Category Archives: Current Volume (2017)

Methylphenidate remains first-choice drug treatment for children and young people with ADHD – NIHR Signal

small kid taking medicine
Image: Flickr.com

The stimulant methylphenidate has the best balance of effectiveness against side effects in children and young people with attention deficit hyperactivity disorder. Amphetamines are more effective, but also more likely to be stopped for a reason other than side effects.

This large, NIHR-funded systematic review compared a range of drugs against each other through a network meta-analysis. Effectiveness and tolerability were assessed at about 12 weeks of treatment. Other second-line drug treatments were also effective and well-tolerated, including modafinil which is currently not licensed for children in the UK.

There were some quality issues due to risk of bias. But this study supports NICE guidance on the range of potential drug options to consider in conjunction with behavioural and support strategies for children and young people with attention deficit hyperactivity disorder.

Link to article page here

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Sodium thiosulfate reduces hearing loss in children treated with chemotherapy – NIHR Signal

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Image: National Cancer Institute

Treatment with sodium thiosulfate alongside cisplatin chemotherapy can reduce hearing loss in children with a liver tumour called hepatoblastoma. The risk of hearing loss was reduced by 48% in children who had the combination treatment compared with those who had cisplatin only.

This phase 3 trial involved 109 children with standard-risk hepatoblastoma and tested the addition of sodium thiosulfate six hours after cisplatin treatment. The additional drug caused few major side effects, and there was no difference in event-free or overall survival between treatment groups after three years.

Although small, the study adds to growing evidence that this well tolerated, cheap treatment might reduce cisplatin-induced hearing loss in a range of childhood cancers

Link to article page here

Free online resources on young people and mental health -British Psychological Society

talking therapy
image: Google images

Drawn from across Wiley’s psychology, neuroscience and psychiatry journals, they are grouped under these headings:

  • Caregivers
  • Diagnosis and predictors
  • Intervention
  • Living with mental health conditions
  • Resarch
  • Risk Factors
  • Symptoms
  • Treatment and recovery
  • Wellbeing
  • Other

Kathryn Scott, Director of Policy and Communications at the British Psychological Society, says on Wiley’s website

“There is an unprecedented crisis in young people’s mental health today. More than half of children are not getting the help they need from a mental health professional.

It’s vital children and young people get support from trained professionals early, as soon as they need help.

The British Psychological Society knows early intervention and prevention makes a difference. It’s the best way to stop mental health issues from escalating into more serious conditions that can last a lifetime.”

All articles are free for you to read online until 31 December 2018

Click here to access these papers on the Wiley website

A Review of Systematic Reviews Targeting the Prevention and Treatment of Overweight and Obesity in Adolescent Populations – Journal of Adolescent Health

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Image: Google images, copyright free

Abstract

Purpose

Adolescent obesity is a powerful predictor of morbidity and mortality, yet amenable to modifiable behaviors. To accurately summarize the effects of behavioral interventions on changes in adolescent body mass index and/or weight status, we assessed existing systematic reviews for reporting transparency and methodological quality.

Methods

Five databases were searched through September 2017 to identify relevant systematic reviews. Reviews were evaluated for reporting transparency and methodological quality using PRISMA Reporting Checklist and Assessment of Multiple Systematic Reviews Instrument. Evidence was synthesized across high-quality reviews.

Results

Four of twelve systematic reviews were of high methodological quality. All four focused on the treatment of overweight/obesity in adolescent populations, representing 97 international studies. Findings indicate intervention compared with no intervention/wait list showed larger effects for improving BMI/BMI z-scores. Small improvements (averaging a 3.7-kg decrease) in weight/weight percentile were observed following a supervised exercise plus dietary and/or behavior support intervention. Health-related quality of life may improve following interventions, but overall attention to associated psychological variables (depression, self-esteem/perception) is limited.

Conclusions

Adherence to objective checklists and protocols for rigorous conduct and reporting of systematic reviews is warranted. Consensus evidence is urgently needed to define and report behavior change interventions related to obesity prevention and treatment.

Link to article page here

RESEARCH REVIEW: THE EFFECTS OF MINDFULNESS‐BASED INTERVENTIONS ON COGNITION AND MENTAL HEALTH IN CHILDREN AND ADOLESCENTS – A META‐ANALYSIS OF RANDOMIZED CONTROLLED TRIALS – JOURNAL OF CHILD PSYCHOLOGY & PSYCHIATRY

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Image: Pexels.com

Abstract

Background

Mindfulness based interventions (MBIs) are an increasingly popular way of attempting to improve the behavioural, cognitive and mental health outcomes of children and adolescents, though there is a suggestion that enthusiasm has moved ahead of the evidence base. Most evaluations of MBIs are either uncontrolled or nonrandomized trials. This meta‐analysis aims to establish the efficacy of MBIs for children and adolescents in studies that have adopted a randomized, controlled trial (RCT) design.

Methods

A systematic literature search of RCTs of MBIs was conducted up to October 2017. Thirty‐three independent studies including 3,666 children and adolescents were included in random effects meta‐analyses with outcome measures categorized into cognitive, behavioural and emotional factors. Separate random effects meta‐analyses were completed for the seventeen studies (n = 1,762) that used an RCT design with an active control condition.

Results

Across all RCTs we found significant positive effects of MBIs, relative to controls, for the outcome categories of Mindfulness, Executive Functioning, Attention, Depression, Anxiety/Stress and Negative Behaviours, with small effect sizes (Cohen’s d), ranging from .16 to .30. However, when considering only those RCTs with active control groups, significant benefits of an MBI were restricted to the outcomes of Mindfulness (= .42), Depression (= .47) and Anxiety/Stress (= .18) only.

Conclusions

This meta‐analysis reinforces the efficacy of using MBIs for improving the mental health and wellbeing of youth as assessed using the gold standard RCT methodology. Future RCT evaluations should incorporate scaled‐up definitive trial designs to further evaluate the robustness of MBIs in youth, with an embedded focus on mechanisms of action.

Link to full text here

All-Party Parliamentary Group for Children Who Need Palliative Care

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Together for Short Lives is the Secretariat for the All-Party Parliamentary Group (APPG) for Children Who Need Palliative Care within the UK Parliament. The APPG is a cross-party group of MPs and peers which seeks to educate, inform and motivate other parliamentarians to take action to transform the lives of children and young people across the UK with life-limiting and life-threatening conditions.

Between November 2017 and October 2018, the APPG conducted an inquiry into the extent to which the government is meeting its end of life care choice commitment for babies, children and young people. This was published in July 2016 in the government’s ‘Our Commitment to You for End of Life Care’. This sets out what ministers expect commissioners to achieve for babies, children and young people with life-limiting and life-threatening conditions, including:

  • Respite care, delivered in a children’s hospice setting, by community palliative care services, or ‘hospice at home’ services.
  • Good collaboration between different clinical and non-clinical services across a variety of different settings.
  • Support around bereavement, both before and after a child dies.
  • Prioritisation of children’s palliative care in commissioners’ strategic planning so that services can work together seamlessly and advance care planning can be shared and acted upon.

In September 2017, the government’s ‘One Year On’ report gave an update on progress made in meeting the commitment it made when it responded to the end of life care choice review. It rightly cites the National Institute for Health and Care Excellence’s (NICE) guideline End of Life Care for Infants, Children and Young People: Planning and Management, published in December 2016, as an important step forward. NICE has also published a quality standard on the same topic, which is another important guide to help the NHS, voluntary and private sectors to better plan, fund and provide children’s palliative care.

The ‘One Year On’ report also reiterates the government’s commitment to improve bereavement services for families whose child has died. This includes the introduction of a new entitlement to bereavement leave for parents, a policy which Together for Short Lives campaigned for and will help to support families during this incredibly distressing time.

Link to report page here

Child death review: statutory and operational guidance (England) – DoH

child death guidance 2018

This guidance sets out the full process that follows the death of a child who is normally resident in England. It builds on the statutory requirements set out in Working together to safeguard children and clarifies how individual professionals and organisations across all sectors involved in the child death review should contribute to reviews.

The guidance sets out the process in order to:

  • improve the experience of bereaved families, and professionals involved in caring for children
  • ensure that information from the child death review process is systematically captured in every case to enable learning to prevent future deaths

NHS England will issue guidance for the bereaved, ‘When a child dies: a guide for parents and carers’, setting out the steps that follow the death of a child.

The collation and sharing of the learning from reviews will be managed initially by NHS Digital and then by the National Child Mortality Database when it becomes operational on 1 April 2019. It will be handled through the use of standardised formsGuidance on the transitional arrangements has been published.

Link to article page here