Joseph Hall Flashcards
Levels of evidence in EBM
From most reliable to least
- System. reviews
- RCT
- Cohort
- Case control
- Case series/Case reports
- Editorials, expert opinion
How to ask an answerable question
- Patient characteristics(e.g. children with acutre otitis media)
- Intervention (e.g. course of Ab’s)
- Comparison (a matching placebo in addition to adequate analgesia)
- Outcome
- Study Design
What does the children act 1989 say about child abuse
- (1) When a court determines any question with respect
to: –
a. the upbringing of a child; or
b. the administration of a child’s property, or the application of any
income arising from it;
the child’s welfare shall be the court’s paramount
consideration
What are the 5 outcomes key to well-being in
childhood and later life: stated in Every Child Matter 2003
1, Be healthy
- Stay safe
- Enjoy and Achieve
- Make a positive contribution; and
- Achieve economic wellbeing
(help remember use SHEEP)
NB* The Children’s Act 2004 gives legal underpinning to ‘Every Child Matters’ to improve children’s lives
What does the children’s act 2004 say about cooperation to improve well-being?
Each children’s services authority in England must make
arrangement to promote co-operation between:–
a. The authority;
b. Each of the authority’s relevant partners; and
c. Such other persons or bodies as the authority considers
appropriate, being persons or bodies of any nature who
exercise functions or are engaged in activities in relation to
children in the authority’s area
INTEGRATE SERVICES FOR THE CHILD
What does the children’s act 2004 say about cooperation to improve well-being? Continued …
2) The arrangements are to be made with a view to
improving the well-being of children in the authority’s area
so far as relating to:–
a. Physical and mental health and emotional well-being;
b. Protection from harm and neglect;
c. Education, training and recreation;
d. The contribution made by them to society;
e. Social and economic well-being.
What does the children’s act 2004 say about cooperation to improve well-being? Continued ..
3) In making arrangements under this section, a children’s
services authority in England must have regard to the
importance of parents and other persons in caring for
children in improving the well-being of children.
What does the children’s act 2004 say about arrangements to safe guard and promote welfare
Each person and body to whom this section
applies must make arrangements for ensuring
that:-
a) their functions are discharged having regard to the need to
safeguard and promote the welfare of children;
b) any services provided by another person pursuant to
arrangements made by the person or body in the discharge
of their functions are provided having regard to that need.
What does the The Children’s Act 1989, 2004 Section 47 say
- ‘If the child is judged to have suffered
significant harm, a strategy discussion is held.
Professional from relevant agencies will meet
to discuss whether a section 47 enquiry
should be held’ NSPCC - Puts a legal duty on professional to
investigate a child they know is suffering
significant harm
Responsibilities of all doctors in protecting children and young people according to the GMC
- identifying children and young people at risk of, or suffering, abuse or neglect
- meeting the communication needs of children, young
people and parents
3, confidentiality and sharing information
- child protection examinations
- giving evidence in court.
GMC Principles and the safety/welfare of a child or young person
A. All children and young people have a right to be protected
from abuse and neglect – all doctors have a duty to act on any concerns they have about the safety or welfare of a child or young person.
B. All doctors must consider the needs and well-being of
children and young people – this includes doctors who treat adult
patients.
C. Children and young people are individuals with rights –
doctors must not unfairly discriminate against a child or young person for any reason.
D. Children and young people have a right to be involved in their
own care – this includes the right to receive information that is appropriate to their maturity and understanding, the right to be heard and the right to be involved in major decisions about them in line with their developing capacity.
E. Decisions made about children and young people must be
made in their best interest
H. Doctors must be competent and work within their
competence to deal with child protection issueS - Doctors must keep up to date with best practicE through training that is appropriate to their role.
F. Children, young people and their families have a
right to receive confidential medical care and advice
but this must not prevent doctors from sharing
information if this is necessary to protect children and
young people from abuse or neglect.
G. Decisions about child protection are best made
with otherS consulting with colleagues and other agencies that
have appropriate expertise will protect and promote
the best interests of children and young people.
Aims of Working Together to Safeguard Children
2010
Protecting children from maltreatment.
Preventing impairment of children’s health or
development.
Ensuring that children are growing up in circumstances
consistent with the provision of safe and effective care.
And undertaking that role so as to enable those children to
have optimum life chances and to enter adulthood
successfully.
Aim of the ethos
- Is child centred
- Promotes child and family participation
- Values collaborative working
- Respects diversity
- Promotes equality
Caldicott principles of information sharing
Justify the purpose
Don’t use patient identifiable information unless
absolutely necessary
Use the minimum necessary patient-identifiable
information(pii)
Access to pii should be on a strict need-to-know basis
Everyone with access to pii should be aware of their
responsibilities
Understand and comply with the law
What is neglect
When an adult deprives a child of basic and
compulsory needs such as food and shelter,
hygiene, medical care, schooling, a clean and safe living environment and emotional nurturance.
Leaving a child unsupervised for extensive periods
of time.
Diagnostic features of physically
abusive parents
- Delay in seeking medical help
- The “accident” story doesn’t make sense or is not
compatible to the injury observed - Parental behaviour (hostile, argumentative or
leave prior to doctor’s arrival) - Child’s appearance or interaction with parent is
not “normal”
Characteristics of emotional abuse
Aggression or irrational requests
Extreme shyness when it wasn’t there before and giving in to the
demands of others
Oversensitivity / crying all the time/ feeling depressed all the time or
having angry outbursts
Hyperactivity when there was none before or the opposite (being
very passive)
Social withdrawal, difficulty forming friendships
Being overly suspicious or hesitant
Characteristics of physical abuse
Open wounds, bruises, scratches
Broken bones
Injuries on the head and face (bruising around eyes and
mouth)
Hair falling out due to excessive pulling
Cigarette, hot liquid, iron burning
Poisoning
Starvation, lack of hygiene that can cause illnesses
Cognitive characteristics of abuse
Speech delays
Impaired ability to learn
Inability to focus or sustain attention to a task at
hand
School performance deteriorates
Symptoms of abuse in teenagers
Difficulty walking
Pain and itching in the genital area
Stomach pain and headache
Nightmares
Increased eating disorders
When the child wears loose clothes
