Managing magnets: An audit of introduction of the Royal College of Emergency Medicine Best Practice Guideline.

AIM: To evaluate management of children and young people presenting to the Emergency Department (ED) with magnet ingestion before and after new guidance. METHODS: In May 2021, a National Patient Safety Agency and Royal College of Emergency Medicine (RCEM) Best Practice Guideline about management of ingested magnets was published. This was implemented in our department. Children and young people presenting after magnet ingestion were identified from SNOMED (coded routinely collected data) and X-ray requests between January 2016 and March 2022. Management was compared to national guidance. RESULTS: There were 138 patient episodes of magnet ingestion, with a rising incidence over the 5-year period. Following introduction of the guideline, there was a higher incidence of admission (36% vs. 20%) and operative intervention (15.7% vs. 8%). Use of follow-up X-ray increased from 56% to 90%. There was substantial variation in the management prior to guidance which reduced after introduction of the RCEM guidance. CONCLUSION: Management of magnet ingestion has become more standardised since introduction of the National RCEM Best Practice Guideline, but there is still room for improvement.

Gene-environment interactions in asthma.

The underlying pathogenesis of asthma, one of the most common chronic diseases of childhood, is not fully understood. There is a well-documented heritable component to this disease and environmental factors associated with a Westernised lifestyle have also been implicated; recent studies suggest gene-environment interactions are important in the development of this disease. In the absence of a previous review in children, the present report presents the accumulating evidence for gene-environment interactions in asthma pathogenesis. Studies of these interactions in different populations have yielded both expected and unexpected results. This is a new and rapidly developing field where there are currently many more questions than answers.