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The new turquoise
A good case could be made for awarding the dynamics of etymology the (centuries overdue) ‘official’ eighth wonder of the world award. I concede this is a more nebulous entity than the already recognised (edificial) jaw-droppers making up the standard listings, but, if artistic value, imagination, development, communication are the pre-requisites, why look further? Expanding the argument, which other ‘ology’ is a more sensitive final common pathway for the amalgam that is history, global migratory patterns, geology, archaeology and genetics. Most of us are off the pulse in terms of 2023 grammar etiquette, much of which has been wrested from the OED, but, while we can rue this loss, we should be in awe of its vitality. In much the same way that the peri-millennial years spawned phrases like ‘grey is the new.’ and (so banal, it still hurts) ‘less is more’, the 2010s became inextricably linked with the ‘windows of opportunity’ epithet. I never warmed to any of these, but, ostrich-like denial of their currency would be, simply, stubbornness on my part. There were, so the argument went, sliding door moments (the eponymous ‘windows’) when an intervention, a tweak, a message could alter a trajectory. This phrase built momentum in the clinical world and, without needing to think for more than a few seconds could cite several paediatric examples: vaccination opportunity; vitamin K prophylaxis, developmental screening. The concept never really disappeared, rather the need to use the term became less pressing and the practice more subconscious. Whatever your bias, this quartet of papers (three oncological one PEM-related) not only open the window but fix the latchkey firmly on. Did I say that – sorry – almost as bad as the examples over which I’ve just been pouring (ice) cold water.
When does one suspect (or at least want to rule out) a malignancy? Well, early obviously, but that requires (and this feels very 2020s) a sensitised environment. Jo-Fen Liu and colleagues at Nottingham University Children’s Cancer centre, UK describe the low general awareness among adults of warning signs in children. On average, only a quarter of the ‘flags’ were recognised and only a third felt ‘confident’ about recognising the hallmarks. Though ‘lumps’ were widely recognised, delayed puberty, slow early growth and development would not have triggered a request for an assessment by the vast majority. See page 987
Decluttering: a sequel
We’ve published extensively in the recent past on safety netting in febrile neutropenia and the phenotypes suitable for earlier than ‘no decisions until the x day blood cultures’ tradition. Part of the ‘sepsis work up’ lore has been to rule out urinary tract infection, the diktat accepted without much fuss until now. Joso-Antonio Alonso. Cadenas and colleagues at the Hospital Infantil Universitario Niño Jesús, Madrid, Spain assess both the real yield in this group of children and sensitivity of analysis as a marker of (culture proven) UTI, both breathtakingly low, the only group with any yield, the children with symptoms. It feels as if this is another evidence-based step towards smoother turnover in this multi admission group where all accruable benefits are welcome. See page 982
Access all areas
Addressing a perennial question, so far never subject to meta-analytical scrutiny, Nigel Hall and colleagues in Southampton synthesise published data on the two IV access groups: the tunnelled (‘wiggly’) Hickman-type and the subcutaneous (‘portacatch’ ports and their respective complication rates – infection and mechanical.
Their proponents argue respectively for the topical anaesthetic-free ease of access (tunnelled), and cosmetic and swimming friendly (port) advantages. Beyond the personal preference point, though, the ports proved superior at every level. Add to that, the likely quality of life benefits (seen in adults), the case for tunnelled lines as a first choice seems off the pulse. See page 975
But, I‘ve gone off at a tangent. Think if there were a way of detecting children at risk of suicide and intervening early: imagine if that were possible in the emergency department. Finza Latif and colleagues at the Sidra Medical Centre in Doha, Qatar describe the current knowledge around universal screening in children with medical symptoms at ED presentation using validated tools. Though the literature is still building, the improved sensitivity with routine screening is substantially better than targeted questioning to those already known to be in a high-risk group, for example with a diagnosed psychosis. Even more attractively for the pressed ED, there were no implications for added consultation time. See page 970
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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.