Patient reported outcomes for preschool children with recurrent wheeze.

Children with preschool wheeze regularly attend UK emergency departments. There is no international consensus on any specific personalised management approach. This paper describes the first attempt to co-design patient-centred outcomes with families.

Understanding case mix across three paediatric services: could integration of primary and secondary general paediatrics alter walk-in emergency attendances?

Objective: To understand the case mix of three different paediatric services, reasons for using an acute paediatric service in a region of developing integrated care and where acute attendances could alternatively have been managed.

Methods: Mixed methods service evaluation, including retrospective review of referrals to general paediatric outpatients (n=534) and a virtual integrated service (email advice line) (n=474), as well as a prospective survey of paediatric ambulatory unit (PAU) attendees (n=95) and review by a paediatric consultant/registrar to decide where these cases could alternatively have been managed.

Results: The case mix of outpatient referrals and the email advice line was similar, but the case mix for PAU was more acute.

Diagnostic omission errors in acute paediatric practice: impact of a reminder system on decision-making.

Background: Diagnostic error is a significant problem in specialities characterised by diagnostic uncertainty such as primary care, emergency medicine and paediatrics. Despite wide-spread availability, computerised aids have not been shown to significantly improve diagnostic decision-making in a real world environment, mainly due to the need for prolonged system consultation. In this study performed in the clinical environment, we used a Web-based diagnostic reminder system that provided rapid advice with free text data entry to examine its impact on clinicians' decisions in an acute paediatric setting during assessments characterised by diagnostic uncertainty.

Chalk and cheese: symptomatic hypocalcaemia during paediatric anti-tuberculous therapy.

Standard anti-tuberculosis therapy may disrupt normal vitamin D metabolism and consequently calcium homeostasis, but this is previously unreported in paediatric patients. We describe two children developed symptomatic hypocalcaemia secondary to hypovitaminosis D, which had been precipitated by rifampicin and isoniazid. The complex relationship between tuberculosis, anti-tuberculosis therapy, vitamin D metabolism and calcium, together with the clinical implications, are discussed.

Measuring the impact of diagnostic decision support on the quality of clinical decision making: development of a reliable and valid composite score.

Objective: Few previous studies evaluating the benefits of diagnostic decision support systems have simultaneously measured changes in diagnostic quality and clinical management prompted by use of the system. This report describes a reliable and valid scoring technique to measure the quality of clinical decision plans in an acute medical setting, where diagnostic decision support tools might prove most useful.

Design: Sets of differential diagnoses and clinical management plans generated by 71 clinicians for six simulated cases, before and after decision support from a Web-based pediatric differential diagnostic tool (ISABEL), were used.