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Background Invasive Aspergillosis (IA) is a life-threatening fungal disease with significant mortality rates. Timely diagnosis and treatment greatly enhance patient outcomes. This study aimed to explore the association between patient age and the development of IA, as well as the potential implications for risk stratification strategies. Methods We searched National Center for Biotechnology Information (NCBI) databases for publications until October 2023 containing age characteristics of patients with and without IA. A random-effects model with the application of inverse-variance weighting was used to pool reported estimates from each study, and meta-regression and subgroup analyses were utilized to assess sources of heterogeneity. Results A systematic review was conducted, resulting in the inclusion of 55 retrospective observational studies with a total of 13,983 patients. Meta-analysis revealed that, on average, patients with IA were approximately two and a half years older (95% Confidence Interval [CI] 1.84–3.31 years; I 2  = 26.1%) than those without the disease ( p  < 0.0001). No significant moderators could explain the observed heterogeneity in age difference. However, subgroup analysis revealed that age differences were more pronounced within particular patient groups compared to others. For example, patients with and without IA who had primary severe lung infections exhibited a greater difference in mean age than other patient cohorts. Conclusions Further research, such as individual patient data meta-analysis, is necessary to better understand the potential relationship between increasing age and the likelihood of IA. Improved risk stratification strategies based on patient age could potentially enhance the early detection and treatment of IA, ultimately improving patient outcomes.

Cystic fibrosis is a severe, inherited, life-limiting disorder, and over half of those living with CF are children. Persistent airway infection and inflammation, resulting in progressive lung function decline, is the hallmark of this disorder. Aspergillus colonization and infection is a well-known complication in people with CF and can evolve in a range of Aspergillus disease phenotypes, including Aspergillus bronchitis, fungal sensitization, and allergic bronchopulmonary aspergillosis (ABPA). Management strategies for children with CF are primarily aimed at preventing lung damage and lung function decline caused by bacterial infections. The role of Aspergillus infections is less understood, especially during childhood, and therefore evidence-based diagnostic and treatment guidelines are lacking. This narrative review summarizes our current understanding of the impact of Aspergillus on the airways of children and young people with CF.

Background Many children and adolescents with Type 1 Diabetes Mellitus (T1DM) don’t meet the recommended levels of physical activity. Healthcare professionals (HCPs) have a key role in supporting and encouraging children and adolescents with T1DM to be physically active. This study aims to understand the perspectives of HCPs in relation to supporting physical activity and implementing guidelines relating to physical activity. Methods An online mixed methods survey was circulated to HCPs in pediatric diabetes units in England and Wales. Participants were asked about how they support physical activity in their clinic and their perceptions of barriers/enablers of providing physical activity support to children and adolescents with T1DM. Quantitative data were analysed descriptively. An deductive thematic approach was applied to the free text responses using the Capability Opportunity Motivation model of Behaviour (COM-B) as a framework. Results Responses were received from 114 individuals at 77 different pediatric diabetes units (45% of pediatric diabetes units in England and Wales). HCPs surveyed felt that the promotion of physical activity is important (90%) and advised patients to increase levels of physical activity (88%). 19% of the respondents felt they did not have sufficient knowledge to provide support. HCPs reported limited knowledge and confidence, time and resources as barriers to providing support. They also felt the current guidance was too complicated with few practical solutions. Conclusion Pediatric HCPs need training and support to be able to encourage and support children and adolescents with T1D to be a physical activity. In addition, resources that provide simple and practical advice to manage glucose around exercise are needed.

Specific support requested by trainees to facilitate research involvement included supervisory and methodological support.Table 1 Results from thematic analysis of responses to motivators and barriers around research Motivators/benefits to research Example quotes Clinical care ‘I feel it can benefit so many more children than I am able to see clinically on an individual basis. The TRN recognises the positive impact of signposting all trainees to relevant support systems when developing research or quality improvement studies.3 Without appropriate exposure to high-quality research while in training, we risk compromising evidence-based care. Contributors Survey review, analysis of data, drafting and review of article—TR, HM, FM, LP, ELW, CWC, CJ and the RCPCH Trainee Research Network Working Group.

Varicella, known as chickenpox, is caused by the varicella zoster virus (VZV), with an estimated 84 million cases annually. It primarily affects children, for most of whom it is a self-limiting illness. However, there are an estimated 950 000 disability-adjusted life years attributed to VZV annually, disproportionately affecting lower-income settings. Children with impaired immunity and neonates are particularly at risk for severe varicella. Epidemiology varies between tropical and temperate regions with infections occurring at an earlier age in temperate climates. Varicella is a vaccine-preventable disease and over 40 countries have a universal one-dose or two-dose paediatric immunisation programme, either administered alone or combined with the measles, mumps and rubella vaccination (MMRV). The UK’s Joint Committee on Vaccination and Immunisation recommended the introduction of MMRV in November 2024. The vaccine, whether monovalent or MMRV, is effective in reducing varicella cases and hospital admissions, and two-dose regimens have further reduced breakthrough infections of shingles, a recognised concern in varicella vaccination programmes. Long-term data on shingles incidence in later life are not yet available and may be mitigated through paired universal shingles vaccination programmes for adults. Cost-effectiveness studies in high-resource settings support vaccination due to reduced hospitalisations and societal costs, such as missed caregiver employment. However, more research is needed for lower-resource regions to determine whether universal vaccination is feasible and cost-effective. While global varicella elimination is unlikely without sterilising immunity, vaccination can significantly reduce the disease burden, depending on regional epidemiology and available resources.

Why did you do this work?Kawasaki disease (KD) is the leading cause of acquired childhood cardiac disease, increasing four-fold over the past decade in the UK.1 It remains perceivably rare, contributing to delayed diagnosis: 7.8 days from symptom onset on average, where best cardiac outcomes necessitate treatment <7 days. Non-specific symptoms and lack of definitive biomarkers further compounds diagnostic delay.2 Only 30% present <1 year old, yet this group carries nearly double the risk of aneurysms.3 Our programme aimed to raise awareness of KD among the paediatric resident workforce.What did you do?A regional training programme on KD was developed, using real case examples provided by Societi, the UK foundation for KD, and the literature aiming to create interactive, case-based sessions which would raise awareness amongst clinicians about KD.4 The cases were chosen as they identified important knowledge gaps or learning from patient morbidity aiming to improve clinician knowledge so that KD is considered earlier and more seriously in the patient journey. The programme was piloted at one Trust in a face-to-face format, with participants ranging from Foundation doctors to Consultants. Feedback was elicited from all participants via LearnLoop and free-text feedback was analysed thematically. Following feedback, the session was refined and expanded regionally via video-link to multiple hospitals. Feedback was used to understand what participants learned with a view to adapting session content and structure to enhance this in future.What did you find?Sessions were attended by resident doctors ranging from Foundation doctors to Consultant. Participants self-identified their take-home learning which included the need for early recognition to prevent poor cardiac outcomes, awareness of the BCG sign and recognition of incomplete Kawasaki presentations, especially in older or younger children, who are more likely to be overlooked. The pilot session achieved a feedback score of 94.3/100, which increased to 95.3/100 following regional roll-out. Themes from free-text feedback included: the importance of recognising incomplete Kawasaki, awareness of epidemiology, diagnostic criteria, and the value of case-based learning. Participants reported feeling more confident in identifying KD following the sessions, but assessing change in practice and long-term retention were beyond the scope of this pilot.What does it mean?The training sessions were valued by participants and increased self-reported confidence in recognising KD among resident doctors in paediatrics. Participants expressed interest in expanding the programme into longer, face-to-face interactive sessions. This initiative contributes to raising awareness of KD and forms part of a larger body of work. Feedback suggests that a longer study day or regional workshop would have merit and meet an identified learning need, alongside formal evaluation of impact on knowledge retention and practice.ReferencesTulloh RMR, Mayon-White R, Harnden A, et al. Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015 [published correction appears in Arch Dis Child. 2020 Mar;105(3):e5. doi: 10.1136/archdischild-2018-315087corr1].Arch Dis Child. 2019;104(7):640–646. doi:10.1136/archdischild-2018-315087Harnden A, Tulloh R, Burgner D. Kawasaki disease.BMJ. 2014;349:g5336. Published 2014 Sep 17. doi:10.1136/bmj.g5336Brogan P, Burns JC, Cornish J, et al. Lifetime cardiovascular management of patients with previous Kawasaki disease.Heart. 2020;106(6):411–420. doi:10.1136/heartjnl-2019-315925Lertamornkitti N, Wangjirapan AA. 3-month-old infant with atypical Kawasaki disease. BMJ Case Rep. 2018;2018:bcr2017221456. Published 2018 May 30. doi:10.1136/bcr-2017-221456

Why did you do this work?Kawasaki disease (KD) is the leading cause of acquired childhood cardiac disease, increasing four-fold over the past decade in the UK.1 It remains perceivably rare, contributing to delayed diagnosis: 7.8 days from symptom onset on average, where best cardiac outcomes necessitate treatment <7 days. Non-specific symptoms and lack of definitive biomarkers further compounds diagnostic delay.2 Only 30% present <1 year old, yet this group carries nearly double the risk of aneurysms.3 Our programme aimed to raise awareness of KD among the paediatric resident workforce.What did you do?A regional training programme on KD was developed, using real case examples provided by Societi, the UK foundation for KD, and the literature aiming to create interactive, case-based sessions which would raise awareness amongst clinicians about KD.4 The cases were chosen as they identified important knowledge gaps or learning from patient morbidity aiming to improve clinician knowledge so that KD is considered earlier and more seriously in the patient journey. The programme was piloted at one Trust in a face-to-face format, with participants ranging from Foundation doctors to Consultants. Feedback was elicited from all participants via LearnLoop and free-text feedback was analysed thematically. Following feedback, the session was refined and expanded regionally via video-link to multiple hospitals. Feedback was used to understand what participants learned with a view to adapting session content and structure to enhance this in future.What did you find?Sessions were attended by resident doctors ranging from Foundation doctors to Consultant. Participants self-identified their take-home learning which included the need for early recognition to prevent poor cardiac outcomes, awareness of the BCG sign and recognition of incomplete Kawasaki presentations, especially in older or younger children, who are more likely to be overlooked. The pilot session achieved a feedback score of 94.3/100, which increased to 95.3/100 following regional roll-out. Themes from free-text feedback included: the importance of recognising incomplete Kawasaki, awareness of epidemiology, diagnostic criteria, and the value of case-based learning. Participants reported feeling more confident in identifying KD following the sessions, but assessing change in practice and long-term retention were beyond the scope of this pilot.What does it mean?The training sessions were valued by participants and increased self-reported confidence in recognising KD among resident doctors in paediatrics. Participants expressed interest in expanding the programme into longer, face-to-face interactive sessions. This initiative contributes to raising awareness of KD and forms part of a larger body of work. Feedback suggests that a longer study day or regional workshop would have merit and meet an identified learning need, alongside formal evaluation of impact on knowledge retention and practice.ReferencesTulloh RMR, Mayon-White R, Harnden A, et al. Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015 [published correction appears in Arch Dis Child. 2020 Mar;105(3):e5. doi: 10.1136/archdischild-2018-315087corr1].Arch Dis Child. 2019;104(7):640–646. doi:10.1136/archdischild-2018-315087Harnden A, Tulloh R, Burgner D. Kawasaki disease.BMJ. 2014;349:g5336. Published 2014 Sep 17. doi:10.1136/bmj.g5336Brogan P, Burns JC, Cornish J, et al. Lifetime cardiovascular management of patients with previous Kawasaki disease.Heart. 2020;106(6):411–420. doi:10.1136/heartjnl-2019-315925Lertamornkitti N, Wangjirapan AA. 3-month-old infant with atypical Kawasaki disease. BMJ Case Rep. 2018;2018:bcr2017221456. Published 2018 May 30. doi:10.1136/bcr-2017-221456

Table 1 Comparison between pain, fear and anxiety scores attributed by patients after blood sampling in each group according to Bonferroni correction Mean score after venepuncture VR, rollercoaster group (n=45) VR, ocean rift group (n=45) Control (n=46) Pain 1.2 1.0 4.1 Fear 0.4 0.3 2.4 Anxiety 1.1 0.5 6.3 P<0.001 for analysis of variance testing. Distraction techniques to reduce perceived pain are supported by strong evidence on meta-analysis.1 Gerçeker et al previously demonstrated reduced pain scores in children aged 7–12 years receiving VR or external cold and vibration during phlebotomy, compared with control.2 This study builds on their previous findings but comparing VR modalities to routine care with an adequately powered sample, randomisation and appropriate statistical analysis. Analysis of variance testing across groups suggested the groups were broadly similar in terms of age and sex of participant, time since last episode of venepuncture, parent present, number of siblings and parental education level.

AimsAdverse reactions to antibiotics are common, however the incidence of true allergy is much lower, confounded by intercurrent infections or predictable side effects. Routine use of second-line antimicrobials due to falsely-labelled drug allergies is a cost burden to the health service and denies patients optimum therapies. Children with penicillin allergy report more medical attendances, antibiotic prescriptions and expensive drug prescriptions compared to the general population.The primary aim of this study is to evaluate the safety and efficacy of drug provocation challenges (DPC) to ‘delabel’ antibiotic allergies in the paediatric population in a large University district general hospital using a risk stratification tool and shorter testing schedule, compared to previous schedules. Our secondary aim was to explore waiting times.MethodsRetrospective case review of children referred to an existing paediatric drug allergy service for antibiotic allergy was performed from March 2016 to February 2022. All patients underwent a DPC, initially four doses then a home course for up to seven days. In August 2020 DPC doses were reduced to three (high risk), and one or two doses for low-risk challenges followed by a two-day home course. Risk was elicited using a validated stratification tool.Results61 patients attended drug allergy clinics for antibiotic allergies from 2016-2022 with 77% of challenges to the penicillin family (n=47). 59 were successfully delabeled (97%).One case of anaphylaxis and four immediate reactions (7%) occurred in the 2016-2020 cohort, with no reactions in the 2020-1 cohort. Three patients (5%) reported delayed reactions after discharge in the 2016-20 cohort; one reported a delayed reaction in the 2020-1 cohort. There were no associated hospital admissions.The median duration on antibiotic therapy in the 2016-20 cohort was 3 days (max 8; min 1) and 2 days in in the 2020-2 cohort (max 3; min 1). For referrals made prior to August 2020 median patient wait for drug provocation was 9.3 months (SD 5.8) and 6.2 months (SD 4.2) thereafter.ConclusionThe use of a risk-stratification tool and shorter DPC are efficacious and safe in our population of children with suspected antibiotic allergies. In our population 97% of participants were successfully delabeled.Economic modelling concluded that delabeling is cost effective if 16.9% of patients are delabeled (2.9% in Europe), with an incremental benefit of $2204 (USD) over not performing testing.1 Continued development of abbreviated antibiotic DPC in the outpatient setting and further evaluation of cost-benefit is merited.ReferenceSousa-Pinto B, Blumenthal KG, Macy E, Pereira AM, Azevedo LF, Delgado L, Fonseca JA. Penicillin Allergy Testing Is Cost-Saving: An Economic Evaluation Study. Clin Infect Dis. 2021 Mar 15;72(6):924-938. doi:10.1093/cid/ciaa194.

ObjectivesMembership examinations are vital for trainee progression, culminating in the Clinical examination. Following changes to its format, trainees in our deanery no longer had access to a regionally co-ordinated Clinical examination course. Our large geographical area covers 200 miles end-to-end including remote rural locations with only one tertiary children’s hospital, and the change in examination format post-pandemic had reduced previous tutors’ confidence in supporting trainees. However, given the significance of the Clinical examination for trainees, provision of support needed addressing.Our aim was to reintroduce a formal face-to-face mock examination for trainees preparing for the MRCPCH Clinical examination.MethodsAll regional trainees were approached via e-mail from the regional paediatric school and newsletter. Trainees revising for the Clinical examination were invited to register for a teaching programme, peer mentoring and mock examination organised by a working group including a teaching fellow and deanery-appointed examination representatives. For the October 2023 diet 13 trainees enrolled for teaching and seven registered for the mock; five attended. The course was free for trainees, costs covered by Covid-19 recovery funding.The format was designed by the working group, two members of which had personal experience of the new examination format. The mock examination followed the current structure encompassing all stations, including patients in clinical stations. All examiners were briefed, provided with RCPCH guidance and mark sheets. Mentors were allocated for candidates. Candidates were asked to share their pre-course expectations and concerns and give post-course feedback.ResultsCandidates stated that their expectations were to practise, experience, and receive feedback on all stations. Candidates were most apprehensive about neurological and musculoskeletal examinations, missing clinical signs, history-taking, communication, summarising, and formulating management plans.Formal feedback was positive, including use of real patients, realistic scenarios, and objective examiners providing thorough feedback (figures 1–3). Candidates commented it gave a clear picture of what the examination would look like. Suggestions for improvement were more video, history and development stations, and the possibility of combining the mock with teaching sessions over two days.ConclusionOur re-introduction of the mock examination was successful, with universally positive feedback. Candidates found it useful, and examiners enjoyed it, showing interest in helping again. Our vision is to run the mock six monthly, embedding it within the annual training calendar and ensuring sustainable funding. We hope a regular event will improve buy-in from faculty and patients, enabling a high-quality day for examination preparation with potential for future expansion.Abstract 6838 Figure 1General course and individual session feedback. Candidates n = 5Abstract 6838 Figure 2Do you feel you had adequate opportunity to practice today?’ Candidates n = 5.Abstract 6838 Figure 3Overall satisfaction of the course. Candidates n = 5.