page 328.
Children and research
Clinical scientists perhaps garner most credit for research advances, but as Robert’s and Liabo’s overview of the determinants of effective studies describes, the unsung advocates, social scientists, anthropologists, engineers, educationalists, town planners and economists have done, arguably, as much. They argue that to understand determinants of health an appreciation of how children themselves experience their health is needed and that for findings of any randomised controlled trial to make sense, qualitative work, surveys and ethnography need to be incorporated. We all know that many well-run studies flounder when the ink has dried on the main paper and that, no matter how well cited, will never achieve their potential unless this essential homework has been done. See page 309.
The paper paves the way for the first of four instalments of a mini series on research in children by Bob Phillips and colleagues which examines premises for, ethics around and practicalities in the area. Many of us are already involved in direct clinical or epidemiological studies, but even those that are will learn something new. This paper, ‘making research central to good paediatric practice’ is my ‘editor’s choice’ for the month. See page 385.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
Patient consent for publication Not required.