Sore throat, fever, and pancytopenia during winter.

Care must be taken to mitigate the effect of cognitive bias in times of frequent common presentations. The etiology of bicytopenias and pancytopenias must always be carefully investigated. Blast cells in low count B ALL may not be seen on a peripheral smear and diagnosis often requires confirmational bone marrow aspirate with flow cytometry and molecular typing.

Common pathway coagulopathy and hemorrhagic edema of infancy.

When screening tests of haemostasis are abnormal, it is important to identify at which point in the coagulation cascade dysfunction may be occurring. This may assist to identify a specific deficiency/dysfunction, the type of bleeding to be anticipated, and replacement therapy if required. Unmasking of an inherited coagulopathy or the development of an acquired coagulopathy may occur in the setting of a second (febrile) illness. Differentiating between inherited and acquired coagulopathies will rely on clinicians taking a thorough personal and family bleeding history, and correlating these findings with the haemostasis screening results.

Trends in Childhood Oncology Admissions to ICUs in Australia and New Zealand.

OBJECTIVES: There are few robust, national-level reports of contemporary trends in pediatric oncology admissions, resource use, and mortality. We aimed to describe national-level data on trends in intensive care admissions, interventions, and survival for children with cancer. DESIGN: Cohort study using a binational pediatric intensive care registry. SETTING: Australia and New Zealand. PATIENTS: Patients younger than 16 years, admitted to an ICU in Australia or New Zealand with an oncology diagnosis between January 1, 2003, and December 31, 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We examined trends in oncology admissions, ICU interventions, and both crude and risk-adjusted patient-level mortality. Eight thousand four hundred ninety admissions were identified for 5,747 patients, accounting for 5.8% of PICU admissions. Absolute and population-indexed oncology admissions increased from 2003 to 2018, and median length of stay increased from 23.2 hours (interquartile range [IQR], 16.8-62 hr) to 38.8 hours (IQR, 20.9-81.1 hr) ( p < 0.001). Three hundred fifty-seven of 5,747 patients died (6.2%). There was a 45% reduction in risk-adjusted ICU mortality, which reduced from 3.3% (95% CI, 2.1-4.4) in 2003-2004 to 1.8% (95% CI, 1.1-2.5%) in 2017-2018 ( p trend = 0.02). The greatest reduction in mortality seen in hematological cancers and in nonelective admissions. Mechanical ventilation rates were unchanged from 2003 to 2018, while the use of high-flow nasal prong oxygen increased (incidence rate ratio, 2.43; 95% CI, 1.61-3.67 per 2 yr). CONCLUSIONS: In Australian and New Zealand PICUs, pediatric oncology admissions are increasing steadily and such admissions are staying longer, representing a considerable proportion of ICU activity. The mortality of children with cancer who are admitted to ICU is low and falling.

Implications for paediatric training and workforce from pandemic disruptions: A view from a tertiary hospital.

AIM: To understand the lived experience of paediatric trainees in relation to their educational opportunities, workforce roles and the interplay between them, during pandemic disruptions. METHODS: Twenty paediatric trainees working at Australian paediatric hospitals during the time of COVID-19 restrictions were interviewed between July and November 2020. Based on a phenomenological approach, the interviews examined junior doctors' experiences in relation to medical education, adaptive education modes, learning opportunities and their workforce roles during the pandemic. Qualitative inductive thematic data analysis was used to develop a cohort narrative. RESULTS: Four overarching themes were identified regarding trainee perceptions of the impact of COVID-19 restrictions on learning opportunities, both positive and negative. These were: impaired rapport building, altered team role, altered care and education affordances versus access. Participants felt ill-equipped to provide optimal clinical care during virtual and stifled in-person consultations, detached from the multidisciplinary team, that changed work roles diminished their professional self-worth, and that online learnings were advantageous if rostering afforded opportunities to engage with them. CONCLUSION: To equip paediatric trainees for the next steps in their careers, we suggest the following areas of focus: the use of new tools of rapport, smart investment in clinical moments, reconnection of multidisciplinary teams and learning, the support of online learning infrastructure with protected education time and roadmaps for learning, and teaching on how to triage information sources and alongside clinical visit types.

The void: COVID-19 restrictions and junior doctor education opportunities.

BACKGROUND: In the setting of the COVID-19 pandemic, the modes of hospital service delivery, education, training, and the context surrounding them has undergone enormous change and disruptions. OBJECTIVE: This study aimed to understand the 'lived-experience' of junior doctors in relation to their education, training, and professional development during the pandemic. METHODS: A qualitative study based on thematic and cohort narrative analysis. 20 junior doctors who trained at an Australian tertiary paediatric hospital during the time of COVID-19 restrictions were interviewed. Based on a phenomenological approach, the interviews examined junior doctors' experiences in relation to medical education, adaptive education styles and the value attributed by participants to different forms of education provided to them. RESULTS: Four overarching themes were identified regarding trainee perceptions of the impact of COVID-19 restrictions on learning opportunities, both positive and negative. These were: 'The void' - learning expectations junior doctors felt were missed, education affordances, peers and networks, and professional identity. CONCLUSION: The pace with which educators have adapted to new teaching modes should be harnessed to incite equally novel curriculum evolution, smart investment in clinical moments, reconnect learning communities and create robust virtual learning environments.

Simulation translation differences between craft groups.

BACKGROUND: Many simulation-based clinical education events (SBCEE) aim to prepare healthcare professionals with the knowledge, skills, and features of professionalism needed to deliver quality patient care. However, how these SBCEE learnings are translated into broader workplace practices by learners from different craft groups has not been described. OBJECTIVES: To understand how learners from different craft groups (doctors and nurses) anticipate simulation-based learnings will translate to their workplaces and the process by which translation occurs. DESIGN: Qualitative descriptive study design using pre- and post-SBCEE questionnaires. SETTINGS: A large tertiary Australian hospital-based simulation centre that facilitates SBCEE for multi-professional graduate and undergraduate clinicians from 16 hospitals. METHODS: Participants who attended SBCEEs between May and October 2021 completed questionnaires at two touchpoints, on the day of attending a SBCEE and 6 weeks after. Based on a phenomenological approach, the study examined clinicians' experiences in relation to simulation education, intended simulation learning use in the workplace, and perceived success in subsequently using these learnings to improve clinical outcomes. Qualitative inductive thematic data analysis was used to develop narratives for different learner cohorts. RESULTS: Three overarching themes were identified regarding simulation participants' perceptions of the success of translating simulation learnings into the workplace. These were: scenario-workplace mirroring, self-assessment, and successful confidence. Doctor participants found it difficult to map SBCEE learnings to their workplace environments if they did not mirror those used in simulation. Nurses sought peer evaluation to analyse the effectiveness of their workplace translations, whereas doctors relied on self-assessment. Learners from both craft groups highly prized 'confidence-building' as a key indicator of improved workplace performance achieved through SBCEE learning. CONCLUSION: A diverse range of factors influences healthcare workers' experiences in translating simulation learnings to their workplace. To equip simulation learners to translate learnings from a SBCEE into their clinical practices, we suggest the following areas of focus: co-development of translation plans with learners during the delivery of an SBCEE including the indicators of success, above table discussions on the generalisability of learnings to different environments and contexts, smart investment in simulation outputs, and cautious championing of confidence-building.

Congenital Tuberculosis Complicated by Hemophagocytic Lymphohistiocytosis.

We present the case of a male infant with congenital tuberculosis in a nonendemic setting complicated by hemophagocytic lymphohistiocytosis, who was treated successfully with antituberculous therapy and corticosteroids. We review the pediatric literature concerning the unusual association of these 2 rare conditions.