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A practical approach to recurrent epistaxis in children

Paediatrics and Child Health - Mon, 05/20/2019 - 00:00
Recurrent epistaxis (nose bleeds) are common in children. The vast majority of nose bleeds are self-resolving and do not require medical input. Clinicians get involved in cases where the nose bleeds are more severe, frequent and take a longer time to resolve. Emergency management involves basic resuscitation and first aid measures. A holistic approach is required, when dealing with non-emergency cases of frequent nose bleeds, including the exclusion of systemic illness. In this article we outline the basic history, examination, investigation and management aspects of evaluating a paediatric patient with epistaxis.
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Managing headache

Paediatrics and Child Health - Thu, 05/16/2019 - 00:00
Managing headache involves being able to make a positive diagnosis of the headache type, reassuring the family that there is no serious underlying cause and enabling self-management. Resisting the urge to investigate is also important.
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Assessing tall stature

Paediatrics and Child Health - Tue, 05/14/2019 - 00:00
Children and adults are considered ‘tall’ when their height is above 98th centile for age i.e. 2 standard deviations (SD) above the mean. Tall stature is familial in most cases. In assessing children with tall stature the mid-parental height centile should always be calculated and this article gives advice on how to proceed with investigation and management for children who are unexpectedly tall. Other common causes of tall stature are obesity or early normal puberty. Precocious puberty, hyperthyroidism and GH excess are less common but these will also cause rapid height velocity at any age and precocious puberty should be excluded in every child presenting with tall stature.
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Checklists in action in neonatal medicine: improving breastfeeding rates

Paediatrics and Child Health - Wed, 05/08/2019 - 00:00
Checklists were initially used within the aviation industry before being extrapolated into a number of other industries and arriving much later to medicine, where they are used as tools to improve patient safety. Checklists improve reliability, reduce variation and standardise care, ensuring that staff can review their tasks and confirm compliance before moving on to the next step. They have flexibility in application and are used in both within the acute care setting, in addition to service planning and delivery.
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Graves’ disease

Paediatrics and Child Health - Tue, 05/07/2019 - 00:00
Graves' disease develops when pathogenic thyroid receptor antibodies stimulate the thyroid gland resulting in excessive thyroid hormone production. Children and adolescents with Graves' disease can present in a variety of ways to many different clinical teams with a diverse range of underlying symptoms and signs. Graves' disease is usually managed initially with the anti-thyroid drug (ATD) carbimazole. However, only 20–25 % of young patients remit (remaining euthyroid when the ATD is stopped in the longer term) after a 2 year course of ATD treatment.
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Management of teenagers with polycystic ovarian syndrome

Paediatrics and Child Health - Tue, 05/07/2019 - 00:00
Polycystic ovary syndrome (PCOS) is a common, complex endocrine and metabolic disorder with a prevalence of 20%. It is variable in aetiology, clinical presentation and prognosis, making it a challenging disease to understand and manage in teenagers. It results from a defect in steroidogenesis, leading to excess luteinising hormone and hyperandrogenism. PCOS is also associated with insulin resistance and compensatory hyperinsulinism. The Rotterdam criteria are the most widely used criteria for diagnosing PCOS, however it is typically challenging to diagnose in teenage girls due to the overlap of symptoms with normal pubertal changes.
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Editorial Board

Paediatrics and Child Health - Wed, 05/01/2019 - 00:00
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Society Page

Journal of Pediatric Health Care - Wed, 05/01/2019 - 00:00
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#NursesToo

Journal of Pediatric Health Care - Wed, 05/01/2019 - 00:00
A nurse in the operating room is the target of vulgar comments made by a surgeon over an anesthetized patient. A cardiology fellow who travels to a conference is told by an attending physician that he'll pay for one more night in the hotel if she'll share the room with him. And, after reporting the incidents to her union and to the medical center, a licensed practical nurse successfully brings legal action against a male nursing assistant who had numerous times shoved her into a closet and groped her.
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The Importance of Professional Advocacy

Journal of Pediatric Health Care - Wed, 05/01/2019 - 00:00
Nurse practitioners (NPs) and other advanced practice nurses are the front-line health care providers to millions of people every single day. Research demonstrates we provide high-quality care equal or superior to other health care providers, yet our restrictions in scope of practice are many. Common issues we face include difficulty achieving third-party payor designation, federal policies that ultimately are costlier to the system than a more streamlined approach, state-level limitations on practice that prevent us from working to the highest scope of our education and practice, and institutional restrictions that lead to fragmented care.
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A Review on the Use of Cystic Fibrosis Transmembrane Conductance Regulator Gene Modulators in Pediatric Patients

Journal of Pediatric Health Care - Wed, 05/01/2019 - 00:00
The literature surrounding the use of cystic fibrosis transmembrane conductance regulator-targeted pharmacotherapies in pediatric patients continues to evolve. These therapies represent a departure from symptom management and infection prevention, which have been the mainstay of cystic fibrosis management in pediatrics, to targeting the genetic defect present within these patients. This article reviews the clinical studies evaluating the safety and efficacy of ivacaftor, ivacaftor/lumacaftor, and ivacaftor/tezacaftor.
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Self-assessment

Paediatrics and Child Health - Tue, 04/30/2019 - 00:00
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Review of resuscitation physiology in children

Paediatrics and Child Health - Tue, 04/30/2019 - 00:00
More than one quarter of children survive to hospital discharge after in-hospital cardiac arrests, and 5–10% of children survive to hospital discharge after out-of-hospital cardiac arrests. Cardio-pulmonary resuscitation (CPR) differs in children from adults. Following the Airway, Breathing, Circulation format, this article reviews the physiology of paediatric cardio-pulmonary resuscitation. It addresses the appropriate interventions during CPR, mechanisms of action of commonly used drugs and special resuscitation circumstances: premature and newly born infants, traumatic cardiac arrest, and ECMO (Extracorporeal Membrane Oxygenation).
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Immunization-Associated Pain: Taking Research to the Bedside

Journal of Pediatric Health Care - Sat, 04/27/2019 - 00:00
Immunization-associated pain is the number one cause of pain in pediatric settings. Untreated pain has many short- and long-term detrimental effects. The purpose of this project was to implement a nonpharmaceutical immunization-associated–pain prevention program.
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Sedation and analgesia for critically ill children

Paediatrics and Child Health - Mon, 04/15/2019 - 00:00
Effective analgesia and sedation in the paediatric intensive care unit (PICU) encompasses the provision of physical comfort and caring for the psychological well-being of critically ill children. In the UK the most commonly used sedative and analgesic agents for critically ill children are midazolam and either morphine or fentanyl. Consensus clinical practice guidelines for the provision of sedation and analgesia in critically ill children were published in 2006 by the UK Paediatric Intensive Care Society, and an ESPNIC position statement on clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children was published in 2016: Despite this, considerable variation in practice persists.
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Preterm patent ductus arteriosus: what the research tells us

Paediatrics and Child Health - Fri, 04/12/2019 - 00:00
Ductus arteriosus is a fetal blood vessel that connects two elastic arteries, pulmonary artery and aorta, with different resistances. It only becomes pathological if it fails to close after birth. The clinical features of patent ductus arteriosus (PDA) depend upon the gestation at birth, severity of lung disease and the postnatal age of the newborn. In premature infants, PDA is associated with significant morbidity and mortality. However, the current literature on treatment of PDA does not report any improvement in long-term neonatal outcomes.
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