Latest news with #paediatric
ABC News
24-05-2025
- Health
- ABC News
A pilot program brought down waiting times for paediatric patients, but its future is in doubt
A pilot program designed to reduce paediatric wait times in Tasmania was abruptly ended six months early, according to one of the doctors involved. The General Practitioners with Special Interest (GPwSI) project was part of a broader strategy to address wait times in outpatient clinics across the state. The idea was to place doctors with a specific interest in a range of outpatient clinics like antenatal, cardiology and mental health services to come up with new models of care. The GPs would be working between half a day to two days a week. According to the Health Department, the funding for the entire program was equivalent to employing two full-time GPs for two years. The ABC has been told that while doctors were offered shorter contracts, some were led to believe the pilot program would run for two years, until June 2025, and were shocked when it ended sooner than expected. Tim Jones is one of the doctors who was employed as part of the pilot in mid-2023. He was placed at the Royal Hobart Hospital (RHH) paediatric clinic. "Because of my natural scope being more linked to younger kids, I prioritised seeing any child of seven or under who was on our waitlist here in southern Tasmania," Dr Jones said. While not a fully qualified paediatrician, Dr Jones was able to provide broader assessments, looking at the child's environment, family and school and then linking them up with the support they needed. "We could tease out which kids needed which layer of support," he said. "That meant the kids that did need to go through and have a full formal ADHD [or autism] assessment, we could screen them out and make sure they then got that assessment, whereas kids who needed other pathways, we made sure they got timely access to those services." Often, Dr Jones said, the primary problem was not attention deficit hyperactivity disorder (ADHD) or autism, but things like poor sleep patterns, inadequate supports in school and dyslexia. By managing to filter out those who could be assisted by other services, it meant children who needed more complex assessments could see a paediatrician in a more timely manner. Then in November, Dr Jones was told his position could no longer be funded, and his contract would not be extended and would end in January. Dr Jones said he had been told from the beginning, including during the interview, that the program would run until the end of June this year. The ABC understands other GPs with specific interests were told similar things. "What we found was that a lot of the GPs were able to …integrate well with the systems and start to deliver some outcomes, so it came as a shock to all of us that we received limited notice that the funding was not to be continued past the 18 month mark," DrJones said. According to the Health Department, wait times in Tasmania for a non-urgent patient to see a public paediatrician can last close to two years. That varies depending on where in the state the person is. The private system is no better, as Anna Nottage knows. When her daughter Lottie was aged two, she tried to get her into a paediatrician, concerned about her delayed development. She was referred to a private clinic and the public one at the Royal. Both had extensive waitlists. In the meantime, Ms Nottage and Lottie were able to see Dr Jones, who was working at the developmental clinic at the RHH. While Lottie turned out to be one of the complex cases who did need to be seen by a paediatrician, Ms Nottage said being able to discuss her concerns with Dr Jones was reassuring. "He was a great support," she said. Labor's Shadow Health Minister Ella Haddad said it was disappointing for Tasmanian families waiting in that system that the program had ended. "This is a program that was actually having a tangible effect on [those long waitlists]," she said. "For that to be cut, we know the wait times are just going to get longer and harder for Tasmanians who already need these services early. In April, the state government opened a specialist service for children and young people with suspected ADHD in the south, and there are plans to expand statewide. It also includes funding for two GPs with special interests in ADHD. But that service will not help kids like Lottie, who was eventually diagnosed with autism and is now seeing one of the new paediatricians at a private clinic. "There are a lot of parents probably going through the same thing," Ms Nottage said. "They haven't got a paediatrician and need that stopgap for children with behavioural or developmental needs. In a statement, a Health Department spokesperson said they acknowledged the positive impact the GPwSI model of care pilot had caused for "some patients, particularly in paediatrics". The spokesperson said an evaluation of the broader pilot was being finalised, which would provide guidance on how the department "can best utilise the state's highly-skilled GPwSI and rural generalist workforce across our health service".
Times
10-05-2025
- Health
- Times
A surgeon was flagged as dangerous — she kept operating for ten years
Hospital bosses were warned about an NHS surgeon almost nine years before she was eventually suspended over botched operations on children. A joint investigation by The Sunday Times and Sky News has discovered a confidential report written for managers at Cambridge University Hospitals Trust in 2016 that identified problems with the surgical technique and practice of Kuldeep Stohr, a paediatric orthopaedic surgeon. A series of recommendations were made in the report but Stohr was allowed to continue operating. Managers at the hospital told staff the investigation into Stohr had not raised any concerns. Almost a decade on, Stohr has been suspended by the trust after a new review identified at least nine children whose care 'fell below the standard' expected. The trust has begun a
Telegraph
06-05-2025
- Health
- Telegraph
I'm allergic to dogs – I've told my fiancé it's me or them
What are allergies? Put simply, allergies occur when the immune system reacts inappropriately to a harmless, foreign substance that gets inside the body. The substance is known as an allergen. Adam Fox is a professor of paediatric allergy at several London hospitals, and one of the UK's leading experts on the subject. 'People who are allergic have a broad genetic tendency called 'atopy' where they have the potential for inappropriate immune responses,' he says. 'The allergy is caused by the genetic tendency, plus environmental factors.' There tend to be four types of allergic conditions – food allergies, eczema, asthma and allergic rhinitis (hay fever falls into the latter category). 'If you have an allergy, your immune system produces antibodies called Immunoglobulin E (IgE),' says Fox. 'Each antibody is specific to the allergen that causes the overreaction when it sees that trigger' – so there can be different ones for different breeds of dogs, or types of trees, for example. This is why some people are only allergic to cat dander – they only have the IgE antibodies specific to cat dander – while others have allergic reactions to multiple allergens because they have many more types of IgE antibodies. ('Dander' is the name for the dead skin cells that can trigger an allergic reaction.) 'These antibodies send signals to cells that release chemicals, causing an allergic reaction,' says Fox. 'The body then releases histamine, which causes itchiness or swelling. Each type of IgE has specific 'radar' for a particular allergen.' Common allergies include pollen, certain foods or, as in my case, hairy animals – (as far as I know, I'm not allergic to fish or snakes). Anaphylaxis – the potentially fatal reaction that leads to swelling of the airways and a dangerous drop in blood pressure – is more prevalent in allergies to foods such as peanuts, and far less likely with animals (though not unheard of). Are allergies – of all types – increasing? It certainly feels like there's more conversation around food allergies these days – all you need to do is receive a menu in a restaurant – but is it actually true that allergies are becoming more common? 'The data on this is conflicting,' says Fox. 'A study from Imperial College last year showed a doubling in food allergies over 10 years, but other research has shown there hasn't been an increase. On the other hand, there is robust data that more people are turning up in A&E with severe reactions to foods.' How is a pet allergy diagnosed? 'If you suspect you have a pet allergy, it is important to discuss this with a GP, especially if you have other allergic conditions such as asthma, rhinitis or eczema,' says the charity Allergy UK. Your GP may refer you for testing to confirm or exclude a pet allergy, done by a blood test for the specific IgE to the suspected animal, or by skin prick testing. Then you might be referred to an allergy specialist. How are pet allergies treated? There are three main approaches, say the experts. Avoidance Keeping away from the allergen. 'This is easier if you are allergic to animals rather than pollen, which can be hard to avoid during the pollen season,' says Fox. (This writer would disagree: dogs, it seems, are as prevalent as trees and flowers these days.) When it comes to pets it's not just as simple as keeping away from their hair or their dander. Anooj Majithia is an consultant ear, nose and throat (ENT) surgeon at the London North West University Healthcare NHS Trust, and the Clementine Churchill Hospital. 'If you are allergic to animals, you will also be affected by the animal's sweat, urine and saliva,' he says. 'For this reason, I'm afraid the idea of a hypoallergenic dog is a myth.' Although, it is true that short-haired dogs such as poodles and schnauzers shed fewer hairs and are less allergenic than other breeds such as labradors and alsatians. The best bet, says Fox, is to keep the pet out of your bedroom at all times. 'Though it can be tricker with cats,' he says. 'Cat dander is lighter than dog dander: it gets around – it was even found on the international space station.' For cat owners unfortunate enough to be allergic to their pets, there are brands of cat food – such as Purina Pro Plan LiveClear – designed to reduce allergens in hair and dander. Sadly, no such product exists for those with dog allergies. Medicines Antihistamines: 'If you know you're going to be in contact with a pet, it's a good idea to start taking long-acting, non-drowsy antihistamines two or three days in advance,' saysFox. 'Fexofenadine or cetirizine are better than short-acting antihistamines such as Piriton. 'If you find these don't work sufficiently, consider doubling the dose after discussion with your GP or pharmacist,' says Fox. There can be a bit of trial and error while you find out which antihistamine works best for you. Nasal sprays: 'Over-the-counter topical steroid nasal sprays such as Beconase, can be useful, but you have to use them every day,' says Fox. Children need a prescription for these. Majithia recommends Dymista, a nasal spray which combines topical steroids and antihistamines – this has just become available over the counter. Note to self: Cetirizine doesn't work that well for me – I'll be trying Fexofenadine, and consider seeing a doctor about Dymista. Immunotherapy, or desensitisation Immunotherapy – often referred to as desensitisation – is a unique treatment for allergic diseases across the spectrum, from pets, to life-threatening allergies such as bee venom or peanuts. It involves the administration of increasing doses of allergen extracts over a period of time, with the view that the patient will develop 'immunity'. There are two types of immunotherapy for allergies: SCIT (subcutaneous immunotherapy) or SLIT (sublingual). The first involves injections and the second, putting drops or tablets containing the allergen under the tongue. Allergy jabs used to be more common, but they carry some risk: according to Fox, between the 1950s and the 1980s, 30 people died of anaphylactic shocks after desensitising injections, so they are rarely used these days. 'Over two billion doses of SLIT have been given, and it's safe,' says Fox, who has prescribed SLIT in families where the parent was a jockey and their child allergic to horses, as well as to the sensitive child of a veterinary surgeon. But for SLIT to be effective, a patient has to take the treatment every day for three years. It's also expensive – at around £100 a month (though exceptional cases have been treated on the NHS). Sadly, for me and other sniffling dog-sufferers, a slam-dunk preventative treatment for animal allergies is still some way off. 'SLIT is most commonly used for grass and tree pollen, as well as house-dust mites, and there are licensed treatments available both on the NHS, and privately,' says Fox. 'As far as pets are concerned, immunotherapy will reduce, rather than eliminate, symptoms, so it's not carte blanche to have a dog or a cat at home.'
