Around a quarter of the world’s population has an active Facebook account. The latest statistics (released in June 2017) showed that 2.07 billion people had logged into their Facebook account in the previous month, a much greater number than for any other social networking site.
As in relation to Internet use more generally, there has been much concern surrounding the potential psychological harm of Facebook use, particularly in relation to younger users, and when such use becomes excessive, intrusive, compulsive or even addictive. ‘Problematic Facebook Use’ (PFU), a wider umbrella term for “addictive-like symptoms and/or scarce self-regulation related to Facebook use reflecting in social and personal problems”, is reportedly an issue for up to 1 in 10 adolescents and young adults worldwide, and has become the focus of a growing body of research focusing on potential associations with psychological distress (including depression and anxiety) and, to a lesser extent, general well-being (e.g. reduced subjective happiness and life satisfaction) (Marino et al, 2016).
The future of mental health services for children and young people are at a turning point. There is increasing recognition that there is huge unmet need. In the UK only approximately 25% of children and young people with a mental health disorder receive treatment, but demand to access care is increasing. At the same time evidence is building on what treatments are effective. This has not been matched by equivalent research evidence on what service configurations are most effective. In their systematic review of ‘the impact of pediatric mental health care provided in outpatient, primary care, community and school settings on emergency department use’, Kirkland et al (2018) found only limited evidence to suggest that the provision of services in the community impact on the use of emergency departments. The absence of robust RCT evidence should not prevent us from improving the outcomes and experience of children and young people facing a mental health crisis. Much is known about the value of early intervention and effective community interventions. Action should be taken now to prioritise the use of scarce resources where they are needed most to reduce unnecessary and sometimes unhelpful attendances at emergency departments and avoid potentially harmful mental health admissions.
Public Health England has published The wellbeing of 15-year-olds: further analysis of the 2014 What About YOUth survey. This report highlights associations between health behaviours, other self-rated life factors (such as bullying and body image) and wellbeing in 15 year olds. The report is intended to help commissioners and providers of health, social care and education to target resources where they are likely to have most impact in improving the wellbeing of young people.
The baseline assessment tool for NG61 was applied to our own organisation (Helen & Douglas House), as well as to partner organisations within Thames Valley Paediatric Palliative Care Network, comprising NHS services and third sector charities.
We identified areas for improvement specific to our own service, as well as those that would be best tackled as a regional network (either by the use of referral pathways or joint working on developing written resources for patients). We were able to demonstrate improved compliance between the assessments at Helen & Douglas House conducted in March 2017 and October 2017 (from 84% to 90%).
We now plan to use our learning to support other organisations in the region to adapt their own internal processes by sharing examples of good practice, such as care plans, symptom assessment tools and referral pathways. Our data has also been submitted to Together for Short Lives, who are mapping a national picture of the baseline assessment outcomes for NG61.
Tonic-clonic convulsions and convulsive status epilepticus (currently defined as a tonic-clonic convulsion lasting at least 30 minutes) are medical emergencies and require urgent and appropriate anticonvulsant treatment. International consensus is that an anticonvulsant drug should be administered for any tonic-clonic convulsion that has been continuing for at least five minutes. Benzodiazepines (diazepam, lorazepam, midazolam) are traditionally regarded as first-line drugs and phenobarbital, phenytoin and paraldehyde as second-line drugs.
This is an update of a Cochrane Review first published in 2002 and updated in 2008.
We have not identified any new high-quality evidence on the efficacy or safety of an anticonvulsant in stopping an acute tonic-clonic convulsion that would inform clinical practice. There appears to be a very low risk of adverse events, specifically respiratory depression. Intravenous lorazepam and diazepam appear to be associated with similar rates of seizure cessation and respiratory depression. Although intravenous lorazepam and intravenous diazepam lead to more rapid seizure cessation, the time taken to obtain intravenous access may undermine this effect. In the absence of intravenous access, buccal midazolam or rectal diazepam are therefore acceptable first-line anticonvulsants for the treatment of an acute tonic-clonic convulsion that has lasted at least five minutes. There is no evidence provided by this review to support the use of intranasal midazolam or lorazepam as alternatives to buccal midazolam or rectal diazepam.
Question Can anti–vascular endothelial growth factor (VEGF) therapy in retinopathy of prematurity (ROP) be improved by using ranibizumab given at lower doses than the standard treatment, bevacizumab, thus alleviating systemic safety concerns while effectively treating disease?
Findings In this randomized clinical trial with 20 patients, both investigated ranibizumab doses were lower than the current standard bevacizumab dose for ROP. Both ranibizumab doses were effective in controlling acute ROP (17 of 18 per protocol treated eyes [94%] with 0.12 mg and 13 of 14 per protocol treated eyes [93%] with 0.20 mg); systemic VEGF levels remained unchanged.
Meaning Low-dose ranibizumab is effective in treating acute ROP without suppressing plasma VEGF levels.