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Roland D.,University of Leicester | Oliver A.,Childrens Hospital for Wales | Edwards E.D.,Singleton Hospital | Mason B.W.,University of Cardiff | Powell C.V.E.,University of Cardiff
Archives of Disease in Childhood | Year: 2014

Objective: To determine the use of paediatric early warning systems (PEWS) and rapid response teams (RRTs) in paediatric units in Great Britain. Design: Cross sectional survey. Setting: All hospitals with inpatient paediatric services in Great Britain. Outcome measures: Proportion of units using PEWS, origin of PEWS used, criterion included in PEWS, proportion of units with an RRT and membership of RRT. Results: The response rate was 95% (149/157). 85% of units were using PEWS and 18% had an RRT in place. Tertiary units were more likely than district general hospital to have implemented PEWS, 90% versus 83%, and an RRT, 52% versus 10%. A large number of PEWS were in use, the majority of which were unpublished and unvalidated systems. Conclusions: Despite the inconclusive evidence of effectiveness, the use of PEWS has increased since 2005. The implementation has been inconsistent with large variation in the PEWS used, the activation criteria used, availability of an RRT and the membership of the RRT. There must be a coordinated national evaluation of the implementation, impact and effectiveness of a standardised PEWS programme in the various environments where acutely sick children are managed.


Doull I.,Childrens Hospital for Wales
Paediatric Respiratory Reviews | Year: 2014

Studies published in the last year have highlighted the need for age and disease severity appropriate outcome measures. There is conflicting evidence on the usefulness of CT scans in infancy, but increasingly lung clearance index (LCI) appears a sensitive and repeatable measure in those with milder CF lung disease. The number of well designed appropriately powered intervention studies continues to increase. © 2014 Elsevier Ltd.


Nagakumar P.,Childrens Hospital for Wales
Paediatric Respiratory Reviews | Year: 2013

Cystic fibrosis (CF) patients may require frequent courses of antibiotics and repeated hospital admissions. Although children with CF have high carriage rate for C.difficile, they rarely develop colitis. Pseudomembranous colitis is more common in adult post lung transplant CF patients. Although rare, paseudomembranous colitis should be considered in CF patients presenting with abdominal symptoms even in the absence of diarrhoea. © 2013 Elsevier Ltd.


Fraser L.K.,University of Leeds | Miller M.,Martin House Childrens Hospice | Hain R.,Childrens Hospital for Wales | Norman P.,University of Leeds | And 3 more authors.
Pediatrics | Year: 2012

BACKGROUND: Life-limiting conditions (LLCs) describe diseases with no reasonable hope of cure that will ultimately be fatal. For children with these diseases, palliative care services should be available but few data are available to estimate the burden of these conditions. METHODS: Children (0-19 years) with LLCs were identified within an English Hospital Episode Statistics dataset (2000/2001-2009/2010) by applying a customized coding framework of the International Classification of Diseases, 10th Revision, disease codes. Prevalence per 10 000 population (0-19 years) was calculated by age, diagnostic group, ethnicity, deprivation, and region for each year. RESULTS: The Hospital Episode Statistics extract contained 175 286 individuals with 1 or more LLCs of which congenital anomalies were the most common (31%). Prevalence increased over 10 years from 25 to 32 per 10 000 population. Prevalence in the South Asian (48 per 10 000); black (42 per 10 000); and Chinese, mixed, and "other" (31 per 10 000) populations were statistically significantly higher compared with the white population (27 per 10 000). Prevalence shows an inverse J-shaped relationship with 5 categories of deprivation, with the highest prevalence in the most deprived areas and the lowest in the second least deprived. CONCLUSIONS: In 2010, the prevalence of LLCs in children in England was double the previously reported estimates and had increased annually in all areas over the past decade. This clearly identifies an escalating need for specialist pediatric palliative care services. When planning services for these increasing needs, the excess prevalence in ethnic minority groups, especially in deprived areas, needs to be considered. Copyright © 2012 by the American Academy of Pediatrics.


Temming P.,Great Ormond Street Hospital | Jenney M.E.M.,Childrens Hospital for Wales
Archives of Disease in Childhood | Year: 2010

The overall survival of childhood leukaemia has increased dramatically over recent decades. With the increasing number of survivors, chemotherapy protocols are designed not only to improve cure rates but also to minimise long-term sequelae. Central-nervous-system-directed therapy given as intrathecal chemotherapy and/or cranial irradiation plays a crucial part in acute leukaemia treatment but can also result in adverse effects on the developing brain. The elimination of cranial irradiation from current treatment protocols has improved the neurocognitive outcome without compromising survival rates. Although neurodevelopmental long-term sequelae after chemotherapy-only central-nervous-system-directed therapies may be more subtle, survivors of childhood leukaemia will continue to require methodical follow-up and appropriate rehabilitation.

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