Atoms
To the unseasoned ear, the sound emanating through the capacious bonnet of the aquamarine lacquered 57 would have been innocuous. A purr rather than a growl, or so its tanned owner thought, simply something to mention at routine maintenance. The mechanic, though, looked perplexed. Unable to put a finger on ‘it’ on a first scan – plugs – yes, alternator- yes – exhaust – yes – carburettor – clean as a whistle. But the sense of unalloyed unease was unattenuated. Prepared for a long haul, recharged with a half pint of tea (three sugars for me) and a bar of confectionary, hands wiped temporarily free of oil, and the serious scrutiny to detail began. Pipes 1: Blended diets Gastrostomy feeding has for years been used as a support for children in need of long term nutritional support for neurological (sometimes temporary) anatomical reasons. Around a decade ago though,...
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Advancing the conversation around blended diets for gastrostomy-fed children
The decision to start home-blended feeds in gastrostomy-fed children can feel controversial. Blending home-prepared foods for administration through a gastrostomy tube, while logical in many ways, has been constrained by a lack of safety and efficacy data in comparison to decades of ‘real-world experience’ with enteral formulae. As a result, professional bodies such as the British Dietetic Association (BDA) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition, while encouraging dietitians to support those home-blending, have stopped short of recommending its routine use.1 2 Despite this, increasing numbers of families are now choosing to give their tube-fed children home-blended food and standardised support may not be available for all. We therefore welcome the publication of data from the YourTube study. This prospective, multicentre cohort study of 180 gastrostomy-fed children in the UK (104 home-blended diets, 76 exclusive sterile formula at baseline) provides the largest...
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Wales Infants and Childrens Genome Service
Over the past decade, the increasing availability of genomic testing and the development of new techniques, such as next-generation sequencing (NGS), have transformed medical practice. The introduction of NGS has resulted in a shift away from single gene testing to multigene panels and whole-genome sequencing (WGS), paving the way for genomic testing to be used in acute healthcare settings. This is well demonstrated by the use of rapid WGS (rWGS) for acutely unwell neonates and children receiving intensive care. The All Wales Medical Genomics Service (AWMGS) provides clinical and laboratory genomics services to the 3.1 million residents of Wales. It is funded by the National Health Service (NHS) Wales Joint Commissioning Committee (formerly the Welsh Health Specialist Services Committee) with additional funding provided by Welsh Government, initially to support the delivery of their Genomics for Precision Medicine Strategy,1 published in 2017 and more recently, the Delivery Plan...
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Disclosing the significance of their competence to the Gillick competent
It is commonplace to meet a competent teenager who with no apparent hesitation brushes away the offer to provide consent for a clinical intervention. Choosing, instead, to defer to his parents for the provision of consent. Evidence for the incidence of this behaviour is sparse but will doubtless be forthcoming. In a recent judgement, a court went as far as setting out the conditions for such a deferral by the Gillick competent child,1 who therefore by definition will have demonstrated sufficient maturity and intelligence to make the treatment-related decision. While the consent of the child in question was required to legitimise treatment, if ‘...for whatever reason he could not give or did not wish to give such consent, preferring to defer to his mother’ that was an acceptable arrangement. The child is taken as saying, in effect, that he ‘...declines to make a decision, and prefers his...
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