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Dear colleagues

Welcome to this small place in cyber world hoping that it will be useful

M Ezzat

Evidence Based DO WRITTEN ASTHMA ACTION PLANS REDUCE HOSPITAL ADMISSIONS?

Clinical bottom line

National guidelines continues to recommend the provision of written asthma management plans in adults and children with asthma (Grade D)

Whilst there is good evidence for this practice in adults (grade A) ,evidence is lacking in children and worryingly hospitalizations maybe increased in those receiving written management plans

Source : Arch Dis Child September 2009 Vol 94 No 9 page 742

Evidence Based IS INTRAVENOUS IMMUNOGLOBULIN SUPERIOR TO EXCHANGE TRANSFUSION IN THE MANAGEMENT OF SYPERBILIRUBINAEMIA IN TERM NEONATES

Clinical bottom line

INTRAVENOUS IMMUNOGLOBULIN (IVIG) is a relatively safe and effective means of reducing the need for exchange transfusion in haemolytic disease of the newborn (Grade A)

The American Academy of Pediatrics 2004 guidelines recommend administration of IVIG in isoimmune haemolytic disease if the total serum bilirubin TSB is rising despite intensive phototherapy or the TSB level is within 2-3 mg/dl of the exchange level.

Source : Arch Dis Child September 2009 Vol 94 No 9 page 739

Evidence Based URETHRAL CATHETER OR SUPRAPUPIC ASPIRATION TO REDUCE CONTAMINATION OF URINE SAMPLES IN YOUNG CHILDERN

Clinical bottom line

Combined evidence indicates that urethral catheter samples are more likely to be contaminated than samples obtained by suprapubic aspiration (Grade C) but not all evidence is of high quality .
Catheter sample contamination can be reduced by culturing the second half of the sample only ( Grade B).
Catheter samples may still be more appropriate than suprapubic aspiration (number needed to harm (NNH 9) where it is felt there is higher chance of success influenced by clinical factors such

as age, the size of the baby, other co- morbidities and potentially parental preference.
Source : Arch Dis Child September 2009 Vol 94 No 9 page 736