Explore the vast range of titles available.

Why did you do this work?Paediatric Oral Fluid challenges (POFC) are a widespread, inexpensive intervention for a common presentation to paediatric emergency departments. However, anecdotally there is significant variation with regards to how they are undertaken (eg. indication, fluid type/volume and antiemetic use) and little consensus about what POFC protocol is most successful. If a standardised, evidence-based POFC protocol could be implemented, we may be able to promote regional best practice, reducing the need for IV fluids and hospital admission.What did you do?We aimed to identify current POFC practices across London by disseminating a survey utilising the London REACH (Research, Evaluation and Audit for Child Health) network.1 Data gathered included indication for POFC, fluid type used, fluid volumes and frequencies used, antiemetic use and pass/fail criteria. For trusts that provided guidelines we compared practitioner reported practice with trust guideline practice recommendations. We also compared the guidelines provided to published guidance from the National Institute for Clinical Excellence (NICE) guidance for rehydration in gastroenteritis (NICE CG842), which recommends that if dehydration is present 50 mls/kg of Oral Rehydration Solution (ORS) is given over 4 hours, without an antiemetic.What did you find?We received 22 survey responses (table 1) and 9 trust POFC guidelines. Gastroenteritis, poor oral intake and fever are the three most common indications for a POFC. Weight and age are the most common basis for calculating the total POFC fluid volume, however in 36% of responses (n=22) no calculations are used. Where specified (73% of responses, n=xx), fluid is reported to be given in frequent increments; usually every 5-10 mins,. Oral rehydration solution is used in 86% (n=22) of responses; however, apple juice, squash, water and milk are also commonplace. 59% (n=22) of responses can use an anti-emetic as part of a POFC; the antiemetic of choice is Ondansetron. Pass criteria are generally a combination of drinking a certain volume, not vomiting and positive clinical assessment. 9 trusts provided guidelines; 2 of the survey responses indicated guidelines were being fully followed in practice (table 2). 2 guidelines were fully adherent to NICE CG84 recommendations; 7 deviated either in amount of fluid per kg or total duration of the POFC.What does this mean?Our survey clearly reflects that clinical practice does not tend to follow NICE or local guidance fully. Reflecting on why this is; it is likely because children are highly variable and require pragmatic approaches to rehydration. What would we recommend? A systematic review of best practice in terms of the protocol for POFCs, and what makes them most successful. This can feed into a best practice guideline that we would aim to implement across the region, to improve the success of POFCs, reducing the need for admission and Intravenous fluids.Abstract 7800 Table 1Practitioner reported paediatric oral fluid challenge practice points as detailed in a total of 22 survey responses, n=22 (received from 22 trusts across the London region)Abstract 7800 Table 2Practitioner survey responses compared to their own guidelines provided and whether these guidelines followed NICE CG84 guidance (50 mls/kg of oral rehydration solution (ORS) is given over 4 hours, without an antiemetic) (trusts that provided guidelines= 9)ReferencesREACH London Network; Research, Evaluation & Audit for Child Health. London. c2021. [Updated 2024 Jan; cited 2024 Oct]. Available from www.reachnetworkldn.comNational Institute for Clinical Excellence; Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management; Clinical guideline [CG84]Published: 22 April 2009. www.nice.org.uk/guidance/cg84

Childhood cancers caused an estimated 75 000 deaths in children aged 0–14 years in 2018, of which 90% were in low-income and middle-income countries, and yet this group is missing from global health agendas. We examined global patterns in public and philanthropic funding for childhood cancer research—a proxy for global research activity—to address the critical gaps in knowledge. We used data from the Dimensions database to systematically search for and analyse 3414 grants from 115 funders across 35 countries between 2008 and 2016, organised by funding source, recipient, tumour type, research focus, and pipeline categories, to investigate trends over time. During this period, global funding for childhood cancer research was US$2 billion, of which $772 million (37·9%) was for general childhood cancer, $449 million (22·0%) was for leukaemias, and $330 million (16·2%) was for CNS tumours. $1·6 billion (77·7%) of funding was awarded from, and to, institutions based in the USA. Preclinical research received $1·2 billion (59·3%), and around $525 million (25·7%) included support for clinical trials, but only $113 million (5·5%) supported health-care delivery research. Overall, funding was inadequate and geographically inequitable, and new commitments to funding have declined since 2011.

Why did you do this work?The PEAR study, conducted by the London REACH (Research, Evaluation and Audit in Child Health) Network identified lack of time as a significant barrier to trainees’ participation in research and quality improvement projects.1Supporting Professional Activity (SPA) time is essential for paediatric training, as emphasised in the RCPCH Trainee Charter.2 This recommends a minimum of 8 or 16 hours SPA time per month for ST1-3 and ST4+ trainees respectively, additional to departmental teaching and clinical administrative time.To address this, we aimed to quantify rostered SPA time for paediatric trainees in comparison to the RCPCH Trainee Charter. Additionally, we reviewed trainees’ subjective experiences of SPA provision.What did you do?We conducted a cross-sectional study utilising the London REACH network, a trainee-led research initiative spanning 28 London hospitals . Local leads at each site carried out a scoping survey to gather information on what paediatric services are present at each hospital, and the levels of trainees they accommodated (Senior House Officer (SHO) or Registrars)).Based on this initial survey, local leads identified one SHO and one Registrar trainee (where applicable) from each paediatric department. These trainees completed a survey regarding their experience with SPA provision and submitted their full-time generic work schedules.We then analysed the submitted schedules for rostered SPA time and compared them with the RCPCH recommendations.What did you find?We received scoping survey responses from 21 out of 28 (75%) London hospitals that have paediatric trainees. From this, there were a total of 110 possible work schedules that could be collated, of which we received 56 (51%). Among these, 14 (25%) had directly rostered SPA time with on average, 8.8 hours of SPA time per month for SHOs, and 11.1 hours for Registrars. Additionally, 31 (57%) rotas included shifts which were ‘occasionally’ used for SPA time. However this was not explicitly rostered for on the work schedule, and respondents reported that it was routinely not available for SPA time, and not protected. It was also reported that SPA days were often required to be taken as leave in order to take a full leave allowance.What does it mean?There is significant variation and insufficiency in the allocation of SPA time for paediatric trainees across the London area, with notable discrepancies between Registrars and SHOs, relative to the RCPCH Trainee Charter values. Moreover, only 7 (13%) work schedules aligned with RCPCH guidance on SPA time, indicating that a large cohort of trainees must use their personal time to engage in quality improvement and research activities. As research is a core competency of the RCPCH curriculum, there is a clear need for dedicated time for trainees to fulfil these important tasks.ReferencesPaediatric Trainee Experience of Multi-site Audit and Research (PEAR), a cross-sectional London REACH Network study. Dore R, D’Souza M, Ghosh N, Carr D, Loucaides E, the REACH collaborative. (2023). Retrieved from https://www.journal.londonpaediatrics.co.uk/index.php/1/article/view/75Training Charter. RCPCH. (2024). Available at: https://www.rcpch.ac.uk/resources/training-charter [Accessed 3 Oct. 2024].

ObjectivesJournal clubs provide an educational platform to develop skills in critical appraisal, keeping clinicians up to date with new evidence.1 Journal clubs can feel daunting for doctors with less academic exposure, which can result in disengagement.Here, we present the evaluation of a journal club resource set developed by the Academic Subgroup of the London School of Paediatrics (LSP) which is designed to be unintimidating and transform Journal Club into an active learning experience.MethodsOur team designed a Journal Club Resource Set to guide participants in their preparation, which includes a Standard of Practice Proforma, presentation slides, a database of papers and feedback forms, all of which are easily accessible on our website. The SOP proforma offers a step-by-step approach to a discussion-based Journal Club, giving advice on the choice of study and promoting use of Critical Appraisal Checklists (CASP). Facilitators are encouraged to split the audience into groups to discuss the various aspects of appraisal, encouraging team participation. This innovative approach to Journal Club has been trialed in 3 district general hospitals in London. Each trial was over a period of six months, with rotational allocations of all paediatric trainees to the role of the facilitator. Their feedback was evaluated with post-pilot surveys.ResultsTwenty-five (n=32) trainees actively participated in Journal Club, and 78.1% (n=25) gave feedback. Most trainees had previous experience of participating in Journal Club (n=20, 80%) but only few of them (n=5, 20%) had participated in a discussion-based journal club. Of the doctors with previous journal club exposure, sixteen (64%) had tried the role of the facilitator before. Those with previous facilitation experience praised the lack of stress and fruitful conversation that a discussion-based journal club promotes, and emphasized the fact that the audience was more engaged. The majority of the trainees (n=19, 76%) felt that their critical appraisal skills were significantly improved by this project. The most notable result is that all of the participants (n=25, 100%) reported enjoying and learning more from our proposed journal club proforma.ConclusionWhile the traditional journal club format has maintained consistency—junior staff present a chosen article and a senior faculty member facilitates discussion among attendees—the journal club’s ability to keep pace has become unsustainable.2 Our proposed resource set encourages trainees of all levels and background to actively engage in journal club, by providing step-by step advice and implementation of evidence-based medicine.3 In conclusion, applying this novel approach in more paediatric departments across the United Kingdom, would markedly enhance the sustainability and clinical utility of Journal Club.ReferencesEbbert J, Montori V, Schultz H. The journal club in postgraduate medical education: a systematic review. Med Teacher. 2001 Sep 1;23(5):455–61.Phillips RS. What makes evidence-based journal clubs succeed? Evidence-Based Medicine 2004 Mar 1;9(2):36–7.Aronson JK. Journal clubs: 2. why and how to run them and how to publish them. Evid Based Med. 2017 Dec;22(6):232–4.

ObjectivesFebrile infants commonly present to the emergency department. Most will have self-limiting infections; however 10–20% will have a serious bacterial infection1 and diagnosis is challenging. In the UK, three national guidelines are in use (NICE NG51, NICE NG143, BSAC2), in addition to local clinical practice guidelines (CPGs). This holds true in London where 36% of trusts used CPGs.3 Thus, there is potential heterogeneity in the management of this patient group. As part of the FIRE (Febrile Infants Regional Evaluation) study we describe variation in management of febrile infants up to 3 months of age across London hospitals.MethodsThis retrospective, multicentre, observational study utilised 19 London hospitals within the REACH Network.4 Data was collected on infants up to 90 days of age presenting with a fever or reported fever (≥38.0°C) between 1st April 2021–31st March 2022. Pseudo-anonymised data was compiled on REDCap by local research teams. HRA ethical approval was granted (22/PR/1377) and each participating site obtained R&D approval. Descriptive statistics are reported (median of total study cohort and range for site medians).Results1880 presentations were included in the study. Across all hospitals, FBC and CRP were taken in 1383/1880 (73.6%; 54.5–96.7%) and 1387/1880 (73.8%; 53.8 -96.7%) of cases respectively. Blood cultures were taken in 1178/1880 (62.7%; 37.8–87.8%), CSF sampling was performed in 776/1880 (41.3%; 21.1–70.7%) and urinalysis/MC&S was performed in 1169/1180 (62.2%; 37.8–85.7%). NPA/throat swabs were taken in 851/1880 (45.3%; 7–82.2%) and SARS-COV-2 investigations were performed in 1162/1880 (61.8%; 26.5–91.8%). Antibiotics were started in 1123/1843 of cases (60.9%; 39.4–91.1%). 1152/1849 (62.3%; 47.3–95.1%) cases were admitted to an inpatient ward following initial presentation; a significant minority 530/1849 (28.7%; 0–46.1%) were discharged from the place of initial assessment. The remaining 9.9% of cases were either transferred to a paediatric assessment unit or equivalent, ambulated from an inpatient setting or via a hospital-at-home service, or were transferred to PICU. The median length-of-admission was 1.4 (0.46–2.6) days. Variation in practice was seen with decreasing age of infants and depending on fever being present at initial assessment (table 1).Abstract 6850 Table 1Variation in practice stratified for age <= 28 days vs. >28 days and febrile vs. afebrile at presentation*ConclusionThere is significant variation between London hospitals with respect to investigation, antimicrobial use, decision to admit and duration of stay. There is a need to standardise the approach to management of this high-risk population and limit variation in care, whilst balancing this against the burden of investigation and treatment.ReferencesWaterfield, et al, on behalf of PERUKI, Validating clinical practice guidelines for the management of febrile infants presenting to the emergency department in the UK and Ireland. Archives of Disease in Childhood. 2022;107:329–334.British Society for Antimicrobial Chemotherapy. Infant <90 days of age with fever and no source, pathway for children presenting to hospital from the community. Amended 2021.Alvarez A, et al, on behalf of the REACH collaborative. Comparing guideline recommendations for management of young febrile infants across London. Poster presented at RCPCH Conference 2023. Available from www.reachnetworkldn.comREACH Network. Available from www.reachneworkldn.com/fire.

ObjectivesThe 2020 RCPCH State of Child Health report highlighted that active participation in research by paediatricians is a priority for children and young people.1 Academic paediatrics faces numerous challenges including limited research opportunities, particularly outside integrated academic training [IAT].2–4 The LSP academic subgroup strives to improve research accessibility for London-based paediatric doctors by organising research-focussed events. Herein, we report the methodology and effectiveness of a selection of these strategies in the hope of encouraging implementation of similar approaches across the UK to tackle the current threats to paediatric research.MethodsFirstly, a year-long mentorship scheme was implemented, matching senior academic clinicians to junior doctors. Mentorship groups independently organised virtual and in- person meetings. Secondly, IAT evenings focussing on Academic Clinical Fellowship (ACF) applications were held. These consisted of talks by previous ACFs and doctors taking other routes into research (e.g., out-of-programme experience). Lastly, three research evenings were organised in which junior doctors could present research or audit findings on a regional platform. All implemented approaches were freely available to paediatric doctors in London and advertised via mailing lists and social media. Utility of each approach was evaluated by pre- and post-event surveys, including measures of confidence in research-related topics.ResultsWithin the mentorship scheme, 46 mentees were assigned to 13 senior mentors. 52.2% of mentees reported low confidence in pursuing an academic career at the start of the scheme. Feedback (n=16) highlighted that confidence remained low following the scheme, with 43.8% of mentees still reporting low confidence. However only 50% of respondents had met their mentorship group primarily due to busy work schedules. Those able to meet found the experience beneficial. ACF events were attended by 26 paediatric doctors. 70% (n=18) of doctors reported low pre-event confidence in applying for IAT, which improved to only one doctor in post event feedback (n=12). Forty doctors attended research evenings, of which 30% (n=12) provided feedback. All respondents found the events helpful, and part icularly appreciated presentation variety and the opportunity to present their own work.ConclusionConfidence in pursuing research within paediatrics is low. Implementing successful mentorship, targeted IAT and research even ings can improve confidence and research accessibility. Time constraints limited successful mentorship relationships and future schemes will include greater meeting structure to allow advanced scheduling and ensure mentee/mentor commitment. Junior doctor collaboration across the UK to implement similar strategies may further improve nationwide access to paediatric research opportunities to address children and young people’s priorities.ReferencesRCPCH report: State of Child Health – What can health professionals do? RCPCH. 2020.RCPCH Trainees participation in child health research survey Report. Trainee Research Network Task and Finish Group. August 2023.Dore R, D’Souza M, Ghosh N, Carr D, Loucaides E, collaborative TR. 317 Paediatric trainee experience of multi-site audit and research (PEAR), a cross sectional London REACH network study. Archives of Disease in Childhood 2023.Hunter L, Greenough A, Modi N. RCPCH report – turning the tide: five years on. March 2018.

ObjectivesKangaroo mother care (KMC) is high impact for survival of low birth weight neonates, but there are few rigorous evaluations of duration required for impact. We conducted a scoping review of KMC duration measurement methods and assessed their validation.DesignScoping review in accordance with Joanna Briggs Institute guidance for conducting scoping review.Data sourcesMEDLINE, Embase, Cochrane Library, PsycINFO, African Index Medicus, Latin American and Caribbean Health Sciences Literature, ClinicalTrials.gov, International Clinical Trials Registry Platform, International Standard Randomised Controlled Trial Number Registry, Medrxiv and OpenGrey were searched through November 2022.Eligibility criteria for selecting studiesPublications with primary data on KMC duration were included. We excluded short procedural skin-to-skin care studies.Data extraction and synthesisSelection and data abstraction were conducted by two independent reviewers. A data charting form based on the variables of interest was used to abstract data.ResultsA total of 213 publications were included, of which 54 (25%) documented a method of measuring KMC duration. Only 20 publications (9%) provided a detailed description of the duration measurement method, and none reported validity. Most studies used caregiver reports (29, 54%) or healthcare worker observations (17, 31%). Other methods included independent observers and electronic monitoring devices.ConclusionOnly 9% of KMC studies reporting duration documented the measurement method applied, and no studies were found with documented validation of duration measurement methods. Accurate and comparable data on the dose response of KMC will require duration measurement methods to be validated against a gold standard such as an independent observer.

A recent Academy of Medical Sciences report clearly illustrates that investing in child health research confers population-level benefits for national health and prosperity.1 But beyond pushing boundaries, research literacy is essential to daily clinical practice through informing evidence-based decision-making and facilitating adaptation of guidelines to evolving medical knowledge. Recognising the value of regional trainee research networks (TRNs), a recently formed central RCPCH TRN group aims to increase opportunities to undertake child health research and provide peer support through these trainee-led organisations, with 12 regional networks now in existence.3 Where are the gaps For most clinical trainees, the above provisions are unlikely to meet core curriculum requirements, which include key capabilities such as ‘undertaking formal research’, ‘carrying out a systematic literature review’ and ‘participating in national projects and publications’. Paediatric Trainee Experience of Multi-Site Audit and Research (PEAR), a Cross Sectional London REACH Network Study.

Why did you do this work?Paediatric Oral Fluid challenges (POFC) are a widespread, inexpensive intervention for a common presentation to paediatric emergency departments. However, anecdotally there is significant variation with regards to how they are undertaken (eg. indication, fluid type/volume and antiemetic use) and little consensus about what POFC protocol is most successful. If a standardised, evidence-based POFC protocol could be implemented, we may be able to promote regional best practice, reducing the need for IV fluids and hospital admission.What did you do?We aimed to identify current POFC practices across London by disseminating a survey utilising the London REACH (Research, Evaluation and Audit for Child Health) network.1 Data gathered included indication for POFC, fluid type used, fluid volumes and frequencies used, antiemetic use and pass/fail criteria. For trusts that provided guidelines we compared practitioner reported practice with trust guideline practice recommendations. We also compared the guidelines provided to published guidance from the National Institute for Clinical Excellence (NICE) guidance for rehydration in gastroenteritis (NICE CG842), which recommends that if dehydration is present 50 mls/kg of Oral Rehydration Solution (ORS) is given over 4 hours, without an antiemetic.What did you find?We received 22 survey responses (table 1) and 9 trust POFC guidelines. Gastroenteritis, poor oral intake and fever are the three most common indications for a POFC. Weight and age are the most common basis for calculating the total POFC fluid volume, however in 36% of responses (n=22) no calculations are used. Where specified (73% of responses, n=xx), fluid is reported to be given in frequent increments; usually every 5-10 mins,. Oral rehydration solution is used in 86% (n=22) of responses; however, apple juice, squash, water and milk are also commonplace. 59% (n=22) of responses can use an anti-emetic as part of a POFC; the antiemetic of choice is Ondansetron. Pass criteria are generally a combination of drinking a certain volume, not vomiting and positive clinical assessment. 9 trusts provided guidelines; 2 of the survey responses indicated guidelines were being fully followed in practice (table 2). 2 guidelines were fully adherent to NICE CG84 recommendations; 7 deviated either in amount of fluid per kg or total duration of the POFC.What does this mean?Our survey clearly reflects that clinical practice does not tend to follow NICE or local guidance fully. Reflecting on why this is; it is likely because children are highly variable and require pragmatic approaches to rehydration. What would we recommend? A systematic review of best practice in terms of the protocol for POFCs, and what makes them most successful. This can feed into a best practice guideline that we would aim to implement across the region, to improve the success of POFCs, reducing the need for admission and Intravenous fluids.Abstract 7800 Table 1Practitioner reported paediatric oral fluid challenge practice points as detailed in a total of 22 survey responses, n=22 (received from 22 trusts across the London region)Abstract 7800 Table 2Practitioner survey responses compared to their own guidelines provided and whether these guidelines followed NICE CG84 guidance (50 mls/kg of oral rehydration solution (ORS) is given over 4 hours, without an antiemetic) (trusts that provided guidelines= 9)ReferencesREACH London Network; Research, Evaluation & Audit for Child Health. London. c2021. [Updated 2024 Jan; cited 2024 Oct]. Available from www.reachnetworkldn.comNational Institute for Clinical Excellence; Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management; Clinical guideline [CG84]Published: 22 April 2009. www.nice.org.uk/guidance/cg84

AimsBackgroundThe involvement of trainees in research in paediatrics is dependent on individual enthusiasm and access to appropriate opportunities and support. These are affected by the frequency of rotations, the demands of busy paediatric training jobs and a lack of guidance on how to get involved. The relatively new RCPCH academic tool-kit goes some way to providing support and guidance and the college’s Trainee Research Network initiative aims to support existing trainee research networks and facilitate collaborative working regionally and nationally. Trainee ownership and leadership of collaborative multi-centre governance and research projects provides trainees with research skills mandated by the RCPCH Progress curriculum and as well as opportunities for peer networking and steering of research priorities.Whilst over the past 5 years several trainee-led research networks have been set up, there are gaps across the country. Arguably, the most successful are those focussing on sub-specialty projects with General Paediatrics falling behind.ObjectivesWe set out to establish a pan-London, trainee-led network that exists to support the conception and coordination of multi-centre research, audit and service evaluation projects to answer relevant general paediatric clinical questions. Additionally, this initiative provides opportunities for trainees to develop research competencies.MethodsFounding trainees sought experiences of existing trainee network organisations active in research and clinical governance. Subsequently, a working group was assembled by promotion on social media and through the regional trainee network. A group of 16 interested trainees from ST1 through to ST8 was formed and initial meetings were held monthly in May-Dec 2021.The working group divided in to 3 key smaller subgroups;1. Guidance documents & first project development2. IT & communications3. Trust network set-upThe group was overseen by a set of co-chairs ranging from ST4-ST8 and senior consultant support.ResultsThe working group set to work on the 3 main workstreams and developed an initial set of resources which included;1. Guidance documents & first project development:- Constitution- Project proposal form- Standard operating procedure guidance for projects2. IT & communications:- Branding including network name and logo- Social media presence- Website1 and dedicated email addressNewsletter outline and mailing list template3. Trust network set-up:- Review of regions and hospitals with collation of potential local stakeholders and consultants leads- Plan for recruitment of interested trust leadsIn parallel the working group conducted successive brainstorming exercises of potential first projects, taking into account the outputs of other trainee networks, feasibility and current views on research priorities. Additionally, in recognition of the need to hear parent and patient as well as pan-region trainee voices, links to patient and public involvement (PPI) organisations are being established and a priority setting exercise is planned for 2023. A central committee was formed in December 2022.ConclusionThe London REACH – Research, Evaluation and Audit for Child Health – network collaborative established its central committee, core guidance documents and communication infrastructure. A first regional trainee-led multi-site project will be conducted in 2022.Referencewww.reachnetworkldn.com