Objective: To ascertain whether therapeutic equivalence exists for the treatment of paediatric community acquired pneumonia by the oral and intravenous (IV) routes. Methods: A multicentre pragmatic randomised controlled non-blinded equivalence trial was undertaken in eight paediatric centres in England (district general and tertiary hospitals). Equivalence was defined as no more than a 20% difference between treatments of the proportion meeting the primary outcome measure at any time. 246 children who required admission to hospital and had fever, respiratory symptoms or signs and radiologically confirmed pneumonia were included in the study. Exclusion criteria were wheeze, oxygen saturations ,85% in air, shock requiring .20 ml/kg fluid resuscitation, immunodeficiency, pleural effusion at presentation requiring drainage, chronic lung condition (excluding asthma), penicillin allergy and age ,6 months. The patients were randomised to receive oral amoxicillin for 7 days (n = 126) or IV benzyl penicillin (n = 120). Children in the IV group were changed to oral amoxicillin after a median of six IV doses and received 7 days of antibiotics in total. The predefined primary outcome measure was time for the temperature to be ,38˚C for 24 continuous hours and oxygen requirement to cease. Secondary outcomes were time in hospital, complications, duration of oxygen requirement and time to resolution of illness.

No abstract

To investigate the impact of early schoolbased screening and educational interventions on longerterm outcomes for children at risk for attention-deficit/ hyperactivity disorder (ADHD) and the predictive utility of teacher ratings.Design: A population-based 5-year follow-up of a randomized, school-based intervention.Setting: Schools in England.Participants: Children between 4 and 5 years of age with high teacher-rated hyperactivity/inattention scores. Follow-up data were collected on 487 children in 308 schools.Interventions: Following screening, using a 2 ϫ 2 factorial design, schools randomly received an educational intervention (books about ADHD for teachers), the names of children with high hyperactivity/inattention scores between ages 4 and 5 years (identification), both educational intervention and identification, or no intervention.Outcome Measures: Parent-rated hyperactivity/ inattention, impairment in classroom learning, and access to specialist health services for mental health or behavioral problems.Results: None of the interventions were associated with improved outcomes. However, children receiving the identification-only intervention were twice as likely as children in the no-intervention group to have high hyperactivity/inattention scores at follow-up (adjusted odds ratio,2.11; 95% confidence interval, 1.12-4.00). Regardless of intervention, high baseline hyperactivity/ inattention scores were associated with high hyperactivity/ inattention and specialist health service use at follow-up. Conclusions:We did not find evidence of long-term, generalizable benefits following a school-based universal screening program for ADHD. There may be adverse effects associated with labeling children at a young age.

Background: This study investigates the ability of primary school teachers to recognise Attention Deficit/Hyperactivity Disorder (ADHD), and the impact of subtype and child gender on recognition and proposed management. Method: Primary school teachers read one of four types of vignette describing the behaviour of a 9-year-old child: either a boy or a girl with inattentive or combined subtype of ADHD. Teachers were asked about their conceptualisation of the child's difficulties and their thoughts about need for specialist referral and other interventions. Results: Of 496 teachers, 99% identified the presence of a problem. Subtype (combined) of ADHD influenced teachers' recognition of ADHD and agreement that medication might be helpful. Only 13% of teachers thought that medication might be helpful. Conclusions: Results suggest a need for better teacher awareness about inattentive subtype of ADHD. Key Practitioner Message:• Epidemiological data show that ADHD is underdiagnosed in girls and in children with inattentive subtype, while research and clinical experience suggest that teachers are important in the process of recognition and referral of children with possible ADHD• Using a case vignette, teachers were more likely to conceptualise the problems as ADHD and think that medication might be helpful for a child with combined subtype than for a child with inattentive subtype of ADHD• We found no evidence that teachers were less likely to recognise ADHD in girls than in boys • Teachers strongly endorsed nonpharmacological intervention approaches for children with ADHD, but few thought that medication would be beneficial; many teachers expressed their views that medication should be 'a last resort'• During the diagnostic process for a child with suspected ADHD, or when offering training to teachers, clinicians should try to increase teacher awareness about inattentive subtype of ADHD

Members of the healthcare team should be aware of concerns related to children attending school/daycare and provide additional support as warranted.

Tinnitus is a condition that is difficult to treat, and treatment outcomes are difficult to measure The majority of people who experience tinnitus are not troubled by it; however, the troubled minority are referred by an otorhinolaryngologist for specialist clinic help. The aim of this study was to investigate how the impact of tinnitus changes following attendance at a tinnitus clinic and to find out how acceptable the questionnaires used were for measuring recovery. Fifty-seven tinnitus sufferers completed three questionnaires covering the characteristics of tinnitus, and its effect on daily life, quality of life, and quality of family life, before and after treatment at the Nottingham Tinnitus Clinic. Questionnaires were answered at patients' homes while they were on the waiting list to attend the clinic, and again I year after their first attendance. Measures of functional and social handicap were significantly reduced following attendance at the clinic (mean change in functional handicap = 13%, p<0.01, and mean change in social handicap = 8%, p<0.01). Quality of life was significantly better after treatment at the clinic (mean visual analog scale difference = 6.5%, p = 0.01). We conclude that attendance at the Nottingham Tinnitus Clinic had a positive effect on the impact of tinnitus on patients and their families, and that the questionnaires gave an accurate measure of patient distress.

No abstract

Background: Whilst women admitted to secure care are believed to require gender-specific services, there is limited research to inform their provision. Method: Clinical and forensic characteristics and outcomes on 93 women were obtained from multiple data sources and compared with 502 men admitted to the same medium secure unit over a 20-year period. Results: Compared to the men, the women were more likely to have more mental health needs and less criminality. At discharge, women were more likely to be transferred to secure care and less likely to be transferred to prison. Following discharge, the women had a higher rate of mortality. While reconviction rates were similar for the two groups for serious offenses, violent or arson incidents not leading to conviction were more likely for women. The women were more likely to be readmitted, and to be readmitted to high secure care. Conclusion: Despite more favorable criminological characteristics at baseline, our data suggest a poorer outcome for women overall following discharge.