(精选)Recent clinical guidelines relevant to paediatrics教学课件.pptVIP

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2018-03-21 发布于天津
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(精选)Recent clinical guidelines relevant to paediatrics教学课件.ppt

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Recent clinical guidelines relevant to paediatrics Dr Harry Baumer Consultant Paediatrician Derriford Hospital Why me? General paediatrician, Plymouth Previous chair RCPCH QPC ADC guideline reviews since 2003 Not involved in guideline development Not an expert in the subjects! No conflict of interest Choosing guidelines Rigorous evidence-based methodology Relevant to paediatricians Non-specialist’s perspective Important messages Likely otherwise to be overlooked Guideline review topics Sweat test for CF Post seizure management Human milk banks Arterial stroke in childhood Otitis media (UK US compared) Parapneumonic effusion/ empyema CFS/ME UTIs in young children Incomplete Kawasaki disease Glucocorticoids in croup Decreased consciousness Tuberculosis 2005 2004 2003 2006 Glucocorticoids in croup:key messages Based on Cochrane review (Russell et al updated 2004) Strong RCT evidence of benefit 51 comparisons, 2,878 patients in placebo controlled studies Settings: inpatient outpatient, mild to severe Outcomes: croup scores, other Rx, LOS, reattendance ↑ by 6 hours, ↓ reattendance/readmission/LOS/ Rx Most studies used dexamethasone Uncertainty about optimum dose (600 vs 150μg/kg) 600μg/kg dexamethasone single dose orally most studied recommended = ~ 5 days prednisolone for asthma Nebulised budesonide an alternative, not an add on Decreased consciousness Nottingham Paediatric AE research group Funded by Reye’s foundation Very broad scope Rigorous methodology Multiple literature searches Supported by Delphi consensus 134 recommendations, 20 Grade A or B Supported by detailed algorithm Not yet piloted Decreased consciousness:scope Children with non-traumatic coma Aged 18 years, not in neonatal unit GCS 15 (not due to chronic disability) Differential diagnosis Immediate investigations Initial management Key messages Core investigations undertaken together Acute management of metabolic conditions Initial management of intracranial infections Contraindications to lumbar