Staff experiences of wearing the Rainbow Badge in a paediatric hospital setting: a mixed-methods survey.

OBJECTIVE: This study aimed to assess staff's experience of wearing the Health Service Executive (HSE) Rainbow Badge, a symbol of inclusion for LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning; + signifying inclusivity of all sexual and gender identities) people, in a paediatric hospital setting. DESIGN: This was a cross-sectional multisite observational study. Participants completed an anonymous online survey, consisting of open and closed-ended questions covering domains of: responses to the badge from staff and patients; experience and impact of wearing the badge; and further training needs. SETTING: All five sites (four clinical and one non-clinical) pertaining to the Children's Health Ireland healthcare group. PARTICIPANTS: All staff, clinical and non-clinical, who had signed up the HSE Rainbow Badge initiative were eligible to participate. RESULTS: A total of 151 eligible participants across a mix of disciplines participated, 29 (19.2%) of whom were members of the LGBTQ+ community. Over half (58.9%, n=89) of respondents said they learnt something new about barriers to care for LGBTQ+ young people from the initiative. Staff reported mostly positive responses to the badge; 5.1% reported mixed/negative responses from colleagues, 4.5% reported mixed/negative responses from young people and 3.7% reported mixed/negative responses from families. Open-ended questions were analysed using a thematic analysis framework. Five themes emerged: pride, a symbol of safety and inclusion, impact on workplace culture, awareness of LGBTQ+ issues and more to do for LGBTQ+ patients. CONCLUSIONS: This study demonstrates that the Rainbow Badge initiative increases staff awareness of LGBTQ+ issues and helps to create a safe, inclusive environment for staff, young people and families.

Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review.

Antibiotics are one of the most prescribed medications in pediatric emergency departments. Antimicrobial stewardship programs assist in the reduction of antibiotic use in pediatric patients. However, the establishment of antimicrobial stewardship programs in pediatric EDs remains challenging. Recent studies provide evidence that common infectious diseases treated in the pediatric ED, including acute otitis media, tonsillitis, community-acquired pneumonia, preseptal cellulitis, and urinary-tract infections, can be treated with shorter antibiotic courses. Moreover, there is still controversy regarding the actual need for antibiotic treatment and the optimal dosing scheme for each infection.

Learnings From a National Cyberattack Digital Disaster During the SARS-CoV-2 Pandemic in a Pediatric Emergency Medicine Department.

OBJECTIVE: The primary objective was to analyze the impact of the national cyberattack in May 2021 on patient flow and data quality in the Paediatric Emergency Department (ED), amid the SARS-CoV-2 (COVID-19) pandemic. METHODS: A single site retrospective time series analysis was conducted of three 6-week periods: before, during, and after the cyberattack outage. Initial emergent workflows are described. Analysis includes diagnoses, demographic context, key performance indicators, and the gradual return of information technology capability on ED performance. Data quality was compared using 10 data quality dimensions. RESULTS: Patient visits totaled 13 390. During the system outage, patient experience times decreased significantly, from a median of 188 minutes (pre-cyberattack) down to 166 minutes, most notable for the period from registration to triage, and from clinician review to discharge (excluding admitted patients). Following system restoration, most timings increased. Data quality was significantly impacted, with data imperfections noted in 19.7% of data recorded during the system outage compared to 4.7% before and 5.1% after. CONCLUSIONS: There was a reduction in patient experience time, but data quality suffered greatly. A hospital's major emergency plan should include provisions for digital disasters that address essential data requirements and quality as well as maintaining patient flow.

Staff competence in caring for LGBTQ+ patients in the paediatric emergency department.

OBJECTIVE: This study aimed to assess the competency of paediatric emergency department (PED) multidisciplinary staff in caring for LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, + inclusive of all identities) adolescents. DESIGN: This was an observational study within which participants were required to complete the LGBT-Development of Clinical Skills Scale self-assessment tool of clinical competence. SETTING: It was conducted across three PEDs and one urgent care centre pertaining to the Children's Health Ireland healthcare group. PARTICIPANTS: Doctors, nurses and healthcare workers were eligible to participate. EXCLUSION CRITERIA: non-front facing staff; prior completion of an eLearning module intended to serve as a future educational intervention. MAIN OUTCOME MEASURES: Participants were assessed on: (1) attitudinal awareness towards LGBTQ+ individuals; (2) knowledge of LGBTQ+ health issues and (3) clinical preparedness in caring for LGBTQ+ patients. Each domain is scored out of a maximum of 7 points. RESULTS: 71 eligible participants completed the study. 40/71 (56%) were doctors, and 31/71 (44%) were nurses. The mean score for attitudinal awareness was 6.54/7 (SD 0.59), indicating overall positive attitudes. The mean score for knowledge was lower (5.34/7, SD 1.03) and lowest for clinical preparedness (3.39/7, SD 0.94). Participants were less confident in caring for transgender than LGB patients and scored very low when asked if they had received adequate training in caring for transgender young people (2.11/7). CONCLUSIONS: This study demonstrates positive attitudes towards LGBTQ+ patients among PED staff. However, there was a gap in knowledge and clinical preparedness. Increased training in caring for LGBTQ+ young people is necessary.

Fifteen-minute consultation: Diagnosing serious pathology in children with headaches presenting to the emergency department.

Headache is one of the most common presentations to the paediatric emergency department. Although challenging, it is important to differentiate serious secondary headaches requiring emergency treatment from primary headache disorders. A detailed history and neurological examination can be used to identify children at higher risk of serious underlying pathology. Neuroimaging decisions should be taken carefully, weighing risk versus benefit in each case. This article will discuss five patient scenarios highlighting red flags and differential diagnoses in children presenting with headache in the emergency department.

It is not Black and White: A spotlight on racial diversity in paediatrics.

Now more than ever, there is a recognition that the existing racial inequality within healthcare systems around the world must be addressed. Preserving this momentum is vital and every profession and specialty must be held accountable for their own shortcomings. In this article, we place a spotlight on the paediatric medical workforce. We explore key areas of concern including differential attainment and the under-representation of paediatricians from minoritised ethnic groups in leadership roles. We use the recent measures adopted by the Royal College of Paediatrics and Child Health in the United Kingdom as a framework for achieving inclusive work environments and equitable opportunities for all paediatricians.

Fifteen-minute consultation: Guide to the young person with menorrhagia and dysmenorrhoea.

Adolescents who menstruate commonly present to acute paediatric services.

Fifteen-minute consultation: The approach to the febrile child.

Febrile children presenting to the emergency department pose unique challenges. This article highlights the importance of identifying children at particular risk of serious bacterial infection (SBI) using risk factors, red flags and appropriate investigations. Emergency clinicians must be aware of the risk factors for SBI in febrile children, including young age, ill-appearing children and those with complex comorbidities or immunodeficiency. The presence of red flags in febrile children should immediately alert concern and prompt senior clinician review. This article also discusses the appropriate use of investigations and their role in complementing clinical assessment. When discharging children home after emergency department assessment, safety netting should be undertaken to ensure parents are aware when to seek further medical opinion. The presence of a prolonged fever of 5 days or longer should alert suspicion and usually requires further investigation.

Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial.

Importance: The optimal dose and duration of oral amoxicillin for children with community-acquired pneumonia (CAP) are unclear. Objective: To determine whether lower-dose amoxicillin is noninferior to higher dose and whether 3-day treatment is noninferior to 7 days. Design, Setting, and Participants: Multicenter, randomized, 2 × 2 factorial noninferiority trial enrolling 824 children, aged 6 months and older, with clinically diagnosed CAP, treated with amoxicillin on discharge from emergency departments and inpatient wards of 28 hospitals in the UK and 1 in Ireland between February 2017 and April 2019, with last trial visit on May 21, 2019. Interventions: Children were randomized 1:1 to receive oral amoxicillin at a lower dose (35-50 mg/kg/d; n = 410) or higher dose (70-90 mg/kg/d; n = 404), for a shorter duration (3 days; n = 413) or a longer duration (7 days; n = 401). Main Outcomes and Measures: The primary outcome was clinically indicated antibiotic re-treatment for respiratory infection within 28 days after randomization. The noninferiority margin was 8%. Secondary outcomes included severity/duration of 9 parent-reported CAP symptoms, 3 antibiotic-related adverse events, and phenotypic resistance in colonizing Streptococcus pneumoniae isolates. Results: Of 824 participants randomized into 1 of the 4 groups, 814 received at least 1 dose of trial medication (median [IQR] age, 2.5 years [1.6-2.7]; 421 [52%] males and 393 [48%] females), and the primary outcome was available for 789 (97%). For lower vs higher dose, the primary outcome occurred in 12.6% with lower dose vs 12.4% with higher dose (difference, 0.2% [1-sided 95% CI -∞ to 4.0%]), and in 12.5% with 3-day treatment vs 12.5% with 7-day treatment (difference, 0.1% [1-sided 95% CI -∞ to 3.9]). Both groups demonstrated noninferiority with no significant interaction between dose and duration (P = .63). Of the 14 prespecified secondary end points, the only significant differences were 3-day vs 7-day treatment for cough duration (median 12 days vs 10 days; hazard ratio [HR], 1.2 [95% CI, 1.0 to 1.4]; P = .04) and sleep disturbed by cough (median, 4 days vs 4 days; HR, 1.2 [95% CI, 1.0 to 1.4]; P = .03). Among the subgroup of children with severe CAP, the primary end point occurred in 17.3% of lower-dose recipients vs 13.5% of higher-dose recipients (difference, 3.8% [1-sided 95% CI, -∞ to10%]; P value for interaction = .18) and in 16.0% with 3-day treatment vs 14.8% with 7-day treatment (difference, 1.2% [1-sided 95% CI, -∞ to 7.4%]; P value for interaction = .73). Conclusions and Relevance: Among children with CAP discharged from an emergency department or hospital ward (within 48 hours), lower-dose outpatient oral amoxicillin was noninferior to higher dose, and 3-day duration was noninferior to 7 days, with regard to need for antibiotic re-treatment. However, disease severity, treatment setting, prior antibiotics received, and acceptability of the noninferiority margin require consideration when interpreting the findings. Trial Registration: ISRCTN Identifier: ISRCTN76888927.

Women and children first? Gender equity in paediatric medicine.

There has been an increased focus on diversity and inclusion in medicine in recent years-the field of medicine still has a long way to go to reach gender equity. We assess how paediatrics is performing by examining the role gender plays in our specialty; and we propose some practical solutions to reach an equitable state. Achieving gender equity is not a simple or easy option and will require an ongoing commitment from all facets of the profession.

BET 2: Antiemetic use in paediatric sedation with ketamine.

A short cut review was carried out to see if administering anti-emetics reduced the incidence of vomiting when sedating children for procedures. The author, date and country of publication, patient group studied, study type, relevant outcomes, results study weaknesses of these papers are tabulated. Three randomised, controlled trials were found and one cohort study. The studies suggested that administration of an anti-emetic was associated with a reduced risk of vomiting during the procedural sedation.