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doi:10.1111/jpc.12751
Letters to the Editor Dear Editor, THE IMPORTANCE OF PHYSICAL EXAMINATION IN PATIENTS WITH MENTAL HEALTH PRESENTATIONS An 8-year-old girl was referred by her GP to the out-patient department for assessment of learning difficulties. She was triaged to the Behaviour Clinic. At the appointment, her mother expressed concern about the limited support her daughter was receiving at school and also requested a brain scan to investigate her poor memory. It was immediately apparent that the mother had poor cognitive function, with limited understanding about her daughter’s symptoms, capacities and needs. On physical examination the girl appeared generally healthy and non-dysmorphic. A large (approximately 8 × 10 cm), firm, non-tender mass was palpated in the lower central abdomen. On further questioning, neither the mother nor the girl were able to provide much information regarding the mass or how long it had been there. The mother thought it was due to constipation. An urgent ultrasound was arranged. The appearance was consistent with a complex ovarian teratoma. She was referred to the paediatric gynaecologists and underwent laparoscopic resection without complication. She recovered well from the operation and returned to the Behaviour Clinic for on-going care. Over recent decades, an increasing proportion of the casemix of paediatricians in Australia involves developmental, behavioural and mental health problems.1,2 Doctors provide skilled assessment and management of developmental and mental health problems in children, including referrals to other health, education and social service care providers. However, it is also incumbent upon doctors to take a full history and perform a physical examination to exclude any causative or unrelated medical condition. Many children have limited contact with medical professionals, and so it is important to perform a thorough medical evaluation when they are seen. In addition, preventive health care issues such as nutrition, exercise, minimising ‘screen time’ and immunisation should be discussed. This case illustrates the importance of taking the opportunity to ‘do the doctor thing’. This is particularly important when seeing families with low cognitive function or psychosocial disadvantage. Dr Doris Tham1 Dr Daryl Efron2,3,4 1 Paediatric Registrar, Centre for Community Child Health, 2 Paediatrician, The Royal Children’s Hospital, 3Senior Research Fellow, Murdoch Childrens Research Institute, and 4 Senior Lecturer, Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
References 1 Hewson PH, Anderson PK, Dinning AH et al. A 12 month profile of community paediatric consultations in Barwon region. J. Paediatr. Child Health 1999; 35: 16–23.
Conflict of interest: There is no conflict of interest connected to this paper.
932
2 Hiscock H, Roberts G, Efron D et al. Children Attending Paediatricians Study: a national prospective audit of outpatient practice from the Australian Paediatric Research Network. Med. J. Aust. 2011; 194: 392–7.
Dear Editor, ANTIBIOTIC PRESCRIBING IN THE PAEDIATRIC EMERGENCY DEPARTMENT AND THE IMPACT OF EDUCATION Increasing numbers of children in the UK are attending the emergency department (ED).1 Data on antibiotic prescribing in this setting are limited. We aim to describe antibiotic prescription in a busy UK paediatric ED and to assess the impact of a targeted educational programme on optimal antibiotic prescribing. We conducted a retrospective study of all children attending the ED for 2 weeks in November 2010 and 2 weeks in November 2011. A month before the beginning of the 2011 study, we provided an educational intervention on antibiotic prescribing for tonsillitis and otitis media for ED and paediatric junior trainees. This intervention had three components. First, we conducted interactive group tutorials with pre- and post-assessment of clinicians’ attitude to antibiotic prescribing. We also placed posters in the ED with a management flowchart based on the National Institute for Health and Care Excellence (NICE) guidelines for Respiratory Tract Infection (CG69 – http:// www.nice.org.uk). The third component of the intervention was the construction of an educational website (http:// www.antibioticsforkids.com) with information on the management of otitis media and tonsillitis. The participating doctors were not informed that the retrospective study would be carried out. Comparison was made with the results of the study in November 2010. This study was conducted as a service evaluation of current NICE guidance. Overall, 2141 children were seen, of whom 303 (14%) received antibiotics. The commonest diagnoses for which antibiotics were prescribed in both years are shown in Table 1. The three most frequently prescribed antibiotics were amoxicillin, amoxicillin/clavulanic acid and phenoxymethylpenicillin. Overall, fewer antibiotics were prescribed in the second year. After the educational intervention, reductions of antibiotic prescribing by 32% and 25% were observed for otitis media and tonsillitis, respectively (Table 1). This study shows that there is scope to change antibiotic prescribing patterns in the paediatric ED following an educational initiative, but larger studies are required to assess the true impact of such an educational tool. The use of a website for the purpose of antibiotic stewardship has been implemented in many institutions worldwide.2,3 Education needs to target the decision-making processes of physicians and engage interest to effectively reduce unnecessary antibiotic prescribing. There is also a need to determine the optimal methodology to maintain these outcomes within an antibiotic stewardship program in the paediatric ED.
Journal of Paediatrics and Child Health 50 (2014) 932–935 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Copyright of Journal of Paediatrics & Child Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
doi:10.1111/jpc.12751
Letters to the Editor Dear Editor, THE IMPORTANCE OF PHYSICAL EXAMINATION IN PATIENTS WITH MENTAL HEALTH PRESENTATIONS An 8-year-old girl was referred by her GP to the out-patient department for assessment of learning difficulties. She was triaged to the Behaviour Clinic. At the appointment, her mother expressed concern about the limited support her daughter was receiving at school and also requested a brain scan to investigate her poor memory. It was immediately apparent that the mother had poor cognitive function, with limited understanding about her daughter’s symptoms, capacities and needs. On physical examination the girl appeared generally healthy and non-dysmorphic. A large (approximately 8 × 10 cm), firm, non-tender mass was palpated in the lower central abdomen. On further questioning, neither the mother nor the girl were able to provide much information regarding the mass or how long it had been there. The mother thought it was due to constipation. An urgent ultrasound was arranged. The appearance was consistent with a complex ovarian teratoma. She was referred to the paediatric gynaecologists and underwent laparoscopic resection without complication. She recovered well from the operation and returned to the Behaviour Clinic for on-going care. Over recent decades, an increasing proportion of the casemix of paediatricians in Australia involves developmental, behavioural and mental health problems.1,2 Doctors provide skilled assessment and management of developmental and mental health problems in children, including referrals to other health, education and social service care providers. However, it is also incumbent upon doctors to take a full history and perform a physical examination to exclude any causative or unrelated medical condition. Many children have limited contact with medical professionals, and so it is important to perform a thorough medical evaluation when they are seen. In addition, preventive health care issues such as nutrition, exercise, minimising ‘screen time’ and immunisation should be discussed. This case illustrates the importance of taking the opportunity to ‘do the doctor thing’. This is particularly important when seeing families with low cognitive function or psychosocial disadvantage. Dr Doris Tham1 Dr Daryl Efron2,3,4 1 Paediatric Registrar, Centre for Community Child Health, 2 Paediatrician, The Royal Children’s Hospital, 3Senior Research Fellow, Murdoch Childrens Research Institute, and 4 Senior Lecturer, Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
References 1 Hewson PH, Anderson PK, Dinning AH et al. A 12 month profile of community paediatric consultations in Barwon region. J. Paediatr. Child Health 1999; 35: 16–23.
Conflict of interest: There is no conflict of interest connected to this paper.
932
2 Hiscock H, Roberts G, Efron D et al. Children Attending Paediatricians Study: a national prospective audit of outpatient practice from the Australian Paediatric Research Network. Med. J. Aust. 2011; 194: 392–7.
Dear Editor, ANTIBIOTIC PRESCRIBING IN THE PAEDIATRIC EMERGENCY DEPARTMENT AND THE IMPACT OF EDUCATION Increasing numbers of children in the UK are attending the emergency department (ED).1 Data on antibiotic prescribing in this setting are limited. We aim to describe antibiotic prescription in a busy UK paediatric ED and to assess the impact of a targeted educational programme on optimal antibiotic prescribing. We conducted a retrospective study of all children attending the ED for 2 weeks in November 2010 and 2 weeks in November 2011. A month before the beginning of the 2011 study, we provided an educational intervention on antibiotic prescribing for tonsillitis and otitis media for ED and paediatric junior trainees. This intervention had three components. First, we conducted interactive group tutorials with pre- and post-assessment of clinicians’ attitude to antibiotic prescribing. We also placed posters in the ED with a management flowchart based on the National Institute for Health and Care Excellence (NICE) guidelines for Respiratory Tract Infection (CG69 – http:// www.nice.org.uk). The third component of the intervention was the construction of an educational website (http:// www.antibioticsforkids.com) with information on the management of otitis media and tonsillitis. The participating doctors were not informed that the retrospective study would be carried out. Comparison was made with the results of the study in November 2010. This study was conducted as a service evaluation of current NICE guidance. Overall, 2141 children were seen, of whom 303 (14%) received antibiotics. The commonest diagnoses for which antibiotics were prescribed in both years are shown in Table 1. The three most frequently prescribed antibiotics were amoxicillin, amoxicillin/clavulanic acid and phenoxymethylpenicillin. Overall, fewer antibiotics were prescribed in the second year. After the educational intervention, reductions of antibiotic prescribing by 32% and 25% were observed for otitis media and tonsillitis, respectively (Table 1). This study shows that there is scope to change antibiotic prescribing patterns in the paediatric ED following an educational initiative, but larger studies are required to assess the true impact of such an educational tool. The use of a website for the purpose of antibiotic stewardship has been implemented in many institutions worldwide.2,3 Education needs to target the decision-making processes of physicians and engage interest to effectively reduce unnecessary antibiotic prescribing. There is also a need to determine the optimal methodology to maintain these outcomes within an antibiotic stewardship program in the paediatric ED.
Journal of Paediatrics and Child Health 50 (2014) 932–935 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Copyright of Journal of Paediatrics & Child Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
