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Gill P.J.,University of Oxford | Goldacre M.J.,University of Oxford | Mant D.,University of Oxford | Heneghan C.,University of Oxford | And 3 more authors.
Archives of Disease in Childhood | Year: 2013

Objective To investigate a reported rise in the emergency hospital admission of children in England for conditions usually managed in the community. Setting and design Population-based study of hospital admission rates for children aged under 15, based on analysis of Hospital Episode Statistics and population estimates for England, 1999-2010. Main outcome Trends in rates of emergency admission to hospital. Results The emergency admission rate for children aged under 15 in England has increased by 28% in the past decade, from 63 per 1000 population in 1999 to 81 per 1000 in 2010. A persistent year-on-year increase is apparent from 2003 onwards. A small decline in the rates of admissions lasting 1 day or more has been offset by a twofold increase in short-term admissions of <1 day. Considering the specific conditions where high emergency admission rates are thought to be inversely related to primary care quality, admission rates for upper respiratory tract infections rose by 22%, lower respiratory tract infections by 40%, urinary tract infections by 43% and gastroenteritis by 31%, while admission rates for chronic conditions fell by 5.6%. Conclusions The continuing increase in very-short-term admission of children with common infections suggests a systematic failure, both in primary care (by general practice, out-of-hours care and National Health Service Direct) and in hospital (by emergency departments and paediatricians), in the assessment of children with acute illness that could be managed in the community. Solving the problem is likely to require restructuring of the way acute paediatric care is delivered. Source


Lakhoo K.,Oxford Childrens Hospital | Msuya D.,Kilimanjaro Christian Medical Center
African Journal of Paediatric Surgery | Year: 2015

Background: To emphasise the value of on-going commitment in Global Health Partnerships. Materials and Methods: A hospital link, by invitation, was set up between United Kingdom and Tanzania since 2002. The project involved annual visits with activities ranging from exchange of skill to training health professionals. Furthermore, the programme attracted teaching and research activities. For continuity, there was electronic communication between visits. Results: Six paediatric surgeons are now fully trained with three further in training in Africa. Paediatric surgery services are now separate from adult services. Seven trainee exchanges have taken place with four awarded fellowships/scholarships. Twenty-three clinical projects have been presented internationally resulting in eight international publications. The programme has attracted other health professionals, especially nursing and engineering. The Tropical Health and Education Trust prize was recently achieved for nursing and radiography. National Health Service has benefited from volunteering staff bringing new cost-effective ideas. A fully funded medical student elective programme has been achieved since 2008. Conclusion: Global Health Partnerships are an excellent initiative in establishing specialist services in countries with limited resources. In the future, this will translate into improved patient care as long as it is sustained and valued by long term commitment. Source


Pike M.,Oxford Childrens Hospital
Handbook of Clinical Neurology | Year: 2013

Opsoclonus-myoclonus syndrome is a very rare disorder with onset usually in the second year of life, and the clinical features of opsoclonus, myoclonus, ataxia, irritability, sleep disturbance, and, often but by no means invariably, an associated neuroblastoma. There is no diagnostic test; brain imaging is normal and other investigations produce nonspecific results; the diagnosis is clinical and the condition is not infrequently mistaken for acute cerebellar ataxia. The pathophysiology is thought to be immunological on the basis of the paraneoplasticity and the symptomatic (though often incomplete) response to immunomodulatory therapies; a number of autoantibodies have been identified to a variety of antigens and cerebrospinal fluid B-cell numbers found to be increased but no diagnostic immunological marker has yet been identified. Therapeutic benefit has been described with steroids, intravenous immunoglobulin, cyclophosphamide, azathioprine, and rituximab, but randomized trials are extremely difficult because of the rarity of the condition. Successful treatment of the tumor, when present, does not usually improve neurological outcome. Disease course may be monophasic or chronic relapsing and children are often left with long-term motor, behavioral, and cognitive sequelae. © 2013 Elsevier B.V. Source


Lokulo-Sodipe K.,University of Southampton | Moon R.J.,University of Southampton | Edge J.A.,Oxford Childrens Hospital | Davies J.H.,University of Southampton
Archives of Disease in Childhood | Year: 2014

Background: Diabetic ketoacidosis (DKA) is the leading cause of mortality in childhood diabetes, and at diagnosis might represent delayed presentation. The extent and reasons for delays are unclear, but identifying and targeting factors associated with DKA could reduce this incidence. Objective: To compare the patient pathway before diagnosis of type 1 diabetes mellitus (T1DM) in children presenting with DKA and non-acidotic hyperglycaemia. Design, setting and patients: Over a 3-month period, children newly diagnosed with T1DM were identified on admission to UK hospitals. Parents and medical teams completed a questionnaire about events before diagnosis. Results: Data were available for 261 children (54% male), median age 10.3y (range 0.8-16.6 y). 25% presented with DKA, but more commonly in children <2y (80% vs 23%, p<0.001). Fewer children with DKA reported polyuria (76% vs 86%) or polydipsia (86% vs 94%) (both p<0.05), but more reported fatigue (74% vs 52%) and weight loss (75% vs 54%) (both p<0.01). 24% of children had multiple healthcare professional (HCP) contacts, and these children had lower pH on admission. 46% of children with a delayed presentation to secondary care had non-urgent investigations. 64% of parents had considered a diagnosis of diabetes, and these children were less likely to present with DKA (13% vs 47%, p<0.001). Conclusions: Multiple HCP contacts increased risk of presentation in DKA, whereas, parental awareness of diabetes was protective. Improved public and health professional education targeting non-classical symptoms, awareness of diabetes in under 2 y, and point-of-care testing could reduce DKA at diagnosis of diabetes. Source


Edge J.A.,Oxford Childrens Hospital | James T.,John Radcliffe Hospital | Shine B.,John Radcliffe Hospital
Diabetic Medicine | Year: 2010

Introduction There is some evidence of long-term tracking of HbA1c levels within diabetes centres, but little evidence of individual tracking.Methods HbA1c levels of children in the clinic over a period of 15-years were retrieved from the clinical chemistry laboratory information system. We measured the correlation of HbA1c between years (Spearman and Pearson rank correlation), as well as the relationship of HbA1c with age and the change over time in the clinic.Results Data were collected from 362 children and young people [158 female (44%)], aged 0-18-years (median 10.4-years), with 0-13.6-years of follow-up (median 4.7-years). Mean HbA1c levels fell from 9.3-±-1.5% (78-±-16 mmol/mol) in 2001 to 8.1-±-1.3% (65-±-14 mmol/mol) in 2009 in those at least 6-months after diagnosis (P-<-0.0001). HbA1c levels gradually rise with increasing age. HbA1c levels from year to year are significantly correlated. This is better for adjacent than subsequent years, but there is a significant correlation up to 9-years from diagnosis. Only 4 of 49 children with a 6-month HbA1c level of 9% (75-mmol/mol) or more had a long-term (2-5-years) median HbA1c <-8% (64-mmol/mol).Conclusions HbA1c levels track in individuals within an improvement in overall clinic levels, suggesting that, if optimal control can be achieved in the first 6-months, it can persist for up to 9-years. © 2010 The Authors. Diabetic Medicine © 2010 Diabetes UK. Source

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