Atoms
3rd May 1891 There it was, the summary in black and white: a record for her own family physician whose suggestions for appropriate remedies for the chronic cough had hit the doldrums. Salt of tartar, usually so reliable, even after combining with cochineal had simply not made a dent in its density – and so another opinion was sought. ‘I regretfully must inform you that Ms X, 15 years of age, whom you referred with such alacrity on 21st April has a classic case of pulmonary consumption. She understands the implications of this diagnosis but is cognisant of and has been educated about the benefits of prophylaxis. Daily exercise, posture and, she informs me her family has the means, an annual Alpine sojourn. Should these fail to bring symptomatic relief, piercing the diseased lobe to induce a pneumothorax would be the next consideration.’ Unmisslabelling the misslabelled...
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Adaptive and innovative study design in rare diseases
Challenges in rare disease trials Rare diseases are defined in the European Union as ones that affect fewer than one person in 2000. Although individually rare, there are more than 6000 rare diseases with more than half of them starting in childhood. As a result, there are approximately 3.5 million individuals with rare diseases in the UK. These rare diseases have significant impact on children and their families with more than 30% of children dying before the age of 5 years.1 Rare diseases in children generally lack focused development of new treatments. One of the important reasons behind this is the difficulty in doing clinical trials using traditional design: the number of patients available to recruit is often too limited to do well-powered randomised controlled trials (RCTs). Paediatric trials have significant complexities and very few patients/parents are keen on placebo controlled trials.2 With methodological developments...
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Time to take it 'out side: delabelling allergy to penicillin and other beta-lactams in children and young people
One in 10 children are labelled as ‘penicillin allergic’, the majority before starting school.1 Most are viral exanthema mislabelled as ‘allergy’. Confirming true allergy is further confounded because around 80% of young children with ‘true’ penicillin allergy will outgrow the allergy within 10 years.2 As a result, around 95% of penicillin allergy labels are found to be incorrect at formal investigation (figure 1).3 The British Society for Allergy and Clinical Immunology (BSACI) published a guideline in 2022 to assist UK clinicians (who do not have formal allergy training) to develop a penicillin allergy delabelling service for their patients.3 The guideline builds on over 10 years of evidence that direct oral ‘challenge’ or drug provocation testing (DPT) without initial specialist assessment is safe.4 Penicillin allergy delabelling needs to be a priority for UK paediatricians.5 The National...
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Covert medication in children: an extrapolation from adult practice
Parents smuggle antipyretics into their feverish infants. At the other end of this continuum, the clandestine administration of any drug to a competent or capacitous person who is oblivious to such treatment, whose consent is absent, is unlawful. It is not a battery, since no touch was involved ... but it is a serious interference with an individual’s right to respect for their private life under Article 8 of the European Convention of Human Rights 1948 (ECHR). While it is simple for a capable person to object, on discovery, that their rights have been trampled upon ... the incompetent or incapacitated may have no such remedy. It was, in part, to give that group of citizens a voice through a legal right, that the Convention was established. There are remarkably few reported common law decisions relating to covert medication in England and Wales; none concerning children. Guidance published by...
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