423 e-Letters

published between 2006 and 2009

  • Re: ‘The information-seeking behavior of paediatricians accessing web-based resources’ (August 2009)
    Gillian Leng

    Dear editor,

    NHS Evidence welcomes any research that looks at the information- seeking behaviour of healthcare professionals and I am pleased to see that so many paediatricians use the internet as their ‘first port of call’ when looking to answer a medical question. It is also very interesting that over three quarters of pediatricians questioned find it difficult to keep up-to-date with new information relevant to...

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  • Bulging fontanelle in febrile infants: lumbar puncture is mandatory
    Sushil Beri

    We read with interest the study by Shacham et al [1]. Out of 153 children with fever and bulging fontanelle, only one child had bacterial meningitis. However we disagree with their suggestion of withholding lumbar puncture in this group of children. In their cohort, 41 out of 153 children had aseptic meningitis but CSF viral cultures and PCR studies were only done in children who have received antibiotics and had an abn...

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  • In response to Images in Paediatrics: A plethoric palm
    Dr Raakhee Ramesh

    The classification of vascular anomalies has been hampered historically by confusing and imprecise nomenclature. For example, the terms capillary haemangioma, portwine stain and naevus flammeus have all been used interchangeably to describe what should be more precisely referred to as capillary malformation.

    In the “Images in Paediatrics” section of ADC, August 2009 (1), Dr Adhisivam describes a 5-year-old boy...

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  • Paediatricians advocating for Consultation / Liaison Psychiatry
    Donald Payne


    Sebastian Kraemer writes that ‘the challenge for hospital paediatricians is to become advocates for a service that brings real benefits to their patients’ [1]. However, ‘because relatively few have seen what good liaison services can do, demand is not well articulated’ [1]. At Princess Margaret Hospital, the only tertiary hospital for children and adolescents in Western Australia, consultation / liaison...

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  • True value of PEWS is to improve awareness of what is happening rather than what’s going to happen
    John J Fitzsimons

    We were interested to read the study by Edwards et al on the predictive value of their paediatric early warning system (PEWS). They clearly identify the challenges inherent in designing triggers that have both a high sensitivity and specificity. We have an alternate understanding of what PEWS can deliver.

    We believe that true value of PEWS is as a situation awareness tool rather than a prediction tool for the...

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  • Children's Doses Should be Measurable
    Neil A Caldwell

    Dear Sir

    We read with interest the suggestion that dosing charts may reduce gentamicin prescribing errors.(1)

    We fully support the concept but raise question with some of the detail.

    BNFc advises against use of unecessary decimal points.(2) They may be misinterpreted or misread and result in 10-fold overdose.(3) Doses in the neonatal table include trailing zero’s. We would suggest that the in...

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  • Vital Signs Monitoring For Severity-Of-Illness Assessment:
    Shomi Raman

    Thompson and colleagues have shown that commonly recorded vital signs can be used to identify children with serious infections in the pediatric- assessment-unit and that its sensitivity is comparable to more complicated triage systems (1). However they did not take their study to the next logical step of developing a scoring system for triage, using these vital signs.

    We have developed such a scoring system and t...

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  • “Best interests” verses “Rights”
    Delan Devakumar

    Thank you for highlighting this important topic that has wider implications than medicine alone. As you rightly say overt conflict is rare and there are several steps before the courts can or should become involved, but the possibilities should be considered.

    I feel the key difference is whether the law is designed "in the best interests" or in terms of the "rights of the child". The arguments that follow dif...

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  • Variation vs. Disorder, Development vs. Differentiation
    Merius Atangcho

    Dear Editor,

    There is no doubt that language is contextual. Disorder as a term, while innocuously descriptive to one, may hold a negative connotation for another, especially those afflicted with whatever said disorder.

    Regarding brain sex, I agree with the Consensus Statement on Management of Intersex Disorders (CoSMID) that “Structure of the brain is not currently useful for gender assignment.” Quan...

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  • Observations and concerns
    John Stone

    Emond [1] sits on the United Kingdom Joint Committee on Vaccination and Immunisation [2] which is not disclosed here, and therefore shares collective responsibility for United Kingdom vaccination policy, particularly since the government handed the committee autocratic powers earlier this year [3,4]. Given the controversy which surrounds the alleged non-disclosure of competing interests by Andrew Wakefield in the paper c...

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