Paediatric respiratory reviews
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This article describes some of the challenges that face trainers and trainees in medical education. There are ethical issues surrounding the use of real patients - particularly children and young people. How much can a young trainee "practise" on a patient? How can they best learn practical skills or gain experience of intimate examinations? The requirements of professional behaviour of trainers towards trainees and of both towards patients are described. Patients involvement in teaching, assessment and formal examinations is discussed.
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An understanding of the physiological processes underlying respiratory function in the healthy individual is essential in recognising and understanding disease processes. Departure from the normal pattern of tidal breathing is an early and reliable sign of respiratory disease. ⋯ Respiratory signs and symptoms are based on alterations of normal physiology by the disease process. Unfortunately, these basic principals are rarely emphasised in current teaching programs.
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Paediatr Respir Rev · Jan 2006
ReviewThe pharmacologic approach to airway clearance: mucoactive agents.
The term "mucoactive agent" refers to any medication used to improve the clearance of airway secretions. It is not synonymous with the word "mucolytic" as this strictly means a drug that decreases the viscosity of secretions. ⋯ For this reason many of the older mucolytic agents such as acetylcysteine are not effective for the therapy of lung disease and their use is not recommended. I review here the many classes of mucoactive agents and identify a number of medications with great promise for the treatment of chronic airway disease.
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A growing interest has recently directed toward non invasive methods, such as exhaled nitric oxide (FE(NO)) measurement and exhaled breath condensate (EBC) collection, for the assessment of asthmatic inflammation. FE(NO) is a reliable marker of eosinophilic airway inflammation and it can be measured by means of a standardized technique in children starting from the age of 4. ⋯ The compounds detected in EBC are markers of inflammation and oxidative stress occurring in asthmatic lung. While EBC is still only a research tool, FENO measurement is closer to clinical practice and lately it has been included in some treatment algorithms for asthma.
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Paediatr Respir Rev · Jan 2006
ReviewSpinal muscular atrophy type 1: what are the ethics and practicality of respiratory support?
Spinal Muscular Atrophy Type I (SMA I) is the most severe form of SMA. It presents in infancy and without treatment death occurs by 2 years. Treatments in use address respiratory and nutritional issues but even with aggressive treatment death is still likely in childhood. ⋯ However, pediatric respirologists must be willing and comfortable at presenting all treatment options, including the option of palliative care, to families and then supporting the family's choice. Whatever the chosen treatment regimen, decision making is difficult for families. Support and help must be provided from the time of presentation till death by a knowledgeable and compassionate team.