153 e-Letters

published between 2012 and 2015

  • Shape of Training and Integrated Child Health
    Robert E Klaber

    Thank you for your response to our article on Shape of Training, and for sharing your interesting and innovative programme for GP registrars in Northumbria, UK.

    We know of a number of different innovative 'integrated child health' programmes that are emerging across the UK and would encourage clinicians and educators innovating in this area to continue to evaluate programmes and to share learning. Your experienc...

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    Patrick J. Gavin

    To the Editor

    We read with interest the recent report by Murphy and Oshin regarding reptile-associated salmonellois (RAS) in children aged <5 years in South West England [1]. We agree that further work is required to better inform the public of the potential risks pet reptiles pose for infants and young children. Ireland, as elsewhere, has seen an increase in ownership of exotic pets, particulary reptiles, and...

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  • A response to 'Shape of Training: the right people with the right skills in the right place'
    Graeme M. Denman

    We welcome Kalber et al's article on the 'Shape of Training', particularly in relation to the needs of primary care clinicians and wish to share with the authors our experience of innovative primary care training.

    Paediatric rheumatology is an exemplar of a paediatric subspecialty focussed on the management of specific diseases, such as Juvenile Idiopathic Arthritis, by multidisciplinary care. One of the challe...

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  • Developmental influences on the pharmacokinetics and pharmacodynamics of midazolam
    Frans B. Plotz

    I have read with great interest the systematic review to determine the extent of inter-individual variation in clearance of midazolam in children and to establish which factors are responsible for this variation (1). The authors found that the coefficient of clearance in plasma was greater in critically ill patients than non-critically ill patients. Furthermore, there is also a large inter-individual variation in midazola...

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  • Cardioinversion for supraventricular tachycardia
    Paul A.J. Heaton

    There is not much new under the sun, and this includes headstands as a treatment for supraventricular tachycardia (SVT). In 1995 I reported this technique as an effective method of converting SVT to sinus rhythm [1]; details of this safe and simple technique were published widely in the medical press at the time [2]. The manoeuvre had been discovered by the father of a patient in desperation when his son suffered a prolo...

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  • International Charter for Ethical Research Involving Children (ERIC) 2013
    Andrew N. Williams

    Professor Modi's excellent review has a curious omission that of the International Charter for Ethical Research Involving Children (ERIC) 2013.

    http://childethics.com/ accessed November 2nd 2014

    Its project partners include, amongst others, the UNICEF Office for Research and Childwatch International Research Network.

    This Charter addresses the issues raised in her review about moving forwa...

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  • Re: Clarifying the diagnosis of PBB
    Francis J Gilchrist

    Authors: Francis J Gilchrist1,2 ,Mark G Pritchard1, Warren Lenney1,2.

    1. Academic Department of Child Health, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom

    2. Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Thornburrow Road, Stoke-on-Trent ST4 7QB, United Kingdom

    Correspondence Dr Francis J Gil...

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  • Clarifying the diagnosis of PBB
    Anne B Chang

    We congratulate Dr Pritchard and colleagues for reporting on a retrospective follow-up of their patient cohort with protracted bacterial bronchitis (PBB) and thank them for acknowledging the importance of PBB as a cause of chronic cough. The diagnostic criteria of PBB do however need clarification as the 10 children whose wet cough failed to resolve with antibiotics do not have PBB. Instead, they may have bronchiectasis,...

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  • Distinction between bronchopneumonia, acute bronchiolitis, and asthma
    Davendralingam Sinniah

    Acute bronchiolitis and asthma come under the category of obstructive airway disease while bronchopneumonia does not. The main clinical manifestation of an obstructive airway disease would be hyperinflation that would have the clinical features of viscero-ptosis (upper border of liver pushed down), and loss of cardiac dullness on chest percussion.The other clinical feature of obstructive airway disease is prolonged expi...

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  • Management of chronic hepatitis B infection - will NICE guidance lead to over investigation?
    Andrew Riordan

    We were pleased to read Dr Davison's review of the two recently published guidelines for managing chronic Hepatitis B infection in children [1]. We have recently audited our practice against both of these guidelines. As Dr Davison points out; "The level of Alanine transaminase (ALT) at which treatment should be considered highlights a fundamental difference between the guidelines". NICE suggests that ALT in males above 3...

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