Things We Like This Month – December 2019

Another month rolls by, and the temperatures have started to fall. I don’t know about anywhere else, but here in Norwich, we are still uneasily waiting with baited breath for the bronchiolitic wave to crash ashore…

Whilst we dust off the high flow, rummage through the NG tubes and lock away the salbutamol in a top cupboard, why not take a second with a cup of something hot, and take a peek at the things we like this month, our round-up of our favourite things from the internet world of #teampaeds

Journal Articles we like

Fifteen Minute Consultations: Vaccine-hesitant parents

Infectious diseases makes up a large portion of paediatric acute admissions, and we are exceptionally lucky to live in an age where devastating bacterial infections are now rarely seen on the children’s assessment unit. There can be no denying the impact that vaccinations have had on massively reducing the number of these infections we will see on that paediatric unit. Unfortunately, in the age of social media, alongside historically concerns borne out of the Andrew Wakefield scandal, we are seeing a large resurgence in parents hesitant to vaccinate their children, and the effect on dropping herd immunity is now being felt across the world, with a resurgence of measles causing large numbers of cases, recently causing 50 deaths and rising in Samoa. We have a public health duty to our patients to open the conversation with vaccine-hesitant parents, and this excellent article gives a great framework for initiating this possibly difficult conversation.

Penicillin V: 5 days vs 10 days in acute bacterial tonsillitis

Here at Norwich PEM will make no excuses for being extraordinarily boring about antibiotics and antimicrobial resistance. An emerging trend in infectious diseases literature is promoting the idea that #ShorterIsBetter – breaking down the dogma that long courses of antibiotics are required for common infections. Non-inferiority has been shown for short courses of antibiotics for CAP, septic arthritis, gram-negative bacteraemia, and pyelonephritis, to name but a few.

Here, adding weight to the argument is a Swedish paper which looked at patients >6 years old with CENTOR 3-4 and a positive rapid strep throat test, randomised into either a 5 day course of Pen V or a 10 day course of Pen V. They found that time to clinical cure was non-inferior with a 5 day course rather than a 10 day course. So, shorter is better, right? 5 days for everyone?

My important take home from this paper was that Shorter Is Better…when your patients actually need antibiotics. The vast majority of patients that we see in paediatrics with acute sore throat are under the age of 3, which is almost always caused by viruses, and antibiotics have been repeatedly shown to have negligible effects in symptom time reduction, and no tangible effect in complication reduction (see here, here, and here for references). So, Shorter Is Better, and what could be shorter than 0 days of antibiotics?

#FOAMed we like

Nikki Abela for RCEM Learning – Assessing (de)Hydration in Children

We were brought back to this excellent RCEM Learning post following Nikki’s talk at DFTB19, which we were lucky enough to attend. Dehydration is a key concern for an enormous number of children and parents that attend our hospitals, and assessing hydration status is a key part of our job at the front line. In this post, Niki breaks down the evidence for the tools that are in our arsenal for assessing dehydration, and looks at the evidence-based approach to rationalise what we do unconsciously every day.

For those with an aural inclination, here is Nikki giving her talk at DFTB19

Cards Against Paediatric Dermatology – EM3

Isn’t it funny how long we spent learning the classification of rashes in medical school, and yet every rash you speak to a dermatologist about happens to be maculopapular? Well, if your dermatology knowledge needs a little refresh, why not get some friends together and play Cards Against Paediatric Dermatology, an excellent game from our friends at EM3.

Podcasts we like

Nephrotic Syndrome – Dragon Bytes

Dragon Bytes is a fantastic new podcast series from Wales. Launched in September, these short “commute sized” podcasts are a fantastic learning device, and have shot up to the top of our favourite audible car treats. In this episode, Dr Stacey Harris talks to Dr Raj Krishnan, consultant nephrologist at UHW, Cardiff on nephrotic syndrome, including top tips on examination, management, complications, and when to consider biopsy.