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Selected AbstractsLong bone fractures in children under 3 years of age: Is abuse being missed in Emergency Department presentations?JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2004J Taitz Objective: Distinguishing injuries due to accidents from those due to child abuse in young children is important to prevent further abuse. We aimed to study the presenting features, mechanism of injury, type of fracture and indicators of possible abuse in children under 3 years of age, presenting to the Emergency Department (ED) of a tertiary referral Children's Hospital, to see whether those injuries that were more likely abusive were distinguished from those that were more likely accidental. Methods: We analysed the medical records from the Emergency Department Information System of all children below 3 years of age, who were treated for a long bone fracture at the Sydney Children's Hospital, Randwick, NSW, over a 1-year period. Demographic details, presenting complaint, mechanism of injury, type of fracture, other historical and examination data and action taken were noted. Nine indicators that raise suspicion of abuse were developed from the literature. Using these indicators, patients' ED notes were reviewed to establish whether long bone fractures suspicious for abuse had been referred for further evaluation. Results: One hundred patients with a total of 103 fractures presented during the study period. No child had multiple fractures at a single visit. The fractures included 36 radius/ulna, 27 tibia/fibula, 20 humeral, 17 clavicular and three femoral. The mean age of patients was 21.6 months (range 13 days , 35 months). Fourteen patients were younger than 12 months. Review of the notes revealed 31 children with indicators suspicious for abuse, of whom 17 children had one indicator, 11 children had two indicators, and three children had three indicators. Only one child was referred for further evaluation to child protection. Conclusion: Abuse cannot usually be determined by fracture type alone. Doctors in the ED miss indicators for abuse because they do not look for these indicators in the history and examination. Knowledge of indicators that raise suspicion of abuse is needed for a further forensic assessment to occur. The development of specific referral guidelines, ongoing education and a comprehensive injury form may improve referral of children from the ED to child protection. [source] Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic regionANZ JOURNAL OF SURGERY, Issue 11 2004Tahsin Colak Background: Because controversy still continuous to surround use of total thyroidectomy for the management of benign multinodular goiter, the present study aims to prospectively compare the safety and efficacy of total thyroidectomy with subtotal thyroidectomy. Methods: A total of 200 consecutive patients with benign multinodular goiter were assigned to have either total thyroidectomy (n = 105) or subtotal thyroidectomy (n = 95) based on preoperative evaluation, intraoperative macroscopic findings and nodular dissemination. The patients with no healthy tissue or nodules localized in the dorsal part of the gland, which are usually left during normal subtotal resection, were assigned to the total thyroidectomy group. Demographic details, biochemical findings, indications for operation, operating time, specimen weight, complications and hospital stay were noted. Results: There was no significant difference in the sex, hormonal status or duration of goiter between the two groups (P = 0.74, P = 0.59 and P = 0.59, respectively). The mean operating time was longer (148.52 min ± 51.10 vs 135.10 min ± 32.47, P = 0.03), and the mean weight of the specimens was greater (228.40 g ± 229.91 vs 157.01 g ± 151.23, P = 0.01) for total rather than subtotal thyroidectomy. Either temporary recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism occurred in 10 (9.3%) or 12 (11.4%) of the patients undergoing total compared with six (6.3%) or nine (9.5%) of the patients undergoing subtotal thyroidectomy (P = 0.40 and P = 0.65, respectively). Either permanent RLN palsy or hypoparathyroidism was observed in one patient undergoing total thyroidectomy (P = 0.34 for each comparison). The mean hospital stay was longer in the total thyroidectomy group (2.24 days ± 1.18 vs 1.89 days ± 0.72 for subtotal thyroidectomy, P = 0.01). Conclusions: The present study shows that total thyroidectomy can be performed without increasing risk of complication, and it is an acceptable alternative for benign multinodular goiter, especially in endemic regions, where patients present with a huge multinodular goiter. [source] Short-term outcome after active perinatal management at 23,25 weeks of gestation.ACTA PAEDIATRICA, Issue 7 2004A study from two Swedish tertiary care centres. Aims: To provide descriptive data on women who delivered at 23,25 wk of gestation, and to relate foetal and neonatal outcomes to maternal factors, obstetric management and the principal reasons for preterm birth. Methods: Medical records of all women who had delivered in two tertiary care centres in 1992,1998 were reviewed. At the two centres, policies of active perinatal and neonatal management were universally applied. Logistic regression models were used to identify prenatal factors associated with survival. Results: Of 197 women who delivered at 23,25 wk, 65% had experienced a previous miscarriage, 15% a previous stillbirth and 12% a neonatal death. The current pregnancy was the result of artificial reproduction in 13% of the women. In 71%, the pregnancy was complicated either by preeclampsia, chorioamnionitis, placental abruption or premature rupture of membranes. Antenatal steroids were given in 63%. Delivery was by caesarean section in 47%. The reasons for preterm birth were idiopathic preterm labour in 36%, premature rupture of membranes in 41% and physician-indicated deliveries in 23% of the mothers. Demographic details, use of antenatal steroids, caesarean section delivery and birthweight differed between mothers depending on the reason for preterm delivery. Of 224 infants, 5% were stillbirths and 63% survived to discharge. On multivariate logistic regression analysis comprising prenatally known variables, reasons for preterm birth were not associated with survival. Advanced gestational duration (OR: 2.43 per wk; 95% CI: 1.59,3.74), administration of any antenatal steroids (OR: 2.21; 95% CI: 1.14,4.28) and intrauterine referral from a peripheral hospital (OR: 2.93; 95% CI: 1.5,5.73) were associated with survival. Conclusions: Women who deliver at 23,25 wk comprise a risk group characterized by a high risk of reproductive failure and pregnancy complications. Survival rates were similar regardless of the reason for preterm birth. Policies of active perinatal management virtually eliminated intrapartum stillbirths. [source] Guidelines for the descriptive presentation and statistical analysis of contact allergy dataCONTACT DERMATITIS, Issue 2 2004Wolfgang Uter The present guidelines aim to support clinical researchers in adequately presenting data on contact allergy, and to use statistical tests appropriate for their data. A description of the mode of selection of patients, and of their relevant demographic details, is an essential prerequisite for the correct interpretation of study results. Proportions and rates, if regarded as estimate of these parameters of a target populations, should normally be supplemented with confidence intervals to address precision. Concordance, i.e., agreement between two ratings in a dependent sample, must be quantified with a chance-corrected measure such as Cohen's kappa coefficient. If the diagnostic quality of an outcome is being assessed, standard measures like sensitivity and specificity, as well as the prevalence-dependent positive and negative predictive values should be calculated. Often, contact allergy to a certain substance depends on several factors. In this situation, depending on the research question, techniques like stratification, standardization or multifactorial analysis should be employed. With increasing complexity of statistical description and analysis, consulting with a biostatistician is often mandatory. [source] Human immunodeficiency virus-associated progressive multifocal leucoencephalopathy: epidemiology and predictive factors for prolonged survivalEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2007A. K. Drake We performed a retrospective review of cases of human immunodeficiency virus-associated progressive multifocal leucoencephalopathy in four hospitals (three in Australia and one in Hong Kong) between 1987 and 2003 in order to describe the local experience with this disease and to evaluate parameters impacting upon survival. Eighty-seven cases were identified and demographic details, baseline parameters and treatment methods and response were described. Survival was substantially increased in the post-highly active antiretroviral therapy (HAART) era with a median survival increase from 14 to 64 weeks. On multivariate analysis, variables associated with prolonged survival included a CD4 count of >100 cells/,l at diagnosis and the use of HAART post-diagnosis, with no significant additional advantage from the use of neuroactive antiretrovirals. [source] Characteristics of patients with rheumatoid arthritis presentingfor physiotherapy management:A multicentre studyMUSCULOSKELETAL CARE, Issue 1 2007Grad Dip Statistics, Norelee Kennedy BSc (Physio) Abstract Objectives:,To describe the characteristics of patients with rheumatoid arthritis (RA) attending for physiotherapy management in Ireland. Methods:,Managers of physiotherapy departments in the 53 hospitals in Ireland were invited to participate in a multi-centre observational study over a 6-month period. Data on patients with RA the day of presentation for physiotherapy management were recorded. These data related to patient demographic details, disease management, aids and appliances, splint and orthoses usage and occupational issues. The Health Assessment Questionnaire was also recorded for each patient. Results:,A total of 273 patients from eight physiotherapy departments participated in the survey (n = 199; 73% female). Mean age of the participants was 59.3 (SD 12.5) years with mean disease duration of 13.8 (SD 10.6) years. The majority of the patients were inpatients (n = 170, 62%). Sixty-eight per cent of patients had attended for previous physiotherapy treatment and 98% were under current rheumatologist care. Biologic therapies were prescribed to 11% of patients. Use of splint and foot orthoses was high with 133 patients (49%) wearing splints and 75 (31%) wearing foot orthoses. The majority of patients had moderate (n = 119, 44%) or severe (n = 94, 35%) disability as per Health Assessment Questionnaire (HAQ) score. Mean HAQ score was 1.5, with HAQ scores showing increasing disability with increasing age, disease duration and erythrocyte sedimentation rate (ESR) levels. Conclusions:,Patients with RA attending for physiotherapy management present with varied profiles. This study provides valuable information on the characteristics of patients with RA attending for physiotherapy management which will contribute to physiotherapy service planning and delivery and will optimize patient care. Copyright © 2006 John Wiley & Sons, Ltd. [source] Poor recognition of the UK minimum driving vision standard by motorists attending optometric practiceOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 3 2007Jonathan S. Pointer Abstract Purpose:, To evaluate the current level of recollection of the vehicle number plate viewing distance in a group of motorists. Knowledge of this distance is required to self-check compliance with the UK legal minimum driving vision standard. Methods:, A cohort of 480 motorists aged ,17 years attending optometric practice for a routine sight test agreed to participate in a short verbal survey. They were asked whether they could state the current UK statutory vehicle number plate viewing distance as specified in the Highway Code. Also recorded were each motorist's high contrast logMAR visual acuity, whether or not an optical prescription was habitually worn when driving, and brief demographic details (age, gender). Results:, No statistically significant gender-based difference was present in age distribution, mean logMAR binocular acuity, or age and number (proportion) of motorists who habitually wore a refractive correction when driving. The level of mean binocular acuity was uniformly good (<0.0 logMAR, or better than 6/6 Snellen). However, the recollection by respondents of the statutory viewing distance was poor: only 5% were able to state correctly the current distance (20 m), and 22% recalled the previous (20.5 m/67 ft) or the original (22.9 m/75 ft) statutory distance. Of the remainder, 28% underestimated and 45% overestimated the distance. A statistically significant gender-based difference (p = 0.01) between the recollections of non-prescription wearers became marked (p = 0.001) for habitual wearers, in which latter case the median value and range of estimates by female motorists was greater than their male counterparts. Conclusions:, The level of recognition by these motorists of the viewing distance necessary to satisfy the legal minimum vision standard required for driving on UK roads was low and comparable to the levels recorded in two similar surveys undertaken by other authors 10 and 20 years ago. An inexpensive and easily implemented publicity innovation is suggested which could help improve driver appreciation of the statutory distance and promote compliance with the legal vision standard. [source] An interim analysis of a cohort study on the preoperative anxiety and postoperative behavioural changes in children having repeat anaestheticsPEDIATRIC ANESTHESIA, Issue 9 2002A. Watson Introduction Anxiety in the preoperative period and at induction of anaesthesia in children is associated with disturbances in postoperative behaviour (1,4). There is little work looking at the effects of repeat anaesthetic procedures on anxiety and subsequent postoperative behaviour disturbances. The aim of this study was to see if the effect of repeat anaesthetics was cumulative on postoperative behavioural problems and whether repeated anaesthetics provoke increasing anxiety. We investigated factors that may identify children who are susceptible to behavioural changes following repeat anaesthetics. We present an interim analysis of data on 8 patients as part of a long-term cohort study on 40 children with retinoblastoma who have required repeat anaesthetics for assessment and treatment of their condition. Method Approval for this study was granted by the East London and City Health Authority ethics committee. 40 patients are being recruited and being followed over a two year period. All children have retinoblastoma and are between the ages of 18 months to 4 years. The anaesthetic technique was not standardised but details of it were collected. Data collected were demographic details of child (age, sex, weight, ASA grade, siblings, stressful events in the last 3 months, recent immunisations, number of previous anaesthetics, problems with previous general anaesthetics, medical history of children, temperament of child using the EASI scoring system (4); demographic data of parents (age, parental education, family members affected, baseline measure of parental anxiety using State trait anxiety inventory (STAI). Anxiety on entry into the anaesthetic room and at induction was measured by the modified Yale preoperative anxiety scale (mYPAS), cooperation of the child at induction was measured by the Induction compliance checklist (ICC). Anxiety of the parent after induction was measured by the STAI score. Behaviour was measured at 1 day, 1 week, 1 month and 4 months after each procedure by means of the post hospital behaviour score (PHBQ) (5). A comparison with preoperative behaviour was made and data is presented of the percentage of children with new negative behavioural problems. A detailed analysis of the types of behaviour change was noted. anova for repeat measures with multiple dependent measures was used to analyse data on child anxiety and postoperative behavioural problems. Results Eight patients have had 3 separate anaesthetics over one and a half years. These have been at 4 monthly intervals. There was no significant increase in anxiety levels with repeat anaesthetics. The median mYPAS score at induction were 100 for all 3 anaesthetics. (P = 0.41). The type of behavioural change was variable and demonstrated no trend. No patient was identified as being prone to behavioural changes after every anaesthetic. Patients who displayed new negative behavioural problems would have them after any anaesthetic with no obvious cumulative effect with each repeat anaesthetic. Conclusions Our patients had maximum anxiety scores at induction, so the mYPAS scoring system is not sensitive enough to show that repeat anaesthetics provoke increasing anxiety. There is a very random pattern to behavioural disturbances after repeat anaesthetics with no evidence that negative behavioural changes are compounded with repeated anaesthetics. Collection of complete data from the remaining 32 patients may yield some trends regarding behavioural disturbances but our use of the mYPAS to measure anxiety in this very anxious population is unlikely to be helpful. [source] Thromboembolism in children with sarcomaPEDIATRIC BLOOD & CANCER, Issue 2 2007Uma Athale MD Abstract Background Thromboembolism (TE) is a common complication and cause of death in adults with cancer. Cancer has been identified as a major risk factor in children with TE. However, the information regarding the epidemiology of TE in children with cancer, especially in association with childhood solid tumors, is scant. Objective To define the prevalence and epidemiology of TE in children with sarcoma. Procedure Hospital records of children ,18 years of age with sarcoma diagnosed and treated at McMaster Children's Hospital during January 1990 to December 2005 were reviewed for demographic details, details of diagnosis and therapy for sarcoma, and details of diagnosis and management of TE. Statistical analysis was performed using Fisher's exact t -test. Results Ten of 70 (14.3%; 95% CI; 7.1, 24.7) patients with sarcoma developed symptomatic TE. Patients with CVL-dysfunction (n,=,9) were at significantly higher risk for symptomatic TE compared to those without CVL dysfunction (n,=,61) (55.5 vs. 8.2%; P,=,0.002, 95% CI; 14.2, 80.5). Patients with pulmonary disease (n,=,23) had higher prevalence of TE compared to those without pulmonary disease (n,=,47) (26 vs.8.5%; P,=,0.07, 95% CI; ,2.06, 37.2). Older patients, patients with metastatic disease and those with Ewing sarcoma had higher prevalence of TE. Conclusions TE is a significant complication in children with sarcoma. Over 50% of patients with CVL dysfunction had symptomatic TE; such patients may warrant careful evaluation for associated TE. Large prospective studies are needed to define the epidemiology and identify risk factors predisposing to TE in children with sarcoma. Pediatr Blood Cancer 2007;49:171,176. © 2006 Wiley-Liss, Inc. [source] Antibiotic-treated infections in intensive care patients in the UKANAESTHESIA, Issue 9 2004B. H. Cuthbertson Summary The purpose of this audit was to study reasons for starting antibiotic therapy, duration of antibiotic treatment, reasons for changing antibiotics and the agreement between clinical suspicion and microbiological results in intensive care practice. We conducted a multicentre observational audit of 316 patients. Data on demographic details, site, treatment and nature of infection were collected. The median duration of antibiotic therapy was 7 days. Infections were community-acquired in 160 patients (55%). Antibiotics were started on clinical suspicion of infection in 237 patients (75%). Pulmonary infections were the most common, representing 52% of all proven infections. Gram-negative organisms were the most common cause of proven infections (n = 90 (50%)). The antibiotic spectrum was narrowed in light of microbiology results in 78 patients (43%) and changed due to antibiotic resistance in 38 patients (21%). We conclude that the mean duration of treatment contrasts with existing published guidelines, highlighting the need for further studies on duration and efficacy of treatment in intensive care. [source] TRANSFER OF FACIALLY INJURED ROAD TRAUMA VICTIMS AND ITS IMPACT ON TREATMENTANZ JOURNAL OF SURGERY, Issue 6 2005Martin Batstone Background: Road trauma is a common cause of severe facial injuries. The aim of the present study is to define patients involved, and determine the effect of their geographical origin on treatment and follow up. Methods: All patients over 14 years of age suffering facial injuries caused by road trauma presenting to the two study hospitals from 1994 to 1999 were identified and details were collected on demographic details and treatment. Results: Four hundred and nine patients met the inclusion criteria. The majority required hospital transfer. Young men were the most frequently injured group of patients. Patients from peripheral regions had significant delays in transfer and treatment. They were made fewer outpatient appointments but attended at the same frequency as patients from the immediate region of the study hospitals. Conclusions: To minimize delays the process of patient transfer needs to be streamlined and education of staff in peripheral hospitals undertaken regarding facial injuries. [source] Screening of antenatal depression in Pakistan: risk factors and effects on obstetric and neonatal outcomesASIA-PACIFIC PSYCHIATRY, Issue 1 2010Nazish Imran MBBS MRCPsych Abstract Introduction: To determine the frequency of probable antenatal depression (AD) in pregnant women in third trimester, assess the risk factors and its impact on obstetric and neonatal outcomes in a developing country. Methods: A prospective study conducted in a tertiary care hospital in Lahore from March 2007 to July 2007. Two hundred and thirteen pregnant women in the third trimester, attending the Gynecology Outpatient Clinic were recruited. They were assessed by a semistructured questionnaire to gather demographic details and various risk factors for AD. AD was assessed by Edinburgh Postnatal Depression Scale. All women were followed until delivery to determine their obstetric and neonatal outcomes. Results: Out of 213 women, 91 (42.7%) scored above the cut-off for AD. More women with depression reported problems in their marriage, problems with parents/in laws, history of domestic violence, past history of psychiatric problems and history of postnatal depression. In the obstetric risk factors history of previous miscarriages, stillbirths, and complications in previous pregnancy reached statistical significance. Thirty-seven (17.3%) women were lost to follow up. Women with AD had more obstetric complications during delivery. Babies of mothers with AD had significantly low birth weight, as well as low mean APGAR scores at 1 and 5 minutes following birth. Discussion: AD is a common problem in Pakistani Society. In view of the risk factors and adverse outcomes associated with depression during pregnancy, there is need for close liaison between Gynaecologists and Psychiatrists in managing these patients. [source] Depression, anxiety and body image after treatment for invasive stage one epithelial ovarian cancerAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009Karin C. H. M. BISSELING Background:, Diagnosis of epithelial ovarian cancer (EOC) in young women has major implications including those to their reproductive potential. We evaluated depression, anxiety and body image in patients with stage I EOC treated with fertility sparing surgery (FSS) or radical surgery (RS). We also investigated fertility outcomes after FSS. Methods:, A retrospective study was undertaken in which 62 patients completed questionnaires related to anxiety, depression, body image and fertility outcomes. Additional information on adjuvant therapy after FSS and RS and demographic details were abstracted from medical records. Both bi- and multivariate regression models were used to assess the relationship between demographic, clinical and pathological results and scores for anxiety, depression and body image. Results:, Thirty-nine patients underwent RS and the rest, FSS. The percentage of patients reporting elevated anxiety and depression (subscores , 11) were 27% and 5% respectively. The median (interquartile range) score for Body Image Scale (BIS) was 6 (3,15). None of the demographic or clinical factors examined showed significant association with anxiety and BIS with the exception of ,time since diagnosis'. For depression, post-menopausal status was the only independent predictor. Among those 23 patients treated by FSS, 14 patients tried to conceive (seven successful), resulting in seven live births, one termination of pregnancy and one miscarriage. Conclusion:, This study shows that psychological issues are common in women treated for stage I EOC. Reproduction after FSS is feasible and led to the birth of healthy babies in about half of patients who wished to have another child. Further prospective studies with standardised instruments are required. [source] Diabetes in Victoria, Australia: the Visual Impairment ProjectAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2000Rob McKay Objectives:To establish the prevalence and characteristics of self-reported diabetes in a representative sample of Victorian residents aged 40 years and older, and to compare the vision between people with and without self-reported diabetes. Design:Cross-sectional survey. Setting:Nine randomly selected suburban Melbourne clusters and four randomly selected rural Victorian clusters. Participants:4,744 subjects (86% participation rate) aged ,40 years. Main outcome measures:Subjects answered a detailed questionnaire which provided demographic details, body mass index, and the duration and treatment of any diagnosis of diabetes. Refraction was performed and best-corrected visual acuity was measured. Results:The prevalence of self-reported diabetes was 5.1%. In a multivariate analysis, self-reported diabetes was positively associated with age (p<0.01), male sex (p=0.01), higher body mass index (p=0.01), Mediterranean ethnicity (p=0.01), unemployment (p=0.05) and lack of private health insurance (p<0.05). People with self-reported diabetes were more likely to have mild or moderate levels of visual impairment than people who reported no previous diagnosis of diabetes (p<0.01). Conclusions:Diabetes in Victoria is more prevalent among men and among people of Mediterranean origin. When planning educational programs and health service delivery, it is also important to consider that, compared with the general population, people with diabetes are less likely to be employed or to have private health insurance, and are more likely to have impaired vision. [source] Laparoscopic splenectomy: a suitable technique for children and adultsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2000T. J. Wheatley Aims: Splenectomy retains an important role in the management of certain haematological conditions that fail to respond to conventional medical therapy, and has traditionally been performed through a midline or left subcostal incision with patients requiring 5,7 days in hospital. The well recognized benefits of laparoscopic surgery should also apply to splenectomy. This study aimed to develop a safe and effective technique suitable for all age ranges and without the requirement for expensive stapling devices. Methods: An operative technique evolved over the 5-year period from 1994, from an initial six-port approach with the patient supine, to a four-port approach in a modified right lateral position, with locking surgical clips applied down a 5-mm port to vessels in the hilum, and removal of the spleen within a retrieval bag through a 4,6-cm Pfannanstiel incision. Data were collected prospectively for all patients undergoing laparoscopic splenectomy at Leicester Royal Infirmary, including demographic details, indication for surgery, duration of surgery, length of inpatient stay, transfusion requirement, postoperative complications and the response of the original condition to surgical intervention. Results: A total of 40 patients underwent laparoscopic splenectomy (14 children, 26 adults) for a variety of conditions (idiopathic thrombocytopenia (ITP) (n = 24), haemolytic anaemia (n = 9) or malignancy (n = 7)) with a median operating time of 180 min for the first 20 patients and 100 min for the second 20 (P < 0·0001), and median inpatient stay of 3 days for the first 20 patients and 2 days for the second 20 (P < 0·0003). None of the operations was converted to open surgery, five patients required blood and/or platelet transfusion perioperatively, none of the patients had major postoperative complications, 23 of the 24 patients with ITP developed normal platelet counts after operation, and all nine patients with haemolytic anaemia maintained a normal haemoglobin concentration after operation. Conclusions: Laparoscopic splenectomy can be performed safely and effectively in adults and children without the need for stapling devices. © 2000 British Journal of Surgery Society Ltd [source] | ||||||||||||||||||||||