Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006.
There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.
Read the results of our latest survey, which looks at the experiences of children, young people and their parents and carers attending hospital for treatment as an inpatient or day case.
Key findings for England
Overall children and young people’s experiences of inpatient and day case care were mostly positive. The majority of children and young people said they were well looked after while in hospital, staff were friendly and that they received answers to their questions. Most parents and carers reported positive experiences for how their child’s pain was managed and for receiving enough information about new medication.
The survey results suggest there is scope for improvement in a number of areas, including:
Children and young people having enough things to do whilst in hospital
Involving children and young people in decision making
National Health Service (NHS) surveys have consistently shown that a considerable proportion of staff (more than 36% in 2016) report feeling ‘unwell due to work-related stress’.1 In addition, the General Medical Council (GMC) recently published reviews on medical education and practice2 and on national training.3 These concluded that ‘a state of unease exists within the medical profession’.4 The GMC’s assessment was echoed by the Royal College of Physicians,5 and work-related stress may even have been implicated in the suicides of young doctors.6 Overwork, low morale and mental health issues undoubtedly affect the medical workforce7 and are likely to have contributed to the first industrial action for decades following threatened imposition of a new contract.8 Strikingly, a recent survey of 30 000 nurses revealed that 53% felt ‘upset/sad’ because they could not deliver the level of care they wanted.9 Emotional well-being at work is therefore an important issue. In 2013, the Francis Report10 made recommendations directed at promoting compassionate care, including the implementation of Schwartz Center Rounds (SCR). ‘Developing People, Improving Lives’—the national improvement and leadership framework—was aimed at addressing this problem and advocates compassionate leadership at all levels of NHS organisations.11
Over the past 8 years, nearly 100 NHS trusts and other organisations (eg, hospices; higher education institutes) have introduced SCR to their settings. The aim is to allow staff from all disciplines to consider their experience of providing care, especially challenging emotional and social issues. It is hoped that by sharing such aspects of work, stress and anxiety can be reduced and thereby the capacity to give more compassionate care to patients enhanced. Our aim in this commentary is to provide an overview of SCR, and describe the organisational processes necessary to set these up.
Objective To determine the trajectory of cognitive test scores from infancy to adulthood in individuals born extremely preterm compared with term-born individuals.
Design A prospective, population-based cohort study.
Setting 276 maternity units in the UK and Ireland.
Patients 315 surviving infants born less than 26 completed weeks of gestation recruited at birth in 1995 and 160 term-born classroom controls recruited at age 6.
Main outcome measures Bayley Scales of Infant Development-Second Edition (age 2.5); Kaufman Assessment Battery for Children (ages 6/11); Wechsler Abbreviated Scale of Intelligence-Second Edition (age 19).
Results The mean cognitive scores of extremely preterm individuals over the period were on average 25.2 points below their term-born peers (95% CI −27.8 to −22.6) and remained significantly lower at every assessment. Cognitive trajectories in term-born boys and girls did not differ significantly, but the scores of extremely preterm boys were on average 8.8 points below those of extremely preterm girls (95% CI −13.6 to −4.0). Higher maternal education elevated scores in both groups by 3.2 points (95% CI 0.8 to 5.7). Within the extremely preterm group, moderate/severe neonatal brain injury (mean difference: −10.9, 95% CI −15.5 to −6.3) and gestational age less than 25 weeks (mean difference: −4.4, 95% CI −8.4 to −0.4) also had an adverse impact on cognitive function.
Conclusions There is no evidence that impaired cognitive function in extremely preterm individuals materially recovers or deteriorates from infancy through to 19 years. Cognitive test scores in infancy and early childhood reflect early adult outcomes.
We found that short-term use of methylphenidate might improve symptoms of hyperactivity and possibly inattention in children with ASD who are tolerant of the medication, although the low quality of evidence means that we cannot be certain of the true magnitude of any effect. There was no evidence that methylphenidate has a negative impact on the core symptoms of ASD, or that it improves social interaction, stereotypical behaviours, or overall ASD. The evidence for adverse events is of very low quality because trials were short and excluded children intolerant of methylphenidate in the test-dose phase. Future RCTs should consider extending the duration of treatment and follow-up. The minimum clinically important difference also needs to be confirmed in children with ASD using outcome scales validated for this population.
Background We sought to determine clinical variables in children tested for suspected pulmonary embolism (PE) that predict PE+ outcome for the development of paediatric PE prediction rule.
Methods Data were collected by query of a laboratory database for D-dimer from January 2004 to December 2014 for a large multicentre hospital system and the radiology database for pulmonary vascular imaging in children aged 5–17. Using explicit, predefined methods, trained abstractors, determined if D-dimer was sent in the evaluation of PE and then recorded predictor data which was tested for association with PE+ outcome using univariate techniques.
Results D-dimer was ordered in 526 children for clinical suspicion of PE. Thirty-four of 526 were PE+ (6.4%, 95% CI 4.3% to 8.7%). The radiology database identified 17 additional patients with PE (n=51 PE+ total). Children evaluated for PE were primarily in the ED setting (80%), teenagers (88%) and 2:1 female:male. Children with PE had higher mean heart and higher respiratory rate and a lower pulse oximetry and haemoglobin concentration. On univariate analysis, five conditions were more frequent in PE+ compared with no PE: surgery, central line, limb immobility, prior PE or deep vein thrombosis and cancer.
Conclusions The rate of PE diagnosis in children with D-dimer was 6.4%, similar to that seen in adults; most children with PE are over 13 years and had clinical predictors known to increase probability of PE in symptomatic adults. Future studies should use these criteria to develop a clinical decision rule for PE in children.
Paediatric neurodiagnostic investigations, including brain neuroimaging and electroencephalography (EEG), play an important role in the assessment of neurodevelopmental disorders. The use of an appropriate sedative agent is important to ensure the successful completion of the neurodiagnostic procedures, particularly in children, who are usually unable to remain still throughout the procedure.
The quality of evidence for the comparisons of oral chloral hydrate against several other methods of sedation was very variable. Oral chloral hydrate appears to have a lower sedation failure rate when compared with oral promethazine for children undergoing paediatric neurodiagnostic procedures. The sedation failure was similar for other comparisons such as oral dexmedetomidine, oral hydroxyzine hydrochloride, and oral midazolam. When compared with intravenous pentobarbital and music therapy, oral chloral hydrate had a higher sedation failure rate. However, it must be noted that the evidence for the outcomes for the comparisons of oral chloral hydrate against intravenous pentobarbital and music therapy was of very low to low quality, therefore the corresponding findings should be interpreted with caution.
Further research should determine the effects of oral chloral hydrate on major clinical outcomes such as successful completion of procedures, requirements for additional sedative agent, and degree of sedation measured using validated scales, which were rarely assessed in the studies included in this review. The safety profile of chloral hydrate should be studied further, especially the risk of major adverse effects such as bradycardia, hypotension, and oxygen desaturation.