Detection of child abuse Arch Dis Child 2011; 96: 422-5
This study compared the detection rates of child abuse in children attending emergency departments in Holland that did or did not comply with screening guidelines.
The child abuse could be physical, sexual or mental. Nurses typically performed screening and if one screening question was positive, the doctor was alerted.
Overall, 36 per cent of children were screened in those hospitals considered to be complying with guidelines compared with 0.4 per cent in those that were not.
A suspicion of child abuse arose in 0.2 per cent of all attendees, with the average age being 3.9 years. Most were cases of physical abuse and fractures were the most common diagnosis. There were significantly more children suspected of being a victim of child abuse in those departments that screened compared with those that did not (0.3 per cent vs. 0.1 per cent, p<0.001).
While rates were low, these results do show that systematic screening as a policy does increase suspicion rates.
Markers for bacterial infection in children Arch Dis Child 2011; 96: 440-6
A child with a fever but no discernable cause is a common presentation. Often it is due to a viral infection but it can be difficult to tell if it is a serious bacterial infection.
This Canadian study compared clinical assessment with the following markers of bacterial infection: neutrophil count, white cell count, CRP and procalcitonin. The children also had an MSU and blood cultures to make a microbiological definitive diagnosis.
Of the 54 children diagnosed with a serious bacterial infection (16 per cent of all the children in the study) there were 48 UTIs, four pneumonias, one meningitis and one bacteraemia.
The researchers found all the surrogate blood test markers were similarly effective, and all much better than clinical assessment when it came to spotting a serious bacterial infection.
Teenage pregnancies that end in abortion and contraceptive risk taking
J Fam Plann Reprod Health Care 2011; 37: 97-102
The ambitious government target set in 1999 to halve teenage pregnancies by 2010 has failed. While much media attention is given to teenage pregnancy, less is given to the 50 per cent of unwanted teenage conceptions that end in abortion. This London-based qualitative study examined teenage behaviour through interviews.
Key factors were difficulties with user-dependent methods, such as erratic pill taking and condom use; lack of control over sexual encounters, sex involving drunkenness, coercion and lack of contraceptive preparation and chaotic lifestyles.
This paper highlights the need for service providers to understand the lifestyle difficulties faced by young women and the implications these have on the use of effective contraception. Providing a full range of easily accessible services, including emergency contraception, is important. Time for sexual health consultations is crucial in order to cover STI risk, safe sex, relationship issues and the understanding of young women's own bodies and fertility.
Prostate cancer screening and mortality BMJ 2011; 342: d1539
Screening for prostate cancer is repeatedly being debated, after all prostate cancer is a significant illness and there is a test, PSA. So far, short-term trials have not been promising, but long-term data have been lacking.
This study followed up patients who had been screened in Sweden starting in 1987, 20 years down the line. The subjects were picked at random, were aged between 50 and 69 years and screened every third year. The first two screens were done by digital examination, to which PSA was added in 1993.
Of the screening group, 5.7 per cent were diagnosed with prostate cancer compared with 3.9 per cent of the control group, but there was no significant difference in death from prostate cancer between the two groups.
With the discomfort of biopsies, the psychological effects of being given a cancer diagnosis and the hazards associated with treatment, this study indicates that there is no argument for screening at present.
Radial access for coronary angiography Lancet 2011; 377: 1409-20
Percutaneous angiography is becoming more and more common, with hospitals geared up for angiography acutely following MIs. This is done via the femoral route, which, while being undeniably effective, can lead to local vascular problems at the site of insertion.
This study compared the usual femoral route with gaining access via the radial artery. Patients with acute coronary syndrome were assigned to coronary intervention by either the radial or femoral approach.
Patients were assessed at 30 days for major non-CABG bleeding, death, MI, stroke and a composite of all of these outcomes. More than 7,000 patients were enrolled.
The composite of outcomes occurred in 3.7 per cent of the radial group and 4 per cent of the femoral group. There were significantly less large haematomas and pseudoaneurysms in the radial group.
Overall, both approaches were effective but the radial group experienced less local problems. Perhaps in 10 years' time the femoral route will be part of the history of medicine.
- Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team who regularly review the journals.
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