A four gene signature of chromosome instability (CIN4) predicts for benefit from taxanes in the NCIC-CTG MA21 clinical trial.

Recent evidence demonstrated CIN4 as a predictive marker of anthracycline benefit in early breast cancer. An analysis of the NCIC CTG MA.21 clinical trial was performed to test the role of existing CIN gene expression signatures as prognostic and predictive markers in the context of taxane based chemotherapy.RNA was extracted from patients in cyclophosphamide, epirubicin and flurouracil (CEF) and epirubicin, cyclophosphamide and paclitaxel (EC/T) arms of the NCIC CTG MA.21 trial and analysed using NanoString technology.After multivariate analysis both high CIN25 and CIN70 score was significantly associated with an increased in RFS (HR 1.76, 95%CI 1.07-2.86, p=0.0018 and HR 1.59, 95%CI 1.12-2.25, p=0.0096 respectively). Patients whose tumours had low CIN4 gene expression scores were associated with an increase in RFS (HR: 0.64, 95% CI 0.39-1.03, p=0.06) when treated with EC/T compared to patients treated with CEF.In conclusion we have demonstrated CIN25 and CIN70 as prognostic markers in breast cancer and that CIN4 is a potential predictive maker of benefit from taxane treatment

The transition to clinical expert: Enhanced decision making for children aged less than 5years attending the paediatric ED with acute respiratory conditions

© Published by the BMJ Publishing Group Limited. Background Rates of unplanned paediatric admissions are persistently high. Many admissions are short-stay events, lasting less than 48 hours. Objective This qualitative research explores factors that influence clinical decision making in the paediatric ED (PED) for children under 5 attending with acute respiratory conditions, focusing on how management decisions adapt with increasing experience. Method Semi-structured interviews were conducted with 15 PED clinicians (doctors, emergency nurse practitioners and registered nurses) with varying levels of experience in paediatric emergency medicine (PEM), emergency medicine or paediatrics. Audio-recorded interviews were transcribed and analysed thematically. Results There were clear differences in decision-making approaches between experienced clinicians and junior staff. The latter were more risk adverse, relying heavily on guidelines, set admission criteria, clinical theory and second opinions. This was particularly true for doctors. 'Informal' learning was apparent in accounts from less-experienced doctors and nurses, whereby tacit knowledge and risk management played an increasing role in the development of clinical intuition that permitted rapid assessment and treatment of young patients. Conclusions The emergence of intuition entwined with approaches to risk management and the role of these skills in clinical decision making, carry implications for the development of training programmes for clinicians working in PEM. Enhanced training for such groups to permit development of the supplementary skills described in this study could have the ability to improve care delivery and even reduce paediatric admissions

New onset strabismus in association with ear pain

Case report of rare diagnosis with peculiar finding

Are you a SCEPTIC? SoCial mEdia Precision and uTility in Conferences

We analysed Twitter feeds at an emergency medicine scientific conference to determine the (1) accuracy of disseminated educational messages and the (2) use in providing rapid feedback to speakers. Most speakers were happy for key messages to be tweeted, and the majority of tweets (34/37) represented these accurately. It is important that speakers and conference organisers consider Twitter use and its potential benefits and disadvantages

British guideline on the management of asthma: SIGN Clinical Guideline 141, 2014

Overview of national asthma guidance for paediatric

Confirmation of traumatic cardiac arrest in children: A literature review to inform the peruki ptca consensus study

Aims Traumatic cardiac arrest (TCA) is associated with high mortality and poor neurological outcomes. Several methods of confirming cardiac arrest are utilised including auscultation of heart sounds, palpation of pulses and echocardiography. We did a literature review to identify the best method of confirming traumatic cardiac arrest in children.Methods A Medline search from 1966 to 1/11/2016 was performed using the search terms: (Cardiac AND arrest OR standstill) AND confirm* AND auscult*OR (palpat* AND pulse) OR ultrasound OR echo* AND trauma* AND pediatr* OR paediatr*. 59 papers were identified, of which 8 were deemed relevant and of sufficient quality; 2 related to palpation of pulses and 6 related to point of care ultrasound (POCUS) in adult TCA. There were no papers related to POCUS in childhood TCA, or to auscultation.Results 2 papers examined palpation of pulses on ECMO patients, concluding that diagnosis of cardiac arrest by palpation alone was unreliable, and that the most important factor in accuracy was clinical experience. Papers related to POCUS discussed its role in predicting outcomes, and reducing unnecessary procedures or duration of resuscitation efforts. One stated a positive predictive value of 100\% for death in the presence of cardiac arrest on POCUS, another stated POCUS increased confidence in decision making, while another discussed its use in a pre-hospital training course. No papers described the performance accuracy of POCUS in confirming cardiac arrest {\textendash} this may be because its advocates view it as the gold standard test in such situations.Conclusion There is little evidence to support which method of confirming paediatric cardiac arrest is optimal, and no evidence specific to cardiac arrest which occurs after energy transfer mechanisms seen in childhood trauma. Further work is needed to determine the optimal combination of methods for identifying cardiac arrest from medical and traumatic conditions, which may be best done through the creation of a robust childhood cardiac arrest registry. It is therefore important to derive consensus in this area to guide clinicians, though this must be pragmatic and may be restricted in part by the availability of emerging technologies such as POCUS

Which intravenous bronchodilators are being administered to children presenting with acute severe wheeze in the UK and Ireland?

During a prospective 10-week assessment period, 3238 children aged 1-16 years presented with acute wheeze to Paediatric Emergency Research in the UK and Ireland centres. 110 (3.3%) received intravenous bronchodilators. Intravenous magnesium sulfate (MgSO4) was used in 67 (60.9%), salbutamol in 61 (55.5%) and aminophylline in 52 (47.3%) of cases. In 35 cases (31.8%), two drugs were used together, and in 18 cases (16.4%), all three drugs were administered. When used sequentially the most common order was salbutamol, then MgSO4, then aminophylline. Overall, 30 different intravenous treatment regimens were used varying in drugs, dose, rate and duration

Criteria led discharge of wheezy children from a short stay assessment unit

Implementation and evaluation of criteria led discharge from a Short Stay Assessment unit (SSU) for children with wheeze