Peer review in child protection

Safeguarding children work is complex and challenging. Peer review provides a forum for paediatricians to discuss child protection cases to ensure the management of the child meets accepted standards of practice. The process involves retrospective review of cases, photo documentation, the medical report and multiagency working. It provides a culture of learning, professional development and support, with an opportunity to discuss cases in a suitable environment and to debrief following difficult cases.Clinical governance frameworks identify the importance of peer review and clinical supervision: there are increasing expectations that Health Trusts/Boards will have to provide data on attendance for external review. Both clinical supervision and peer review are forms of reflective practice and developmental activities that give practitioners the opportunity to learn from their experience and develop their expertise within clinical practice.Child protection peer review meetings with clear terms of reference should be set up in all health organisations employing paediatricians working in child protection. All paediatricians should be able to access and attend child protection peer review, supervision and support which should be identified in their job plans. Peer review is recognised as Continual Professional Development.Following discussion any change in opinion is the lead consultant's responsibility. It must be clear that peer review supports the responsible paediatrician in reaching a conclusion and does not provide a formal second opinion to be used in court.Peer review has a role to play in maintaining public and court confidence. It is the paediatrician's attendance at peer review that provides assurance to court that standards are being met, not that the specific case has been peer reviewed. Clinicians who don't attend are at risk of being perceived as maverick.     

Easy guide to conducting a systematic review

A systematic review is a type of study that synthesises research that has been conducted on a particular topic. Systematic reviews are considered to provide the highest level of evidence on the hierarchy of evidence pyramid. Systematic reviews are conducted following rigorous research methodology. To minimise bias, systematic reviews utilise a predefined search strategy to identify and appraise all available published literature on a specific topic. The meticulous nature of the systematic review research methodology differentiates a systematic review from a narrative review (literature review or authoritative review). This paper provides a brief step by step summary of how to conduct a systematic review, which may be of interest for clinicians and researchers.     

Peer review and its ethical implications

Peer review is an essential tool for institutions and providers to meet the modern goals of safety and quality in health care. It is a mechanism that leads to a just culture within a health care institution whereby errors and complications are considered products of the system rather than isolated actions by an individual. The benefits and potential drawbacks of peer review are outlined in this review with a special emphasis on the interface between peer review and principles of medical ethics. It is argued that peer review, in the ideal setting, is founded upon the principles of beneficence and justice, and to varying levels on non-maleficence and autonomy.     

Learning with digital recording and video review of delivery room resuscitation

Digital recording and video review of delivery room resuscitations is a proven useful tool to evaluate neonatal resuscitation program (NRP) technical and non-technical skills. It is also valuable for research, quality improvement, and individual and group learning. Digital recording and video review programs are growing in number, and planning and implementation of digital recording requires careful thought. Consideration of technology requirements, policy implementation, and stakeholder involvement is essential to implement a successful digital recording and video review program. Video review can then be applied for individual and team-based learning. An approach to sustainability and on-going quality review of the program are key components critical to success.     

Lung transplantation: Literature review 2003–2004

Abstract:  This is the second review in a series providing summaries of the recent medical literature in the field of pediatric transplantation. In this review we summarize important articles in the field of pediatric lung transplantation that were published in 2003 and 2004. This review is intended to be comprehensive, but not exhaustive.     

How to read a systematic review

A systematic review is a carefully planned and conducted study designed to answer a specific focused clinical question. A systematic review differs from the frequently encountered narrative review article. Systematic review must be completed using a prespecified methodology. The reader must ask eight important questions when reading a systematic review : (i) did the review address a focused clinical question (ii) is it likely that important, relevant studies are missed (iii) were the inclusion criteria used to select appropriate articles (iv) was the validity of the included studies assessed (v) were the assessments of studies reproducible (vi) were the results similar from study to study (vii) what were the overall results and how precise are they and (viii) will the results help in caring for patients. The article also provides sources for systematic reviews.     

Evaluation of a children's hospital medical peer review programme

Abstract The records of medical peer review meetings at the Royal Children's Hospital, Melbourne, were audited for the period 1983-87. This investigation focused on the peer review process, but also evaluated the extent to which recommended changes in medical practice were carried out. The results showed that few recommendations arose from the meetings despite the clear recognition of a number of problem areas. In the instances where firm recommendations were made, few appeared to have been implemented. The main reasons for this failure were: (i) the review was not an integrated part of the medical management structure of the hospital; (ii) recommendations were frequently not made despite clear expressions of the need for action; (iii) the absence of a designated individual to ensure that recommended actions were implemented, together with the lack of a feedback or internal review process to monitor effectiveness; and (iv) a relatively low profile of the peer review. Despite these shortcomings, the peer review is widely perceived to be a valuable exercise, especially as a general educational tool. However, its potential is far greater, and a model is proposed for a more effective medical peer review programme.     

What evidence‐based strategies have been shown to improve breastfeeding rates in preterm infants?

Breast milk is the preferred form of nutrition for all infants and has been shown to reduce morbidity and improve health outcomes in preterm infants. However, mothers of preterm infants face many challenges initiating and sustaining breastfeeding within the neonatal unit. This scoping review examines evidence‐based practices which aim to improve breastfeeding rates in preterm infants at the time of hospital discharge. A literature review identified 17 articles which are included in this review. Supporting evidence was found for the implementation of kangaroo mother care and/or skin‐to‐skin care, peer counsellors, provision of oropharyngeal colostrum in early infancy and use of donor human milk banks. However, overall it is apparent that high quality research including systematic review and data synthesis in the form of meta‐analysis is required in this area to reach sound conclusions regarding recommendations of different interventions. This scoping review provides an important foundation for further research into this area.     

Quantitative reviewing of medical literature. An approach to synthesizing research results in clinical pediatrics

The quantitative literature review is presented as a unique type of research endeavor complete with formal stages that parallel those associated with primary or experimental research. This article provides a tutorial overview of the quantitative literature review procedure and, in conjunction with the companion article published in this issue, serves to illustrate the application of this technique in the review process. The stages in quantitative review include: (1) problem formation; (2) data collection; (3) data evaluation; (4) analysis and interpretation; and (5) reporting results. It is argued that inferences made in the research review process are as central to the establishment of valid biomedical and clinical knowledge as inferences made in primary research. Despite some limitations, quantitative reviewing procedures constitute a significant advance over the traditional narrative methods of integrating empirical research in an area of interest. The use of quantitative reviewing procedures represents a paradigm shift in which the literature review is conceptualized as a unique form of scientific inquiry complete with formal stages and methods. The adoption of these methods should assist researchers in the behavioral and biomedical sciences in establishing scientifically valid data bases to guide theory development and direct future clinical investigation.     

Infant care review committees. The response to federal guidelines

A 1986 survey of hospitals with neonatal intensive care units and/or 1500 or more births indicated (1) which hospitals had established infant care review committees and (2) what hospital and committee characteristics influenced the functioning of infant care review committees. Of the hospitals surveyed, 51.8% had established infant care review committees. This study provides baseline information on the development of infant care review committees.     

Evaluation of a children's hospital medical peer review programme

The records of medical peer review meetings at the Royal Children's Hospital, Melbourne, were audited for the period 1983-87. This investigation focused on the peer review process, but also evaluated the extent to which recommended changes in medical practice were carried out. The results showed that few recommendations arose from the meetings despite the clear recognition of a number of problem areas. In the instances where firm recommendations were made, few appeared to have been implemented. The main reasons for this failure were: (i) the review was not an integrated part of the medical management structure of the hospital; (ii) recommendations were frequently not made despite clear expressions of the need for action; (iii) the absence of a designated individual to ensure that recommended actions were implemented, together with the lack of a feedback or internal review process to monitor effectiveness; and (iv) a relatively low profile of the peer review. Despite these shortcomings, the peer review is widely perceived to be a valuable exercise, especially as a general educational tool. However, its potential is far greater, and a model is proposed for a more effective medical peer review programme.     

Pediatric spontaneous pneumothorax

The aim of this study was to review pediatric spontaneous pneumothorax and describe diagnostic and therapeutic approaches and to review our institutional experience with spontaneous pneumothorax. A medline search using keywords pneumothorax and pediatric in both French and English from 1988 through May 2002 was performed, and pertinent papers regarding the natural history, diagnosis, imaging, and therapy were reviewed. A 10-year chart review of spontaneous pneumothorax recording data on demographics, diagnostic imaging, therapeutic approach, and outcomes was performed. Only 4 case series and one review article were produced by the medline search involving exclusively pediatric spontaneous pneumothrax. One hundred ninety-six other articles involved adult series with a minority of patients under 18 years of age. A subset of articles from this adult-based group were examined to assist in formulating recommendations for diagnosis, imaging, treatment, and surgical management of pediatric spontaneous pneumothorax. Few articles on this topic report randomized studies in the adult literature and none in the pediatric literature. The chart review yielded 53 cases of spontaneous pneumothorax in 40 patients with important data presented in the current review. Although few articles are able to provide best-evidence information, the diagnosis, imaging, treatment, and surgical management of patients with primary spontaneous pneumothorax is achieved with good results. Stronger data specific to pediatric patients are needed.     

幼儿期支气管哮喘的临床特点及诊断策略

年长儿与成人期的支气管哮喘(哮喘)的诊断并不难,但幼儿期哮喘由于其特殊的生理解剖和免疫特点,并且致喘因素复杂,容易导致诊断不足或过度诊断.目前关于幼儿期哮喘的诊断在全球范围内仍然没有统一的标准,一直是儿科医学界的难点和热点问题.文章总结了幼儿期哮喘诊断的历程及概念,分析幼儿气道生理解剖免疫及临床特点,综合近年来GINA及各国指南对幼儿喘息的诊断观点,探讨幼儿期哮喘的临床特点及诊断策略,以期引起更广泛的关注.     

Heart transplantation: Literature review 2003-2004

The rapid expansion of the volume of peer reviewed publications in recent years, including a large increase in the number of new biomedical journals, makes it difficult for the practicing clinician to stay up to date with the medical literature. This is the first review in a new series that will provide succinct summaries of the recent medical literature in the field of pediatric transplantation. In this review, we summarize important articles in the field of pediatric heart transplantation that have been published over the last 2 years (2003, 2004). The review is intended to be comprehensive but not exhaustive.     

Adverse health outcomes associated with fetal alcohol exposure: A systematic review focused on immune‐related outcomes

Prenatal alcohol exposure (PAE) has well‐known teratogenic effects on the developing fetus, potentially resulting in neurologic impairments. However, there is increasing interest regarding other potential adverse health outcomes related to prenatal alcohol exposure. The objective of this study was to undertake a systematic review to identify all the available clinical and preclinical literature investigating immune‐related outcomes in offspring with PAE. A systematic review searching four electronic databases (PubMed, CINAHL, Web of Science, and Embase) was conducted. Potential articles were screened against strict inclusion/exclusion criteria. This review specifically focused on evaluating studies related to immune‐related outcomes following PAE. Twelve clinical studies were included in the current review. Six included allergy outcomes, four included infection outcomes, and two studies included both. Thirty‐nine preclinical studies were identified examining a wide range of immune outcomes. The current review provides some preliminary clinical evidence that PAE can influence immune function, including atopic allergy and infection outcomes. However, there was variability in results across studies, particularly in the atopy area. Preclinical studies demonstrated some changes in lymphocytes and cytokines in offspring following PAE. More research investigating the effects of PAE on immune responses is warranted.     

Autotransplants with peripheral blood stem cells and clinical results obtained in children: A review

Peripheral blood stem cell transplantation (PBSCT) is increasingly used to support cancer treatment in adults and children. In this review we describe methodological aspects of PBSCT, compare it with autologous bone marrow transplantation (autoBMT), and review the first clinical results obtained with PBSCT in childhood.     

Diagnosis and treatment of bacterial meningitis

This review focuses on recent advances of topical interest regarding the diagnosis and treatment of common causes of bacterial meningitis occurring in children beyond the neonatal period. Tuberculous meningitis is beyond the scope of this review.     

Diagnosis and treatment of bacterial meningitis.

This review focuses on recent advances of topical interest regarding the diagnosis and treatment of common causes of bacterial meningitis occurring in children beyond the neonatal period. Tuberculous meningitis is beyond the scope of this review.     

Tuberculosis in children with acquired immunodeficiency syndrome

With AIDS related tuberculosis in the pediatric population on the rise, we review our experience with 14 such children. A brief review of the pertinent literature is also presented. Received: 20 March 1996 Accepted: 25 June 1996