To our regret we noticed an error in our systematic review “Currently
recommended treatments of childhood constipation are not evidence based. A
systematic literature review on the effect of laxative treatment and
dietary measures (Pijpers et al.).”, published online 19 August 2008
(adc.2007.127233v1).
We would like to make the following corrections:
In table 4b, the correct first outcome measure for the...
To our regret we noticed an error in our systematic review “Currently
recommended treatments of childhood constipation are not evidence based. A
systematic literature review on the effect of laxative treatment and
dietary measures (Pijpers et al.).”, published online 19 August 2008
(adc.2007.127233v1).
We would like to make the following corrections:
In table 4b, the correct first outcome measure for the study of
Gremse et al. (reference number 25) is ‘mean defecation frequency per two
weeks’.
In table 4i, the results in the section of the study of Bongers et
al. (reference number 17) are not correct:
-for the outcome measure ‘mean defecation frequency per week’ the
correct results are: I: 5.6±2.8; C: 4.9±2.5; (p=0.36).
-for the outcome measure ‘improvement of hard to soft stools’ the
correct results are: I: 90% (9/10); C: 50% (5/10); (p=0.14).
Thank you for shedding light on the issue of cough and the
improbability of cough in the context of pertussis as seemingly unlikely
to produce RH. That aspect of your study is quite convincing.
While your prospective study provides valid information, it does not
qualify as a jumping off point to conclude that maltreatment is involved
in 75% of RH that are seen. You have relied on a retros...
Thank you for shedding light on the issue of cough and the
improbability of cough in the context of pertussis as seemingly unlikely
to produce RH. That aspect of your study is quite convincing.
While your prospective study provides valid information, it does not
qualify as a jumping off point to conclude that maltreatment is involved
in 75% of RH that are seen. You have relied on a retrospective study by
King in which children were preclassified as abused by unknown providers
using imprecise, undefined or unknown criteria. From clinical experience,
we know these diagnoses were most likely based on the presence of RH and
SDH. When this occurs, the use thereafter of RH or SDH as indicators of
abuse, is circular logic. It is a logical fallacy to conclude that the RH
that placed a child in an abuse group then becomes proof that they belong
in an abuse group.
RH is linked to increased intracranial pressure. This well
established connection was discussed at length in an article I published
this year (1) and has been general knowledge for more than 100 years since
Terson's work in 1900 and others since (2,3,4,5,6).
While cough alone may not be sufficient to cause RH, coughing in the
context of other comorbidities (pneumonia for example which concurrent low
oxygen states) may be sufficient to damaged already metabolically
compromised capillaries and cause them to leak (7).
That aside, the effort to segue from the absence of RH in pertussis
to RH as a valid diagnostic finding of maltreatment seems to redirect your
efforts to attempting to use, yet again, RH as an indicator of abuse.
Since there 1) has never been a witnessed shaking that has resulted
in RH and two videotaped shakings that produced no findings of RH or SDH
and 2) the link between increased ICP from non-shaken head impacted
children with SDH as been convincingly demonstrated numerous times and
most convincingly by Aoki 1984 (8), I ask why is the link between
increased ICP of any etiology and RH consistently ignored? Also why are
the diagnoses of others, in almost all cases relying on SDH and RH to
diagnose abuse, being used to reach conclusions that RH is associated with
abuse when a circular logic invalidating the link between RH and abuse
appears obvious?
Thank you for clarifying the invalidity of pertussis related cough as
a cause of RH, However, I hope that further investigation of the link
between increased ICP and RH will yield more insight into the etiology of
RH and delink it from an abuse narrative since so many innocent caregivers
languish in jail based on the use of RH as diagnostic of abuse.
Acknowledging the long history of the misuse of RH is also "essential to
safeguard the patient and his or her siblings" from the loss of a loving
caregiver. When accidents and medical problems are misdiagnosed as abuse,
based on the nonspecific finding of RH and SDH, dreadful consequences
arise.
Sincerely yours,
Steven C Gabaeff, MD
1. Gabaeff, S. Challenging the Pathophysiologic Connection Between
Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome. West J
Emerg Med. 2011 May;12(2):144-58.
2. Terson PDA. Hemorrhage in the vitreous body during cerebral
hemorrhage. La Clinique Ophthalmologique 1900;22:309-12.
3. Medele RJ, Stummer W, Mueller AJ, Steiger HJ, Reulen HJ. Terson's
syndrome in subarachnoid hemorrhage and severe brain injury accompanied by
acutely raised intracranial pressure.J Neurosurg.1998 May;88(5):851-4.
4. Walsh FB, Hedges TR. Optic nerve sheath hemorrhage. Am J
Ophthalmol 1951;34:509-27
5. Muller PJ, Deck JHN. Intraocular and optic nerve sheath hemorrhage
in cases of sudden intracranial hypertension. J Neurosurg 1974;41:160-6
6. Reddy AR, Clarke M, Long VW. Unilateral retinal hemorrhages with
subarachnoid hemorrhage in a 5-week-old infant: is this nonaccidental
injury? Eur J Ophthalmol. 2010 Jan 5
7. Koto, T, et.al. Hypoxia Disrupts the Barrier Function of Neural
Blood Vessels through Changes in the Expression of Claudin-5 in
Endothelial Cells, American Journal of Pathology. 2007;170:1389-1397.
8. Aoki N, Masuzawa H. Infantile acute subdural hematoma: clinical
analysis of 26 cases. J Neurosurg 1984;61:273-80.
Conflict of Interest:
I have consulted in 1500 cases of abuse over 23 years and have been certified by the Los Angeles County Superior Court as an expert in child abuse for both the prosecution and defense.
We read with great interest your work on the cost effectiveness of
clinical decision rules for minor head injury. As you point out, increased
CT scanning reduces the risk of missing patients that require neurosurgery
at the expense of increased radiation risk. This latter point has been
recently raised in the literature [1,2] and prompted us to audit our
practice of the appropriateness of CT scanning c...
We read with great interest your work on the cost effectiveness of
clinical decision rules for minor head injury. As you point out, increased
CT scanning reduces the risk of missing patients that require neurosurgery
at the expense of increased radiation risk. This latter point has been
recently raised in the literature [1,2] and prompted us to audit our
practice of the appropriateness of CT scanning children with
minor/borderline head injury.
We collected data spanning a 3 month period (July 1st - Sept 31st
2013). 78 CT head scans were requested from our A&E for paediatric
patients. 37 requests were for minor head injury. These were audited
against the 2007 NICE guidelines [3]. 4 scan requests were not in
accordance with guidelines but 2 of these yielded positive intracranial
findings. With 89% of scan requests in accordance with NICE standards, 16%
revealed a skull fracture and/or intracranial bleed.
The 2003 NICE head injury guidelines for children were extrapolated
from adult data and subsequently revised in 2007 to integrate the CHALICE
rule (Children's Head injury Algorithm for the prediction of Important
Clinical Event) into a specific paediatric guideline [4]. The CHALICE rule
was derived from a large cohort of children and is yet to be validated
[5].
Furthermore, in their 2014 provisional update, NICE specifically
identify a need for comparison of clinical decision rules such as CHALICE,
CATCH (Canadian Assessment of Tomography for Childhood Head Injury) and
PECARN (Paediatric Emergency Care Applied Research Network) with the
proposed 2014 NICE guidelines.
In conclusion, our data show appropriately requested paediatric head
CT scans as per NICE guidelines. We agree that clinical decision rules
once validated and compared with the upcoming guidelines may have a useful
role in the reducing the number of children missed who could be considered
for neurosurgical intervention.
Yours Sincerely,
Dr Ravindran Visagan (FY2 in Paediatrics)
Dr Ravi Lehal (Consultant Paediatrician)
REFERENCES
1. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL,
Ronckers CM, Rajaraman P, Sir Craft AW, Parker L, Berrington de Gonz?lez
A. Radiation exposure from CT scans in childhood and subsequent risk of
leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012
Aug 4;380(9840):499-505. doi: 10.1016/S0140-6736(12)60815-0. Epub 2012 Jun
7.
2. Mercuri & Einstein. A small but real risk of cancer in
children from undergoing CT. Evid Based Med. 2013 Aug;18(4):158-9. doi:
10.1136/eb-2012-101037.
3. NICE (2007). Head injury: NICE guideline (2007).
4. Harty E, Bellis F. CHALICE head injury rule: an implementation
study. Emerg Med J. 2010 Oct;27(10):750-2. doi: 10.1136/emj.2009.077644.
The study by T Sommerfield et al. (1) provides a valuable insight
into the epidemiological trend of infantile hypertrophic pyloric stenosis
(IHPS) in Scotland. It was interesting to note the proposed association
between incidence of IHPS and deprivation.
We have recently reviewed cases of IHPS presenting to our hospital,
which is a medium sized district general hospital serving a deprived
population in the Sou...
The study by T Sommerfield et al. (1) provides a valuable insight
into the epidemiological trend of infantile hypertrophic pyloric stenosis
(IHPS) in Scotland. It was interesting to note the proposed association
between incidence of IHPS and deprivation.
We have recently reviewed cases of IHPS presenting to our hospital,
which is a medium sized district general hospital serving a deprived
population in the South Wales valleys. We were keen to assess the clinical
presentation and our performance in terms of diagnosing and managing
pyloric stenosis. A retrospective case review of all ultrasongraphically
confirmed cases of pyloric stenosis over a seven year period (January 2000
to September 2007) was undertaken. Standards for notekeeping, clinical
assessment,investigations and fluid management were derived from
literature search and textbooks.
We found that majority of patients were term( 95%), first born(
100%), male infants( 90%) presenting between 2 - 10 weeks of life
.Vomiting was the predominant presenting feature at median age of 24 days.
No significant seasonal variation was noted. With a birth rate of about
2200/ year in our hospital the cumulative incidence of IHPS over the last
7 years amounts to 37 cases in 17,500 births which is about 2.1 per 1000
live births. 38% of infants were initially diagnosed to have Gastro
Oesophageal reflux; however the time between initial presentation and
surgical correction ranged from 2 to 3 days. Recovery was uneventful in
92% of the cases. Apart from one infant who had restenosis of the pylorus,
complications in the rest were minor, responding to conventional
treatment.
A study done in early 1980s by A R Webb et al.(2) showed that the
incidence of surgically confirmed IHPS in the South Glamorgan region rose
sharply after 1976 from 1.4/ 1000 live births to 3.6/ 1000 live births.
This seemed to reflect epidemiological trends throughout Wales. Although
there was speculation that this rise could be attributed to a change in
feeding practises at that time (from formula to breast feeding), the data
lacked statistical significance. Studies since exploring the relation
between IHPS and maternal variables like breast feeding have been impeded
by lack of sufficient data and tend to contradict each other (3, 4).
It was also interesting to note the association between IHPS and
deprivation observed by the authors. Others have also suggested a relation
between rural living and pyloric stenosis (5). Census has shown that
Rhondda Cynon Taff suffers from high levels of economic and social
deprivation with 67% of the total population living within the top third
of the most deprived wards in Wales (6). Besides it also has a high
proportion of rural population. Perhaps somewhat surprisingly the
incidence of pyloric stenosis is only marginally different from the
Scottish population. Social deprivation undoubtedly is an important
contributor to the incidence of pyloric stenosis but it is probably just
one of the many environmental variables determining the incidence of this
fascinating condition.
References
1. The changing epidemiology of infantile hypertrophic pyloric
stenosis in Scotland. T. Sommerfield et al. Arch Dis Child 2008; 93:1007-
1011.
2. Infantile hypertrophic pyloric stenosis in South Glamorgan 1970-9.
Effects of changes in feeding practice. A R Webb et al. Arch Dis
Child.1983 August; 58(8): 586–590
3. Breast feeding and hypertrophic pyloric stenosis: population based
case-control study. Alfredo Pisacane et al. BMJ.1996 march; 312:745-746
4. Does Exclusive Breastfeeding Confer Protection Against Infantile
Hypertrophic Pyloric Stenosis? A 30-year Experience in Benin City,
Nigeria. David Osarumwese Osifo and Iyekoretin Evbuomwan.Journal of
Tropical Pediatrics. 2008; 0: fmn094v1-fmn094.
5. Population demographic indicators associated with incidence of
pyloric stenosis. T. To et al.Arch Pediatr Adolesc Med. 2005;159:520-525.
Van Esso et al highlight interesting differences in primary care
provision between European countries, pointing out a possible change in
the relative balance between paediatric and general practitioner/family
doctor systems since Katz's paper in 2002(1).
Our findings, from an ongoing study for the European Observatory on Health
Systems and Policies, suggest caution in the interpretation of GP/FD
models in some countries....
Van Esso et al highlight interesting differences in primary care
provision between European countries, pointing out a possible change in
the relative balance between paediatric and general practitioner/family
doctor systems since Katz's paper in 2002(1).
Our findings, from an ongoing study for the European Observatory on Health
Systems and Policies, suggest caution in the interpretation of GP/FD
models in some countries. For example Swedish general practitioners and
paediatricians work in teams with children's
nurses in urban community-based children's
centres. Rapid referrals and consultations are easy and commonplace,
rendering the distinction between types of professionals less clear. Some
children's centres are staffed by either a
GP/FD or a primary care paediatrician, and in rural areas the GP/FD model
predominates. In Sweden, planning children's
health services for an area is the responsibility of a senior
paediatrician and paediatric nurse. Similarly in The Netherlands, the
transmural care model enables GPs and paediatricians to work more closely
together than is the case in the UK by aligning financial and managerial
incentives. Hence although defining these countries as having a GP/FD
model for children's first-access is correct,
it is an incomplete explanation as they have advanced further along the
road to integrating primary and secondary care than the UK.
1. Katz M RA, Collier J, Rosen J, Ehrich JHH. Demography of pediatric
primary care training in Europe: delivery of care and training.
Pediatrics. 2002;109:788-96.
I'm a busy paediatrician and commonly commit the sin of reading an
article's conclusions and ignoring the data presented. In that context I
was amazed to see the dissonance between the conclusions of both the
editorial and the paper "Systemic review of studies comparing combined
treatment with paracetamol and ibuprofen, with either drug alone" with the
actual data presented. The conclusions of both seem to have been clear...
I'm a busy paediatrician and commonly commit the sin of reading an
article's conclusions and ignoring the data presented. In that context I
was amazed to see the dissonance between the conclusions of both the
editorial and the paper "Systemic review of studies comparing combined
treatment with paracetamol and ibuprofen, with either drug alone" with the
actual data presented. The conclusions of both seem to have been clearly
written in the minds of both authors well in advance of thinking what the
data say. I read the following conclusions. "There is little evidence of
benefit or harm from combined treatment compared with the use of each drug
alone." "Most studies showed some additional reduction in temperature . .
. this rarely reached clinically or statistically significant levels."
Considering the need for further research, ". . . resources should be
targetted elsewhere."
Compare these comments to the data. Temperature differences as large
as 0.6, 1.1 and 1.2 degrees centigrade with significance levels p = 0.002
and p<0.001. Nearly half more of the combined group afebrile at 7 and 8
hours compared to single treatment groups! Explain that as of no
importance to the parents involved and consider their incredulous
expressions! Similarly try explaining this to the families of the 27% of
children that were still pyrexial at 2 hours and at 4 hours that wouldn't
have been if a combined treatment had been given. Or perhaps try
minimising the superiority of a treatment that reduced reduced a symptom
by 4 and a half hours per 24 hours more than the standard treatment with a
statistical significance level of 0.001.
Both the editorial and the article make the important point that the
temperature is a potentially misleading surrogate for the real treatment
aim of promoting patient comfort during illness. It is a non-sequitur
however to present all this evidence on temperature with lack of evidence
on comfort and conclude that combination therapy should be avoided and not
further studied. These latter conclusions are simply not supported by the
evidence presented in any way whatsoever.
While Purssell may well be proved right in time I can think of a
number examples of strong opinions presented in discussion and conclusion
parts of papers which represent the author's beliefs rather than a
dispassionate induction from the data or argument presented. (MMR scandal,
delay in routine use of antenatal steroids with threatenned pre-term
birth) Could our editors please point these out when they occur rather
than simply echoing them?
Dear Editor-in-chief,
in reaction to Charlotte M Wrights editorial "Failure to wean" (2013, 98:
838-840) we would like to add some data on the option of rapid tube
weaning to enhance the discussion between rapid versus slow weaning
programs and to advocate a flexible and individually tailored approach.
As Mrs Wright comments saying that no program suits every child we would
like to stress that especially medically fragil...
Dear Editor-in-chief,
in reaction to Charlotte M Wrights editorial "Failure to wean" (2013, 98:
838-840) we would like to add some data on the option of rapid tube
weaning to enhance the discussion between rapid versus slow weaning
programs and to advocate a flexible and individually tailored approach.
As Mrs Wright comments saying that no program suits every child we would
like to stress that especially medically fragile patients will need an
individually tailored approach. The more rapid the reduction of tube feeds
is performed, it is more likely that hunger occurs, whereas the child
needs to be evaluated closely during this process.
Our data (1) show that 92% of telemedical vs. 82% onsite treated of
344 children could be weaned completely using a rapid approach ("Graz
model of tube weaning") (2,3). Our data support the option of rapid
reduction of caloric intake. Currently, we are evaluating our long-term
data: relapse rate is <1% (children who had to go back to full tube
feeds - TF), <5% partial TF as a result to unforeseeable medical
events.
As we had 36 patients since 2010 living in the UK, this may show that our
online services (www.notube.com) for counselling are seen as helpful. In
various conferences and lectures throughout GB we taught our approach. We
advocate thorough assessment, team counselling, contact with local
centres. Experience and decidedness give hope for parents and children to
be able to learn to eat.
We understand the concerns of doctors Lin and Fu about reverse
causation regarding the protective effect of fish on eczema at one year of
age. We cannot, of course, be sure that reverse causation does not
contribute to our results, but there are reasons that speak in favour of a
real effect.
Firstly, we found no correlation between time of onset of the eczema
and age at introduction of fish....
We understand the concerns of doctors Lin and Fu about reverse
causation regarding the protective effect of fish on eczema at one year of
age. We cannot, of course, be sure that reverse causation does not
contribute to our results, but there are reasons that speak in favour of a
real effect.
Firstly, we found no correlation between time of onset of the eczema
and age at introduction of fish.
Secondly, when excluding infants with food-induced eczema, there was
still a protective effect, as was the case when excluding infants with
food allergy.
Thirdly, when excluding infants with onset of eczema before 4 months
of age, there was still a protective effect in infants with later onset of
eczema. Also, the protective effect was equal between infants with and
without atopic heredity.
Furthermore, we are not the only group that has reported such
effects. In the BAMSE study (1), Kull et al. found that fish consumption
during the first year of life was protective against allergic disease at 4
years. In a Norwegian study (1), Øien et al. found that fish reduced the
risk of having allergic disease at 2 years. Both studies excluded children
with disease before one year of age to avoid reverse causation.
We are at this moment analysing the data from our follow-up when the
children are 4.5 years old, and will hopefully be able to address the
question further.
References:
1. Kull I, Bergström A, Lilja G, Pershagen G, Wickman M. Fish
consumption during the first year of life and development of allergic
diseases during childhood. Allergy. 2006;61:1009-15.
2. Øien T, Storrø O, Johnsen R. Fish and cod liver oil consumption
during pregnancy and the first year of life and allergic diseases at 2
years of age. A prospective birth cohort study. XXVII Congress of the
European Academy of Allergology and Clinical Immunology, Barcelona.
[Abstract]. 2008.
Yours sincerely,
Bernt Alm MD PhD, Nils Åberg MD PhD, Laslo Erdes MD, Per Möllborg MD,
Rolf Pettersson MD, Gunnar Norvenius MD PhD, Emma Goksör MD, and Göran
Wennergren MD PhD.
In the review by O'Grady and Cody (1), the Authors concluded that "in
the pediatric population with subclinical hypothyroidism (SH), the
majority of children with slightly elevated TSH levels are likely to
normalise without treatment or have persistent mild TSH elevation". Our
goal is to reinforce that conclusion on the basis of the results of an our
study aiming to prospectively evaluate for the first time the natural
co...
In the review by O'Grady and Cody (1), the Authors concluded that "in
the pediatric population with subclinical hypothyroidism (SH), the
majority of children with slightly elevated TSH levels are likely to
normalise without treatment or have persistent mild TSH elevation". Our
goal is to reinforce that conclusion on the basis of the results of an our
study aiming to prospectively evaluate for the first time the natural
course of SH in children and adolescents with no underlying diseases and
no risk factors that might interfere with the progression of SH (2).
In our study clinical status, thyroid function and autoimmunity were
prospectively evaluated at entry and after 6, 12 and 24 months in 92 young
patients (mean age 8.1 /-3.0 years) with idiopathic SH. In the study
population all the etiological causes of SH had been preliminary excluded
at the time of admission. During the two-year follow-up period mean TSH
levels showed a trend towards a progressive decrease while FT4 levels
remained unchanged. Overall, 38 patients normalized their TSH (group A):
16 patients between 6 and 12 months, and 22 patients between 12 and 24
months. Among the remaining 54 patients, the majority maintained TSH
within the baseline values (group B), whereas 11 exhibited a further
increase in TSH above 10 uIU/ml (group C). Baseline TSH and FT4 levels
were similar in the patients who normalized TSH, compared with those with
persistent hyperthyrotropinemia. Even in the patients of group C, both TSH
and FT4 at entry were not different with respect to those of group A and
B. No patients showed any symptoms of hypothyroidism during follow-up and
no changes in both height and body mass index were observed throughout the
observation period (2).
We concluded that the natural course of TSH elevations in children and
adolescents with idiopathic SH is characterized by a progressive decrease
over time and that the majority of patients have a normalization of serum
TSH within a 2-year follow-up (2).
Our conclusions are in agreement with the ones by O'Grady and Code (1) and
support them.
References
1. O'Grady MJ, Cody D. Subclinical hypothyroidism in childhood. Arch Dis
Child 2010. Published Online First: 22 April 2010. doi:
10.1136/adc.2009.181800
2. Wasniewska M, Salerno M, Cassio A, Corrias A, Aversa T, Zirilli G,
Capalbo D, Bal M, Mussa A, De Luca F. Prospective evaluation of the
natural course of idiopathic subclinical hypothyroidism in childhood and
adolescence. Eur J Endocrinol. 2009 Mar;160(3):417-21.
Indeed Peanut Oil is not a well known ingredient of Abidec drops, but
on what basis can the authors say this is "clinically vital information"?
Have there been any reports of allergy to Abidec drops?
Abidec drops are regularly given to British babies. The introduction
of a small amount of peanut oil at that age may induce tolerance and
result in LESS allergy.
Indeed Peanut Oil is not a well known ingredient of Abidec drops, but
on what basis can the authors say this is "clinically vital information"?
Have there been any reports of allergy to Abidec drops?
Abidec drops are regularly given to British babies. The introduction
of a small amount of peanut oil at that age may induce tolerance and
result in LESS allergy.
Abidec has other advantages over "nut-free" drops. NHS Healthy Start
vitamin drops contain less Vitamin D (300 units) than Abidec (400 units)
and Dalivit drops have more Vitamin A (5000 units) which can be a problem
if the dose is doubled (as parents often do) compared to Abidec's 1333
units of Vitamin A.
I would be grateful for any documented data on harmful effects of
supplements in infancy. Caution is required before issuing an edict
against this widely used supplement. Paediatricians such as Reginald
Lightwood wrongly suspected Vitamin supplements of causing toxicity
(hypercalcaemia) 60 years ago. As a result, the UK still lags behind most
of the Western world in our Vitamin D supplementation programme.
To our regret we noticed an error in our systematic review “Currently recommended treatments of childhood constipation are not evidence based. A systematic literature review on the effect of laxative treatment and dietary measures (Pijpers et al.).”, published online 19 August 2008 (adc.2007.127233v1).
We would like to make the following corrections:
In table 4b, the correct first outcome measure for the...
Dear Authors,
Thank you for shedding light on the issue of cough and the improbability of cough in the context of pertussis as seemingly unlikely to produce RH. That aspect of your study is quite convincing.
While your prospective study provides valid information, it does not qualify as a jumping off point to conclude that maltreatment is involved in 75% of RH that are seen. You have relied on a retros...
Dear Sirs,
We read with great interest your work on the cost effectiveness of clinical decision rules for minor head injury. As you point out, increased CT scanning reduces the risk of missing patients that require neurosurgery at the expense of increased radiation risk. This latter point has been recently raised in the literature [1,2] and prompted us to audit our practice of the appropriateness of CT scanning c...
The study by T Sommerfield et al. (1) provides a valuable insight into the epidemiological trend of infantile hypertrophic pyloric stenosis (IHPS) in Scotland. It was interesting to note the proposed association between incidence of IHPS and deprivation.
We have recently reviewed cases of IHPS presenting to our hospital, which is a medium sized district general hospital serving a deprived population in the Sou...
Van Esso et al highlight interesting differences in primary care provision between European countries, pointing out a possible change in the relative balance between paediatric and general practitioner/family doctor systems since Katz's paper in 2002(1). Our findings, from an ongoing study for the European Observatory on Health Systems and Policies, suggest caution in the interpretation of GP/FD models in some countries....
I'm a busy paediatrician and commonly commit the sin of reading an article's conclusions and ignoring the data presented. In that context I was amazed to see the dissonance between the conclusions of both the editorial and the paper "Systemic review of studies comparing combined treatment with paracetamol and ibuprofen, with either drug alone" with the actual data presented. The conclusions of both seem to have been clear...
Dear Editor-in-chief, in reaction to Charlotte M Wrights editorial "Failure to wean" (2013, 98: 838-840) we would like to add some data on the option of rapid tube weaning to enhance the discussion between rapid versus slow weaning programs and to advocate a flexible and individually tailored approach. As Mrs Wright comments saying that no program suits every child we would like to stress that especially medically fragil...
Sir,
We understand the concerns of doctors Lin and Fu about reverse causation regarding the protective effect of fish on eczema at one year of age. We cannot, of course, be sure that reverse causation does not contribute to our results, but there are reasons that speak in favour of a real effect.
Firstly, we found no correlation between time of onset of the eczema and age at introduction of fish....
In the review by O'Grady and Cody (1), the Authors concluded that "in the pediatric population with subclinical hypothyroidism (SH), the majority of children with slightly elevated TSH levels are likely to normalise without treatment or have persistent mild TSH elevation". Our goal is to reinforce that conclusion on the basis of the results of an our study aiming to prospectively evaluate for the first time the natural co...
Indeed Peanut Oil is not a well known ingredient of Abidec drops, but on what basis can the authors say this is "clinically vital information"? Have there been any reports of allergy to Abidec drops?
Abidec drops are regularly given to British babies. The introduction of a small amount of peanut oil at that age may induce tolerance and result in LESS allergy.
Abidec has other advantages over "nut-free"...
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