Archives of Disease in Childhood最新文献

Background: Simulated medical scenarios are useful for evaluating and developing clinical competencies but scheduling them is expensive and time-consuming. Large language models show promise in role-playing tasks. We investigated the fidelity with which ChatGPT can mimic patients, clinicians and examiners in educational settings.

Objective: To determine the realism with which ChatGPT can portray patient, doctor and examiner roles, and the utility of these agents in clinical education.

Method: We selected four paediatric scenarios from mock objective structured clinical examinations (OSCEs) and set up separate patient, doctor and examiner ChatGPT agents for each. The patient and doctor agents conversed with each other in written format. The examiner agent marked the doctor agent based on this conversation. Patients and clinicians familiar with the OSCE assessed the dialogues.

Results: The patient agent was judged to be true to character most of the time and good at expressing emotion. The doctor agent was reported to be an effective communicator but occasionally used jargon. Both agents tended to produce repetitive responses which undermined realism. The examiner agent had good correlation with human clinicians. There was moderate support for using the simulated interactions for educational purposes.

Conclusion: Although the realism of the agents can be improved, ChatGPT can generate plausible proxies of participants in medical scenarios and could be useful for complementing standardised patient-based training.

Objective: To explore parental perceptions of nasogastric tube (NGT) insertion for adolescents who have received inpatient treatment for an eating disorder and to identify factors shaping a positive or negative experience.

Design: Qualitative observational study using semistructured interviews with parents of adolescent patients who underwent NGT insertion during eating disorder treatment.

Setting: Participants' children had received care in eight hospitals across Australia. Videoconferencing software was used, with all participants completing their interview from home. One participant's child was a hospital inpatient at the time of interview.

Participants: Sixteen interviews were conducted: 3 with young people, 12 with parents and 1 joint interview with parent and child. Due to the small sample of patients, only the 13 parent interviews were analysed (including the joint interview).

Results: Five key themes emerged: (1) inconsistencies in hospital protocols and rigidity in their application, (2) unit culture and staff attitudes, (3) perception of autonomy and consent, (4) the psychological impact of NGT insertion and (5) the physical discomfort and pain of NGT insertion. While no quantitative measures apply, the consistency across multiple hospitals and participants underscores the robustness of these findings.

Conclusions: Participants reported substantial variations in protocols and processes across hospitals, including discrepancies in indications for NGT insertion and removal, and approaches to group mealtimes. These differences had a marked impact on patient and parent experience. Our findings provide important insight into the physical and psychological experience of NGT insertion for young people and their parents and identify areas for improvement in future clinical practice.

Objective: To determine the incidence, serotype distribution and clinical outcomes of invasive pneumococcal disease (IPD) in children with acute lymphoblastic leukaemia (ALL) following widespread use of pneumococcal conjugate vaccines (PCVs).

Design: Multicentre cohort study.

Setting: Two tertiary paediatric oncology centres in Australia-Royal Children's Hospital-Melbourne and Perth Children's Hospital.

Patients: Children with cancer, including a defined subgroup with ALL.

Interventions: All children were assessed for provision of pneumococcal vaccines before and after their diagnosis of cancer.

Main outcome measures: Incidence of IPD in cancer (ALL and non-ALL) compared with the general paediatric population, serotype distribution, vaccination status and clinical outcomes.

Results: A total of 29 episodes of IPD in 28 children with cancer were included, of whom 19 had ALL. Less than a quarter had received additional pneumococcal vaccinations beyond the standard PCV schedule. The incidence of IPD in children with ALL was 190-360 times higher than in healthy children (1360 per 100 000 person-years). The majority of episodes (83%) were due to non-PCV13 serotypes, most commonly 23B. Clinical presentation was predominantly bacteraemia. Most patients recovered within 30 days, but there was one death attributable to IPD.

Conclusions: Children with ALL remain at substantially increased risk of IPD despite widespread PCV use, with disease largely caused by non-PCV13 serotypes. Uptake of additional pneumococcal doses was low. These findings underscore the need for optimised vaccination and prophylactic strategies in paediatric oncology populations.

The past century has seen a transformation of education and training in paediatrics and child health, against a background of remarkable developments and scientific progress within the specialty. Many of the changes reflect the wider evolution of medical training, from an apprenticeship model to a time-based model to the current capability-focused approach embodied within Progress+, the Royal College of Paediatrics and Child Health training curriculum introduced in 2023. Wave upon wave of Reports have, to varying degrees, left their mark, each in some way seeking to improve the experience of students and trainees, patient care and the overall health system. In the UK, paediatrics and child health has gradually established itself as a major specialty, growing from its early roots as the British Paediatric Association to becoming a thriving and innovative specialty and Royal College in 1996 and onwards. Tracing these developments, both in undergraduate education and in postgraduate education and training, helps us to understand our current identity and challenges and gives perspective on future direction. We have come a long way, but we are not there yet.

Luigi Pirandello (1867-1936), who won the Nobel Prize for Literature in 1934, is one of the most influential Italian authors of the early twentieth century. His work offers an exact and humane vision of childhood at a time when paediatrics was still emerging as a distinct discipline.This essay explores selected stories from the collection Novelle per un anno (Short Stories for One Year) that depict childhood illness, vulnerability and care. Fragile newborns and neglected or exploited children are shown as shaped not only by disease but also by poverty, limited medical knowledge and cultural beliefs. Through these narratives, Pirandello anticipates key concerns of contemporary medical humanities: the importance of integrating empathy and awareness into paediatric care to help clinicians remain humane in their practice.

Objective: The Phoenix Sepsis Score (PSS) was derived and validated in 10 healthcare systems internationally. We sought to perform an external validation of the PSS among children with suspected infection in a high-resource country in Asia.

Design: Retrospective cohort study.

Setting: A tertiary paediatric hospital in Singapore, between 1 January 2020 and 31 December 2024.

Patients: Children <18 years old hospitalised with suspected infection who received broad-spectrum intravenous antibiotics.

Interventions: Application of the PSS. We defined sepsis as PSS ≥2, as per the Phoenix criteria.

Main outcome measures: The main outcome was in-hospital mortality. We described the performance of PSS using area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (AUPRC).

Results: Among 25 202 children (median age 3.3 years (IQR, 0.7-8.4)) with suspected infection, 13 484 were males (53.5%). 82 (0.3%) children died. There were 660 children (2.6%) with PSS ≥2 and 411 (1.6%) met criteria for septic shock. A PSS ≥2 was associated with a mortality risk of 8.5% (56/660) and predicted for mortality with a sensitivity of 68.3% (95% CI 57.5% to 78.4%) and specificity 97.6% (95% CI 97.4% to 97.8%). PSS had an AUROC of 0.90 (95% CI 0.86 to 0.94) and AUPRC of 0.36 (95% CI 0.24 to 0.47) in our study population, outperforming that of the original cohort.

Conclusions: A PSS ≥2 was highly specific when predicting mortality among children with suspected infection. Our study confirms that the Phoenix criteria can be used as a data-driven benchmark for sepsis research.

Background: Respiratory syncytial virus (RSV) is a leading cause of infant hospitalisation due to lower respiratory tract infections. Until 2022, prevention was limited to the costly monoclonal antibody palivizumab. In August 2024, the UK introduced the RSVpreF (Abrysvo, Pfizer) maternal vaccine into its national immunisation schedule. The success of this programme depends not only on vaccine effectiveness, but also on maternal access, acceptance and uptake.

Objective: To explore maternal perspectives on the RSVpreF vaccine and identify barriers and facilitators to vaccine uptake, to inform antenatal education and public health strategies.

Methods: This qualitative analysis is based on free-text survey responses from 388 vaccine-eligible mothers of infants hospitalised with bronchiolitis, lower respiratory tract infection or acute wheeze, collected between September 2024 and March 2025 across 30 sites, as part of the BronchStop study.

Results: Four key themes were identified: (1) access-related barriers to vaccination, (2) insufficient RSV awareness and information to support informed decision-making, (3) vaccine safety concerns and hesitancy and (4) perception of the maternal RSV vaccine as beneficial and protective. These themes were consistent across sociodemographic groups.

Conclusions: Uptake of the maternal vaccine was influenced by barriers to access, informational gaps and perceived safety concerns. Improved vaccine delivery, enhanced awareness and personalised antenatal counselling are essential to increase vaccine uptake. There is an urgent need to address structural inaccessibility and provide tailored antenatal education to address informational gaps. Ongoing qualitative research is crucial to guide targeted public health interventions ahead of future RSV seasons.

Purpose: Sarcomas are cancers of connective tissue and account for approximately 10-15% of all cancer cases in children aged ≤16 years. Treatment often involves chemotherapy, surgery and radiotherapy. The disease and the side-effects of treatments can adversely affect patients and their families' health-related quality of life (HR-QoL). Poorer HR-QoL is reported compared with other cancers; however, these studies are limited to generic cancer QoL measures. This qualitative study explored the psychosocial impact of sarcoma on children affected by sarcoma and their parents.

Methods: Nine children (aged 8-16 years) and 12 parents from three UK Principal Treatment Centres participated in semistructured interviews based on the core domains of HR-QoL. The interviews were recorded, transcribed verbatim and analysed using thematic analysis.

Results: Six themes were identified from the analysis, mapping the journey from symptom onset and diagnosis to treatment experience and the lasting effects of living with sarcoma. The themes included: (1) experience of diagnosis; (2) consequences of treatment; (3) impact on family; (4) support systems; (5) disability and inclusion; (6) finding a way forward.

Conclusion: The study's findings illustrate a marked lack of awareness of sarcoma among patients and their families, leading to pronounced distress for parents following their child's diagnosis and an initial sense of limited peer support. Treatment-related disability was an important issue for children and their families who described the lasting psychological and physical impact on life after surgery for sarcoma.