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Kilham H. Measuring empathy. J Paediatr Child Health 2021; 57:2025. [PMID: 33908673 DOI: 10.1111/jpc.15521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Henry Kilham
- Clinical Ethics, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Isaacs D, Elliot C, Kilham H, Preisz A. The ethics of publishing in medical journals. Paediatr Respir Rev 2021; 39:41-47. [PMID: 31678037 DOI: 10.1016/j.prrv.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/18/2022]
Abstract
Ethics has been defined as the way we ought to behave. Medical publishing essentially exists to broadcast current and new medical knowledge to aid in the practice of medicine. In this review article we consider many of the aspects of medical publishing with regard to 'what we ought to do' and, equally, 'what we ought not to do' from the perspective of various ethical frameworks. Although ethics is not the law or a set of rules, nor a code of conduct, an ethical lens can be useful when developing good general guidelines for medical publishing.
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Affiliation(s)
- David Isaacs
- Clinical Ethics Service, Sydney Children's Hospital Network, Children's Hospital at Westmead and Sydney Children's Hospital, Randwick, Australia; Sydney Health Ethics, 92/94 Parramatta Rd, Camperdown, NSW 2050, Australia.
| | - Chris Elliot
- Clinical Ethics Service, Sydney Children's Hospital Network, Children's Hospital at Westmead and Sydney Children's Hospital, Randwick, Australia; Sydney Health Ethics, 92/94 Parramatta Rd, Camperdown, NSW 2050, Australia
| | - Henry Kilham
- Clinical Ethics Service, Sydney Children's Hospital Network, Children's Hospital at Westmead and Sydney Children's Hospital, Randwick, Australia; Sydney Health Ethics, 92/94 Parramatta Rd, Camperdown, NSW 2050, Australia
| | - Anne Preisz
- Clinical Ethics Service, Sydney Children's Hospital Network, Children's Hospital at Westmead and Sydney Children's Hospital, Randwick, Australia; Sydney Health Ethics, 92/94 Parramatta Rd, Camperdown, NSW 2050, Australia
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Kilham H. Technology takeover. J Paediatr Child Health 2020; 56:1984-1985. [PMID: 33351250 DOI: 10.1111/jpc.14850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Henry Kilham
- Department of Clinical Ethics, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Dawson A, Isaacs D, Jansen M, Jordens C, Kerridge I, Kihlbom U, Kilham H, Preisz A, Sheahan L, Skowronski G. An Ethics Framework for Making Resource Allocation Decisions Within Clinical Care: Responding to COVID-19. J Bioeth Inq 2020; 17:749-755. [PMID: 32840833 PMCID: PMC7445717 DOI: 10.1007/s11673-020-10007-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/03/2020] [Indexed: 05/13/2023]
Abstract
On March, 24, 2020, 818 cases of COVID-19 had been reported in New South Wales, Australia, and new cases were increasing at an exponential rate. In anticipation of resource constraints arising in clinical settings as a result of the COVID-19 pandemic, a working party of ten ethicists (seven clinicians and three full-time academics) was convened at the University of Sydney to draft an ethics framework to support resource allocation decisions. The framework guides decision-makers using a question-and-answer format, in language that avoids philosophical and medical technicality. The working party met five times over the following week and then submitted a draft Framework for consideration by two groups of intensivists and one group of academic ethicists. It was also presented to a panel on a national current affairs programme. The Framework was then revised on the basis of feedback from these sources and made publicly available online on April 3, ten days after the initial meeting. The framework is published here in full to stimulate ongoing discussion about rapid development of user-friendly clinical ethics resources in ongoing and future pandemics.
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Affiliation(s)
- Angus Dawson
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
| | - David Isaacs
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- The Children’s Hospital Westmead, Sydney, Australia
| | | | - Christopher Jordens
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
| | - Ian Kerridge
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Ulrik Kihlbom
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Henry Kilham
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- The Children’s Hospital Westmead, Sydney, Australia
| | - Anne Preisz
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- The Sydney Children’s Hospitals Network, Sydney, Australia
| | - Linda Sheahan
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- St George Hospital, Sydney, Australia
- South East Sydney Local Health District, Sydney, Australia
| | - George Skowronski
- Sydney Health Ethics, The University of Sydney, Medical Foundation Building (K25), Sydney, NSW 2006 Australia
- St George Hospital, Sydney, Australia
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Kilham H. HISTORICAL CONTEXT OF BLACK LIVES MATTER MOVEMENT. J Paediatr Child Health 2020; 56:1656. [PMID: 33099827 DOI: 10.1111/jpc.15123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Henry Kilham
- Clinical Ethics, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Kilham H. Re: Sexual Harassment. J Paediatr Child Health 2018; 54:591. [PMID: 29756368 DOI: 10.1111/jpc.13911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Henry Kilham
- Department of General Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Isaacs D, Kilham H. Words that wound. J Paediatr Child Health 2017; 53:433-434. [PMID: 28470809 DOI: 10.1111/jpc.13545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Isaacs
- Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Henry Kilham
- Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Mellis C, Kilham H, Selvadurai H. Farewell
P
eter van
A
speren
FT
hor
S
oc,
FRACP. Respirology 2016; 21:398. [DOI: 10.1111/resp.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gray K, Isaacs D, Kilham H, Tobin B, Waters K. Use of guidelines when planning home care of a girl with severe congenital myopathy. J Paediatr Child Health 2016; 52:7-10. [PMID: 26776543 DOI: 10.1111/jpc.13065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/29/2022]
Abstract
We use issues that arose in the management of a 4-year old girl with a congenital myopathy to consider the tension between respecting the choices and decisions of the child's parents and applying clinical practice guidelines that emphasise minimising risk to the child. This case raises the issue of when it is reasonable to override parents' choice of management options.
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Affiliation(s)
- Kelly Gray
- Long-Stay Ventilation Team, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - David Isaacs
- Department of Clinical Bioethics, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Henry Kilham
- Department of Clinical Bioethics, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Bernadette Tobin
- Plunkett Centre for Ethics in Health Care, St Vincent's Hospital Sydney and Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - Karen Waters
- Long-Term Ventilation and Sleep Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Child Health, University of Sydney, Sydney, New South Wales, Australia
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Affiliation(s)
- David Isaacs
- Department of Clinical Ethics, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Henry Kilham
- Department of Clinical Ethics, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Abstract
In this article, we address how general paediatrics has evolved and adapted to change over the past 50 years and speculate on its future directions. We compare the state of general paediatrics with that of general adult medicine. We argue that general paediatrics must continue to have a strong role both in paediatric teaching hospitals and the community.
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Affiliation(s)
- Hasantha Gunasekera
- General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Abstract
AIMS The study aims to: (i) estimate the prevalence of spinal muscular atrophy type 1 (SMA 1); (ii) describe what practices characterise end-of-life care of patients with SMA 1; and (iii) ascertain whether a consistent approach to the management of these patients exists in Australia. METHODS An audit of the Australasian pathology laboratories offering the diagnostic SMN1 deletion test was conducted for patients diagnosed with SMA in Australia for 2010 and 2011. In addition, a retrospective clinical audit was conducted in eight major Australian paediatric hospitals of the end-of-life care provided to children with confirmed SMA 1 from 2005 to 2010. RESULTS Thirty-five children were included in the clinical audit, accounting for an estimated 61% of children diagnosed with SMA 1 from 2005 to 2010. Twenty-six per cent were ventilated invasively, only two of whom were intubated after the diagnosis was confirmed. No children were ventilated long term (>90 days) or had a tracheostomy performed. Nasogastric tube feeding was a common measure to support adequate nutritional intake. Total parenteral nutrition, gastrostomy and fundoplication were not provided for any children. Conflict over end-of-life care decisions was documented in one instance, without the involvement of a guardianship tribunal. CONCLUSION There appears to be a consistent approach in the management of children with SMA 1 in Australia, which can be characterised as 'actively managed dying'. This study could contribute to the development of Australian consensus guidelines for the management of these children. These results also highlight a number of ethical issues related to the management of children with SMA 1.
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Affiliation(s)
- Benjamin Tassie
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Affiliation(s)
- Henry Kilham
- Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Mehr S, Rego S, Kakakios A, Kilham H, Kemp A. Treatment of a case of pediatric hypereosinophilic syndrome with anti-interleukin-5. J Pediatr 2009; 155:289-91. [PMID: 19619754 DOI: 10.1016/j.jpeds.2009.01.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 12/16/2008] [Accepted: 01/22/2009] [Indexed: 11/30/2022]
Abstract
We report the use of anti-interleukin-5 (mepolizumab) during an 18-month period in a pediatric hypereosinophilic syndrome. Infusions every 3 months allowed better control of hypereosinophilic syndrome flares and maintained blood eosinopenia with significantly less steroid use compared with all other therapies (prednisolone alone, interferon alpha, or imatinib mesylate).
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Affiliation(s)
- Sam Mehr
- Department of Allergy & Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Isaacs D, Kilham H, Leask J, Tobin B. Ethical issues in immunisation. Vaccine 2009; 27:615-8. [DOI: 10.1016/j.vaccine.2008.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 10/08/2008] [Accepted: 11/03/2008] [Indexed: 10/21/2022]
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Abstract
We report a 10-year-old girl with enthesitis and Staphylococcus aureus tendon sheath abscess as complications of severe carbamazepine hypersensitivity. Our patient had an adverse reaction to intravenous immunoglobulin and this, as well as the use of corticosteroids, may have contributed to her condition.
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Affiliation(s)
- Ameneh Khatami
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
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Abstract
We present a baby with spinal muscular atrophy type 1, an inherited disorder causing progressive weakness, leading to complete paralysis of respiratory, facial and limb muscles. Without intervention, death occurs in infancy due to respiratory failure. Mechanical ventilatory support can prolong life, but the child's quality of life is highly debatable. We discuss the appropriateness of initiating and continuing intensive care for this child and others in a similar position.
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Affiliation(s)
- Monique M Ryan
- Department of Neurology, Children's Hospital at Westmead, Westmead, and University of Sydney, Sydney, Australia
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Isaacs D, Kilham H, Gordon A, Jeffery H, Tarnow-Mordi W, Woolnough J, Hamblin J, Tobin B. Withdrawal of neonatal mechanical ventilation against the parents' wishes. J Paediatr Child Health 2006; 42:311-5. [PMID: 16712566 DOI: 10.1111/j.1440-1754.2006.00861.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neonatologists and parents usually agree when intensive treatment should be stopped. We describe the management of two babies where there was disagreement between the parents and hospital staff, and discuss the medical, legal and ethical implications of the two cases.
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Affiliation(s)
- David Isaacs
- Clinical Ethics Advisory Committee, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
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Cooper P, Collins J, Leveaux V, Isaacs D, Kilham H, Tobin B. Rebecca's story. J Paediatr Child Health 2005; 41:453-5. [PMID: 16101983 DOI: 10.1111/j.1440-1754.2005.00669.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Peter Cooper
- Department of Respiratory Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Isaacs D, Kilham H, Hodson E, Tobin B. Parent-requested treatment. J Paediatr Child Health 2001; 37:501-2; discussion 502-3. [PMID: 11885717 DOI: 10.1046/j.1440-1754.2001.00731.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The decision about EPO was referred to and made by the Drug Committee, a committee of physicians, nurses and pharmacists. This committee has perforce to make decisions about drugs and vaccines, decisions which sometimes have a significant ethical component due to concerns about cost, safety and efficacy. Our hospital is considering developing a Clinical Ethics Advisory Committee, to assist with difficult ethical decisions such as this one. Should such a committee be asked to make acute ethical judgements on patient management? Larcher describes his ideal Hospital Ethics Committee as nonprescriptive, and suggests a more appropriate role is retrospective analysis and reflective discussion of clinical ethical problems. Such discussion may help with future rather than current management issues, and can help support clinicians in their decisions and hospital staff in their management of patients.
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Affiliation(s)
- D Isaacs
- The Children's Hospital at Westmead, NSW, Australia.
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Hanlon MG, Gacis ML, Kakakios AM, Kilham H. Investigation of suspected deficient Fas-mediated apoptosis in a father and son. Cytometry 2001; 43:195-8. [PMID: 11170106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND A 2-year-old boy presented with symptoms consistent with a diagnosis of autoimmune lymphoproliferative syndrome (ALPS). His father had been splenectomized at age 12 with similar symptoms. ALPS is a rare hereditary syndrome that may result from a functional defect in Fas-mediated apoptosis. METHODS Peripheral blood lymphocytes (PBL) and splenic lymphocytes from the patient and PBL from his father and a normal control were analyzed for surface Fas expression. They were then stimulated with an anti-Fas monoclonal antibody (DX2). Apoptosis was assayed by flow cytometry at 0, 20, 28, and 34 h. RESULTS There was no significant difference in expression of Fas (CD95) in the PBL of the patient, his father, or the normal control, or the splenic lymphocytes. Compared with the normal control, the PBL of the patient and his father failed to progress to apoptosis. They also contained a markedly elevated proportion of CD3+CD4-CD8- "double-negative" cells. CONCLUSIONS PBL from both the patient and his father expressed CD95, but failed to proceed to apoptosis after stimulation, suggesting a functional defect. These results and the clinical presentation are consistent with published descriptions of ALPS.
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Affiliation(s)
- M G Hanlon
- Department of Immunology and Infectious Diseases, The New Children's Hospital, Westmead, NSW, Australia.
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Cooper C, Kilham H, Ryan M. Ipecac--a substance of abuse. Med J Aust 1998; 168:94-5. [PMID: 9469196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Affiliation(s)
| | - Henry Kilham
- Child Protection UnitThe New Children's HospitalPO Box 3515ParramattaNSW2124
| | - Michael Ryan
- Child Protection UnitThe New Children's HospitalPO Box 3515ParramattaNSW2124
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Jones KJ, Wilcken B, Kilham H. The long-term evolution of a case of 3-hydroxy-3-methylglutaryl-coenzyme A lyase deficiency associated with deafness and retinitis pigmentosa. J Inherit Metab Dis 1997; 20:833-4. [PMID: 9427155 DOI: 10.1023/a:1005388205719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- K J Jones
- Department of Clinical Genetics, Royal Alexandra Hospital for Children, Sydney, Australia
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Kilham H, Benn R. Diphtheria--the Australian perspective. Commun Dis Intell (2018) 1997; 21:164-5. [PMID: 9198303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Burgess MA, Levy M, Alperstein G, Mira M, Bek M, Isaacs D, Kakakios A, Fasher B, Hanson R, Kilham H, Malcolm M. "On the spot' vaccination: does it work? J Paediatr Child Health 1996; 32:63-7. [PMID: 8652218 DOI: 10.1111/j.1440-1754.1996.tb01545.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To trial and evaluate a system of "on the spot' vaccination for children up to the age of 15 years in the Early Childhood Centres of the Central Sydney Area Health Service, at the Royal Alexandra Hospital for Children and in a number of general practices in the area. METHODOLOGY A brief questionnaire was used to collect data from parents and health care professionals about the child's vaccination status and vaccines given "on the spot'. RESULTS Over an 8 week period in August-September 1993, 5162 questionnaires were completed; 71% of children were up to date with their vaccination. If Haemophilus influenzae type b vaccine, which had been introduced only 2 months before commencement of the study, was excluded, 84% of the children were up to date. A total of 441 children were given 663 vaccinations "on the spot'. Very few children were too ill to be vaccinated (6%). However, only 30% of those who needed vaccination "on the spot' actually received it (441 of 1480), and only 41% (24 of 58) of a subset of those who were not vaccinated were known to have complied 1 month later. Children attending Early Childhood Centres were younger than children attending general practices or the hospital. CONCLUSIONS A high proportion of children who attended for routine or acute health care had vaccinations overdue (30%). If this scheme could be continued and expanded it would have an important impact on vaccination coverage, and hence on the incidence of vaccine-preventable diseases.
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Affiliation(s)
- M A Burgess
- Royal Alexandra Hospital for Children, Camperdown, New South Wales, Australia
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McEniery J, Gillis J, Kilham H, Benjamin B. Review of intubation in severe laryngotracheobronchitis. Pediatrics 1991; 87:847-53. [PMID: 2034489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Of 208 children who required relief of severe airway obstruction due to laryngotracheobronchitis by an artificial airway (nasotracheal intubation or tracheostomy) during a 10-year-period, 181 (87%) were intubated and later extubated. Twenty-seven children (13%) had tracheostomies performed. The tracheostomies were for severe subglottic narrowing precluding the passage of an adequate size endotracheal tube in 10 children, and for severe endotracheal tube trauma in 17 children. Five children developed acquired subglottic stenosis (2.4% of 208) and 1 of these has a retained tracheostomy. One child died of cardiac disease. The remaining 202 children had no long-term complications of laryngotracheobronchitis, intubation, or tracheostomy. It is concluded that nasotracheal intubation is a satisfactory artificial airway for laryngotracheobronchitis. Endoscopic evaluation in a selected group of these children will identify those with significant intubation trauma or severe subglottic narrowing in whom continued intubation may cause permanent subglottic damage. The low incidence of acquired subglottic stenosis in this series supports the practice of selective endoscopy and tracheostomy.
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Affiliation(s)
- J McEniery
- Intensive Care Unit, Children's Hospital, Camperdown, Sydney, Australia
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Affiliation(s)
- D Fitzgerald
- Infectious Diseases Unit, Children's Hospital, Camperdown, NSW, Australia
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Gillis J, Kilham H. Entrapment. Crit Care Med 1990; 18:897. [PMID: 2379407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Sixty-four (48%) of 133 children with hematologic malignancy who were admitted to three pediatric ICUs died. Children who required management because of airway obstruction or after general anesthesia had the best outlook (mortality rate of 7% or less); those children who required major circulatory support or mechanical ventilation for hypoxemia did poorly (mortality rate of 84% or greater). Certain conditions in children with hematologic malignancy that require intensive care are associated with a mortality rate of approximately 75%. These include the following: suspected sepsis, interstitial pneumonitis, encephalopathy due to sepsis or hemorrhage. In children with these life-threatening conditions, therapy must be improved because at this stage, the patients do not benefit from admission to the ICU.
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Affiliation(s)
- W Butt
- Intensive Care Unit, Royal Children's Hospital, Victoria, Australia
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Abstract
A retrospective review was conducted of all children admitted to our intensive care unit over eight years with a diagnosis of pertussis that had been proved on culture. Altogether 789 children were seen as outpatients and inpatients. Twenty four of these children were admitted to the intensive care unit, 13 of whom required ventilatory support; two of the ventilated patients died. Intubation and ventilation were usually started for appreciable apnoea. Most patients requiring support were less than 3 months of age and required intervention within the first 16 days of cough. For these patients ventilation was neither difficult nor prolonged. Coughing spasms were not a problem and intubation and ventilation appeared to attenuate the progress of the disease. The presence of severe bacterial pneumonia associated with difficult ventilation requiring neuromuscular paralysis indicated a poor prognosis. It is suggested that intubation and ventilation can be safely used in very severe pertussis infection and, because of their greater risk of hypoxic damage and death, it should not be reserved as a last resort in critically ill infants.
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Affiliation(s)
- J Gillis
- Intensive Care Unit, Children's Hospital, Camperdown, Sydney, Australia
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Kilham H. Venom diseases in Australia and their treatment. Aust Fam Physician 1987; 16:1000-1. [PMID: 3662943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
This article describes management of newborn and older children with severe upper airway obstruction, that is, those needing or likely to need airway support for their intact survival. These children have more to gain from optimal care, and more to lose from any error than most other children requiring admission to a pediatric intensive care unit.
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Abstract
To examine further the relation between type of exercise, workload, ventilation, and exercise-induced asthma, we compared treadmill walking with treadmill running and treadmill running with isocapnic hyperventilation in separate studies in children and adolescents. Inspired air conditions were identical during each pair of tests. Walking and running with similar minute ventilation and oxygen consumption were followed by similar falls in peak expiratory flow rate as were running and hyperventilation with similar minute ventilation and end-tidal carbon dioxide tension. This study supports the concept that hyperventilation is a central mechanism in exercise-induced asthma.
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Truscott RJ, Hick L, Pullin C, Halpern B, Wilcken B, Griffiths H, Silink M, Kilham H, Grunseit F. Dicarboxylic aciduria: the response to fasting. Clin Chim Acta 1979; 94:31-9. [PMID: 455718 DOI: 10.1016/0009-8981(79)90183-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The urine of a child who presented with an episode of a disease resembling Reye's syndrome was found to contain large quantities of the dicarboxylic acids adipic and suberic acids, as well as the glycine conjugate of suberic acid, suberyl glycine. A variety of other dicarboxylic acids, both saturated and unsaturated, were also found in the urine at the time of the attack. It was found that the excretion of these unusual metabolites could be markedly increased by fasting for periods of greater than 10 h. These results indicate that the patient may have a defect in fatty acid oxidation which becomes clinically significant during periods of prolonged fasting.
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40
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Posen S, Lee C, Vines R, Kilham H, Latham S, Keefe JF. Transient hyperphosphatasemia of infancy--an insufficiently recognized syndrome. Clin Chem 1977; 23:292-4. [PMID: 832398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Spectacular transient increases in serum alkaline phosphatase were observed in five infants in the absence of demonstrable pathology.
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Abstract
Abstract
Spectacular transient increases in serum alkaline phosphatase were observed in five infants in the absence of demonstrable pathology.
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