bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum ferritin and Helicobacter pylori infection in children: A sero‐epidemiologic study in Korea
Authors: SEO JEONG KEE , KO JAE SUNG , CHOI KYUNG DAN
Published: March 2003

Abstract
Background
: Helicobacter pylori
infection is known to affect iron metabolism and serum ferritin levels, which are reduced in adults with
H. pylori
infection. The aim of the present study was to investigate the association between
H. pylori infection and iron status in healthy Korean children.

Methods
: The H. pylori seropositivity in 753 schoolchildren aged 6–12 years was screened for using an ELISA and confirmed by western blot analyses. Serum ferritin levels were measured using an immunoradiometric assay in 36 H. pylori‐seropositive children and in 72 age‐ and gender‐matched seronegative controls.

Results
: The median serum ferritin levels were significantly lower in H. pylori‐seropositive children than in seronegative controls (24 vs 39 ng/mL; P < 0.001). The prevalence of iron deficiency (ferritin < 15 ng/mL) in H. pylori‐seropositive children was significantly higher (13.9%) than in seronegative children (2.8%). This association persisted after adjusting for age and their socioeconomic status (odds ratio, 5.6; 95% confidence interval, 1.0–30.6).

Conclusion
: Serum ferritin levels are reduced in children with H. pylori infection. The H. pylori infection may lead to iron deficiency in children.

© 2002 Blackwell Publishing Asia Pty Ltd
Aldehydic products of lipid peroxidation do not directly activate rat hepatic stellate cells
Authors: OLYNYK JOHN K , KHAN NADEEM A , RAMM GRANT A , BROWN KYLE E , O'NEILL ROSEMARY , BRITTON ROBERT S , BACON BRUCE R
Published: March 2003

Abstract
Background and Aim
: Activation of hepatic stellate cells (HSC) results in the transdifferentiation of the resting (quiescent) phenotype to one characterized by loss of vitamin A droplets, increased α‐smooth muscle actin (SMA) expression and increased collagen production. Aldehydic products of lipid peroxidation have been shown to increase collagen production by cultured fibroblasts and by passaged HSC, but it is unclear whether these products of lipid peroxidation can initiate the activation of HSC. In the present study the effects were examined of two aldehydic products of lipid peroxidation, malondialdehyde (MDA) and 4‐hydroxynonenal (HNE), on activation of rat HSC in early culture as measured by SMA and desmin expression, and collagen production.

Methods
: The HSC from normal rat liver were plated in plastic wells and exposed to either MDA (5–200 µmol/L), HNE (0.1–20 µmol/L) or vehicle for either 3 or 7 days. The cells were then harvested; SMA and desmin levels were measured by western blotting. Collagen production was measured by radiolabeled proline incorporation after 6 h of aldehyde exposure.

Results:
Malondialdehyde (100 and 200 µmol/L) decreased SMA expression during the 3‐day and 7‐day exposures compared with controls. 4‐Hydroxynonenal (20 µmol/L) decreased SMA expression significantly while no effects were observed with lower concentrations compared with controls during the 3‐day exposure. Seven‐day exposure to HNE (0.1–20 µmol/L) failed to alter SMA expression compared with controls. Exposure to MDA or HNE did not influence desmin expression or collagen production.

Conclusions
: Aldehydic products of lipid peroxidation do not directly activate HSC in early culture and alternative pathways may be responsible for HSC activation during oxidative stress.

© 2002 Blackwell Publishing Asia Pty Ltd
Factors affecting complete resection of gastric tumors by the endoscopic mucosal resection procedure
Authors: Ohyama Takanori , Kobayashi Yasuki , Mori Katsumi , Kano Katsumi , Sakurai Yukihiro , Sato Yuzuru
Published: March 2003

Abstract Background: In Japan, endoscopic mucosal resection (EMR) has been widely used as a treatment option for small early gastric cancer (EGC). The present study reviewed 178 cases for the 10‐year period 1987–1997 in order to clarify the factors affecting the successful outcome of EMR.

Methods: Logistic regression analysis was used to examine whether complete resection of EGC correlated with the patient's age, gender, the characteristics of the tumor (location, macroscopic form, and size), the duration of the procedure and the experience of the doctor.

Results: The location of the tumor and the duration of the procedure correlated with the completeness of the resection (P < 0.01 and P < 0.05, respectively). Endoscopic mucosal resection was more difficult to perform for tumors in the gastric body than in the antrum or incisura region, and the longer the procedure the less complete the resection.

Conclusion: The outcome of EMR is affected significantly by the location of the EGC.
Evaluation of two stool antigen tests for the detection of Helicobacter pylori infection in the Chinese population
Authors: WONG BENJAMIN CHUN YU , XIA HARRY HUA XIANG , CHEUNG HESS KWAN LOK , NG FOOK HONG , WONG SIU YIN , CHOW KAI CHIU , LIN SHAO KAI , YIN YAN , WONG WAI MAN , YUEN MAN FUNG , LAM SHIU KUM
Published: March 2003

Background and Aim: The stool antigen test, the HpSA test, has been validated mainly in Western countries, but not properly in the Chinese population. Recently, another stool antigen test, the Apollo test, was developed, but its accuracy has rarely been validated. The aim of this study is to compare the accuracy of these two tests in the diagnosis of Helicobacter pylori infection in the Chinese population.

Methods: Consecutive dyspeptic patients referred for upper endoscopy were recruited. During endoscopy, biopsies were taken for the rapid urease test and histological examination as the gold standard. Stool specimens were collected and used for the HpSA and Apollo tests.

Results: Overall, 86 patients (39 males and 47 females, with a mean age of 55.8 years) were recruited. Helicobacter pylori infection was present in 44 (51%) patients as determined by the gold standard. The sensitivity, specificity and accuracy were 86.4, 100, and 93.0%, respectively, for the HpSA, and 90.9, 97.6, and 94.2%, respectively, for the Apollo test when cases with equivocal results were considered as positive. In addition, agreement was achieved in 81 (94.2%) cases between the two tests, with a Kappa value of 0.887.

Conclusion: Both the HpSA and Apollo tests achieve acceptable sensitivity and excellent specificity, with accuracies of over 90% for the detection of H. pylori infection in the Chinese population.

© 2003 Blackwell Publishing Asia Pty Ltd
The evolution of diagnostic trends in congenital heart disease: A population‐based study
Authors: Grech V
Published: March 2003

Objective: To analyse historical trends in diagnosis of congenital heart disease (CHD) in all diagnosed cardiac malformations born between 1945 and 1994 in a population‐based study, the first of its type.

Methodology: Retrospective analysis of age and mode of diagnosis was carried out in 953 patients with CHD, in the setting of a regional hospital providing diagnostic and follow up services for all of Malta. Main outcome measures were age at diagnosis, cumulative percentage diagnosis by age and mode of diagnosis.

Results: A significant negative correlation of age at diagnosis with time was found for both lesions not requiring intervention, and requiring intervention (P < 0.0001). Cumulative percentage diagnosis by age increased progressively with time. Echocardiography increased the birth prevalence of definitively diagnosed defects, particularly of lesions not requiring intervention. The annual number of cardiac catheters for these conditions has decreased with an increased number and proportion of interventional catheters. The current catheterization rate for CHD is 6.1/100 000 population.

Conclusion: Echocardiography has led to an increase in the diagnosis in the birth prevalence of CHD, and provided early diagnosis, supplanting cardiac catheterization as a primary diagnostic tool.
Evaluating the potential for opportunistic vaccination in a Northern Territory hospital
Authors: Skull SA , Krause V , Roberts LA , Dalton CB
Published: March 2003

Objective: To evaluate the potential for opportunistic vaccination and a simple intervention aimed at improving vaccination coverage for children in hospital.

Methods: Hospital records were reviewed for children under 7 years, discharged from paediatric wards (PW) and the emergency department (ED) for 4 weeks before and after an intervention (423 and 446 children, respectively). This comprised the education of staff and the introduction of prompts to record vaccination status.

Results: Documentation of vaccination status increased in the PW (63–90%) and the ED (24–46%), as did the adequacy of detail recorded (51–77% and 8–36%, respectively). Opportunistic vaccination increased from zero of 84 opportunities during the first audit to six of 139 following the intervention. All but one vaccine was given in the PW. Opportunistic vaccination improved when documentation identified a need for vaccination (P = 0.02).

Conclusion: There were numerous missed opportunities to vaccinate children in hospital, especially in the ED. Simple prompts improved documentation of vaccination status and the detail of information recorded. Despite improved documentation, opportunistic vaccination failed to improve in the ED. Improving documentation of vaccination status is not sufficient in itself to improve opportunistic vaccination.
Reference ranges for blood pressure in preschool Australians, obtained by oscillometry
Authors: Blake KV , Gurrin LC , Evans SF , Newnham JP , Landau LI , Stanley FJ , Beilin LJ
Published: March 2003

Objective: To derive reference centiles for blood pressure in children aged 1–6 years which seek to address shortcomings in available reference ranges.

Methods: Prospective cohort study of 2876 children in Perth, Western Australia, commenced in 1989 with serial blood pressure measurements through early childhood obtained by oscillometry under standardized conditions.

Results: Gender‐specific reference centile charts for systolic and diastolic blood pressure, (i) across ages 1–6 years and (ii) across the range of corrected Body Mass Index values at ages 1, 3 and 6 years, were generated by fitting linear models with both fixed and random effects.

Conclusions: Reference values for blood pressure for young children are of clinical use and may be of long‐term predictive value.
Critical influenza virus infection
Authors: Kappagoda C , Isaacs D , Mellis C , Peat J , De Silva L , O’Connell A
Published: March 2003

Objective: To determine the risk of death from influenza infection in children with chronic underlying disease.

Methodology: An 18‐year retrospective study of children with ‘critical’ influenza A or B virus infection, defined as requiring admission to intensive care or resulting in death, but excluding laryngotracheobronchitis (LTB). Influenza infection was diagnosed by viral culture and/or immunofluorescence of respiratory secretions. Patients with LTB were analysed separately.

Results: There were 27 cases of critical influenza virus infection over the study period, comprising 26 admissions to the intensive care unit (excluding LTB) and one death on the general wards. Thirteen (48%) of the 27 children had chronic underlying disease. In addition, 12 children with LTB were admitted to the intensive care unit. The LTB children were older and less likely to have chronic underlying disease. Nosocomial infection caused seven (26%) of the 27 critical infections. Nine (33%) of the 27 children with critical influenza died. Six (46%) of 13 children with chronic underlying disease and influenza admitted to intensive care died, compared with three of 14 (21%) without any underlying disease (odds ratio = 3.1, 95% confidence interval 0.6–14.0).

Conclusions: Critical life‐threatening influenza virus infection was uncommon, but the mortality was high (33%), particularly in children with chronic underlying disease. Nosocomial infection with influenza was an important cause of admission to intensive care.
Acute thrombocytopenia associated with post‐streptococcal acute glomerulonephritis
Authors: Muguruma T , Koyama T , Kanadani T , Furujo M , Shiraga H , Ichiba Y
Published: March 2003

Abstract: A case of acute thrombocytopenia associated with post‐streptococcal acute glomerulonephritis is described. The patient showed a mild glomerulonephritis and a remarkable increase of platelet‐associated immunoglobulin G (PAIgG). The relation between the mild degree of glomerulonephritis and the high PAIgG value is discussed.
X‐Linked agammaglobulinaemia and the underlying genetics in two kindreds
Authors: Pienaar S , Eley B , Beatty Dw , Henderson He
Published: March 2003

Objective: Molecular analysis of the Bruton’s tyrosine kinase (Btk) gene in two unrelated families, with a combined total of seven boys, affected by X‐linked agammaglobulinaemia (XLA).

Methods: Protein electrophoresis and western blotting were used for the examination of Btk protein synthesis in blood leucocytes. Isolation of the coding sequence of the Btk gene was performed by amplification using the reverse transcription–polymerase chain reaction (RT‐PCR) technique. Sequence alterations were screened for by the single‐stranded conformation polymorphism (SSCP) method and characterized by standard sequencing protocols.

Results: Western blotting revealed Btk protein to be absent in leucocytes of affected males from both families. A novel 3 b.p. deletion in exon 3 of the Btk gene was found to be responsible for the XLA phenotype in the affected proband in one family (kindred I). A diagnostic PCR assay was established to detect this mutation in other affected male siblings and carrier females. For the second family (kindred II), the coding sequence of the Btk gene and the promoter region were found to be normal.

Conclusions: The present study has demonstrated genetic heterogeneity in the Btk gene in South African XLA patients and has identified a novel mutation in this gene in the largest of the affected kindreds. The gene mutation in the second kindred was undetermined and may be indicative of a defect in some other gene associated with Btk function or stability. Western blotting was found to be informative in establishing a deficiency of Btk protein in both probands and is recommended as a frontline procedure in the molecular diagnosis and work‐up of XLA.
A review of annual growth screening in Aboriginal schoolchildren in Australia
Authors: Paterson BA , McKinnon CP , Edmond KM
Published: March 2003

Objectives: To determine if growth screening in school‐age Aboriginal children detects new, treatable growth problems.

Methodology: A retrospective review of health centre records of children identified as stunted or wasted from school screening from 11 remote Aboriginal communities in the Top End of the Northern Territory. The age of onset of growth faltering, the occurrence of new growth problems in school‐age children and initiation of treatment in response to the school screening results were determined.

Results: Weight faltering had occurred in all children by 18 months. The average age of onset of weight faltering was 6.6 months (range 3.5–12 months) for stunted children and 8.9 months (range 7.5–18 months) for wasted children. Height faltering in stunted children commenced in all children with documented height measurements by 3 years. Staff did not report anynewinterventions for poor growth as a result of screening school‐age children in 1993 although many children had previously been assessed by the local doctor or visiting paediatrician and were being monitored.

Conclusions: All children that were found to be stunted or wasted were already known to have poor growth prior to school entry. A change in focus is needed from repeatedly weighing and measuring school‐age children to developing community‐ based interventions to improve the nutritional status of all children. Annual measurement of weight and height beyond 5 years of age is not recommended unless it is used to help evaluate interventions aimed at improving nutritional status and educational achievement.
Necrotizing enterocolitis in the full‐term neonate
Authors: Ng SCY
Published: March 2003

Abstract: Necrotizing enterocolitis (NEC) is a relatively common disorder of multifactorial aetiology that primarily affects preterm newborns, but has been reported to occur in the full‐term neonate as well. This review focuses on known and recent developments in the epidemiology, pathogenesis, diagnosis, management and prevention of NEC in the full‐term neonate.
The epidemiology of invasive pneumococcal disease in children in Far North Queensland
Authors: Fagan RL , Hanna JN , Messer RD , Brookes DL , Murphy DM
Published: March 2003

Objectives: To describe the epidemiology of invasive pneumococcal disease in children under 5 years of age in Far North Queensland and to examine the potential impact of a seven‐ and 11‐valent conjugate pneumococcal vaccine.

Methods: A review of all cases of invasive pneumococcal disease in children under 5 years of age in Far North Queensland over a 9 year period (1992–2000). The distribution of the serotypes of isolates causing invasive pneumococcal disease was compared with the serotypes contained in the two vaccines.

Results: The annual incidence in indigenous and non‐indigenous children under 5 years of age was 163 (95% confidence interval (CI) 122–213) and 42 (95% CI 31–55) cases per 100 000 children, respectively. For children under 2 years of age, these figures were 297 (95% CI 208–411) and 71 (95% CI 49–100), respectively. There was a greater variety of serotypes isolated from indigenous children (n = 17) than from non‐indigenous children (n = 9; P < 0.01). The serotypes within the seven‐valent vaccine accounted for 62% (95% CI 46–75%) and 88% (95% CI 76–95%) of the isolates from indigenous and non‐indigenous children, respectively (P < 0.01). Serotypes within the 11‐valent vaccine accounted for 72% (95% CI 57–84%) of the isolates from indigenous children under 5 years of age, but did not account for any extra isolates from non‐indigenous children.

Conclusion: Although the seven‐ and 11‐valent conjugate pneumococcal vaccines cover only approximately 60 and 70%, respectively, of the isolates that cause invasive disease in indigenous children in Far North Queensland, they nevertheless have the potential to prevent much morbidity in and hospitalization of these children. It will be essential to maintain surveillance following the introduction of conjugate pneumococcal vaccines so as to monitor changes in the incidence of invasive pneumococcal disease, particularly in high‐risk children.
Children's adjustment to their divorced parents’ new relationships
Authors: Isaacs AR
Published: March 2003

Abstract:  With new relationships common after divorce, researchers have tried to determine the factors that predict how well children adjust to their stepfamily. The many potential factors are often grouped into the categories of family process, individual risk and vulnerability, and ecological variables. Family process is concentrated on the impact of disrupted family relationships; positive outcomes are associated with low conflict and authoritative parenting. Individual risk and vulner­ability includes attributes of the child and the adults; positive outcomes are associated with children who have an easy temperament. Adolescents and girls may have particular difficulty adjusting. Ecological perspectives include the larger social environment such as peers and school.
3‐M syndrome in two sisters
Authors: Marik I , Marikova O , Kuklik M , Zemkova D , Kozlowski K
Published: March 2003

Abstract:  3‐M syndrome is a rare, autosomal recessive dwarfing syndrome characterized by prenatal growth restriction, facial dysmorphism and absence of both microcephaly and mental retardation. The term 3‐M syndrome originates from the common initial of the first three authors of the first report. The diagnosis is established by a combination of clinical history, clinical examination and radiographic findings. The present report shows two sisters whose facial features were slightly different from those usually reported. In addition, they presented with small nails and abnormal dermatoglyphics. The present report expands the phenotypic spectrum of 3‐M syndrome.
New approaches to parenteral nutrition in infants and children
Authors: Heine RG , Bines JE
Published: March 2003

Abstract:  Parenteral nutrition (PN) has become a mainstay in the treatment of children with intestinal failure or conditions that preclude enteral feeding. Estimated energy and protein requirements can usually be met, unless the patient is fluid volume restricted or glucose intolerant. Although PN is generally well tolerated, in some patients it is still associated with a significant morbidity. Complications include metabolic disturbances, venous access device infection or dysfunction, venous thrombosis and cholestatic liver disease. Patients need to be carefully monitored for evidence of micronutrient deficiencies or excesses. There is a close relationship between line sepsis and thrombosis. Strict aseptic technique is the key to preventing line infections. Recurrent sepsis and thrombosis may eventually lead to loss of venous access and may jeopardize the long‐term delivery of PN. Chronic cholestatic liver disease is common in premature infants with gastrointestinal problems, recurrent sepsis and lack of enteral feeding. The aetiology is multifactorial. Early enteral feeding is the most effective strategy in preventing PN‐associated liver disease. New specialized nutrient solutions and lipid emulsions promise improved clinical outcomes. However, long‐term clinical data are not yet available in children. In recent years, nutrition support teams have improved clinical and economic outcomes by encouraging the appropriate use and monitoring of PN therapy. In patients with intestinal failure, parent‐administered home PN has become an alternative to long‐term hospitalization. Apart from a positive effect on the quality of life of patient and family, home PN is cost‐effective and reduces the risk of nosocomial infections and catheter‐related complications.
House dust mite allergen levels in carpeted sleeping accommodation are higher in private houses than public places
Authors: Mamoon HA , Henry RL , Stuart JE , Gibson PG
Published: March 2003

Objective:  To compare mite allergen levels in carpeted sleeping accommodation in private dwellings and public places.

Methods:  The concentration of Dermatophagoides pteronyssinus Group 1 allergen in house dust was measured in mat­tresses and bedroom floors in 12 homes, 5 hotels, 11 child care centres and a university hall of residence. Indoor temperature and relative humidity were also measured. A questionnaire clarified details regarding the age of the building, age of the carpet, method and frequency of cleaning, frequency of room use and use of air‐conditioning.

Results:  Median allergen levels in mattresses and carpets in private homes (21.1 and 20.6 µg/g dust, respectively) were significantly higher than in public places (2.5 and 3.1 µg/g, respectively; P < 0.0001). Mean relative humidity was significantly higher in private houses (68.5%; 95% CI 67.2−69.3%) than in public places (56.4%; 95% CI 52.7−60.1%; P < 0.0001).

Conclusions:  Carpeted sleeping accommodation in public places has lower house dust mite allergen levels than private houses. Lower levels of relative humidity may be an important component of the explanation.
Marked increase in serum transferrin receptor among Thai children with Hb‐E‐β‐thalassaemia
Authors: Boonchalermvichian C , Paritpokee N , Bhokaisawan N , Nuchprayoon I , Wiwanitkit V
Published: March 2003

Objective:  To determine the serum transferrin receptor (sTfR) level in patients with Hb‐E‐β‐thalassaemia attending a paediatric haematology clinic.

Methods:  Sixty‐four patients with Hb‐E‐β‐thalassaemia aged 2.9−10.8 years were attending a paediatric haematology clinic at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Circulating transferrin receptor was measured, as was the complete blood count and percentage of reticulocytes. A transfusion regimen recommended by the Thalassaemia International Federation was used whenever parents agreed to the treatment.

Results:  In patients with Hb‐E‐β‐thalassaemia, the concentration of sTfR varied from 1.88 to 28.44 mg/L (mean ± SD 13.99 ± 5.37), while in the control group, it varied from 0.95 to 2.56 mg/L (mean ± SD 1.58 ± 0.41; n = 31). The sTfR level correlated inversely to a single measurement of haemoglobin in the same specimen (r = − 0.433; P = 0.00) and was elevated compared to the control group (P = 0.00; α < 0.05). In addition, the sTfR level correlated inversely to mean pre‐transfusion haemoglobin (r = − 0.36; P = 0.003).

Conclusions:  The level of sTfR is elevated in children with Hb‐E‐β‐thalassaemia. The sTfR level can be used as an adjunct real‐time assessment of erythropoietic activity, comparable with mean pre‐transfusion haemoglobin. Measurement of sTfR is easy using most automated chemical analyzers, and material can be obtained from routine specimen collections. Further studies should be carried out in a larger population to verify the benefits of this test to patients.
Facilitation of neonatal nasotracheal intubation with premedication: A randomized controlled trial
Authors: Oei J , Hari R , Butha T , Lui K
Published: March 2003

Objectives: To determine if premedication reduces the time and number of attempts by junior medical staff to achieve nasotracheal intubation in neonates. The experimental design was a non‐blinded randomized controlled pilot trial. The setting was a perinatal centre in a university teaching hospital.

Methods: Twenty infants (within the ranges of 25–40 weeks gestation, 650–3660 g and 1 h to 81 days of age) requiring semi‐urgent intubation were randomized to either premedication with morphine, atropine and suxamethonium, or to awake intubation.

Results: There were no significant differences between the two groups in
regard to prior intubation experience of the staff or infant weight or gestation.
The intubation procedure, including intervening events, to completion was significantly
faster in premedicated infants (median 60 s vs 595 s; P = 0.002) who
were intubated at a younger postnatal age. It took twice as many attempts to intubate
a conscious infant (median 2 vs 1; P = 0.010). There was a greater
decrease in heart rate from the baseline in the unpremedicated group (mean 68 b.p.m.
vs 29 b.p.m.; P = 0.017), but decreases in oxygen saturation were not different. Blood was observed in the oral and nasal passages after intubation in five of the awake infants and in one of the premedicated infants.

Conclusions: The use of premedication reduces the total time and number of attempts taken to achieve successful nasotracheal intubation of neonates by junior medical staff under supervision.
Transfusion in premature infants impairs production and/or release of red blood cells, white blood cells and platelets
Authors: Frey B
Published: March 2003

Objective:  To examine whether red blood cell transfusion in infants with anaemia of prematurity alters peripheral counts of red blood cell precursors, total white blood cells and white cell differential and platelets.

Methodology:  In 18 consecutive stable premature infants with anaemia of prematurity, peripheral cell counts were prospectively recorded immediately before transfusion of 20 mL/kg packed red blood cells (given over 6 h), and at 48 h after completion of the transfusion.

Results:  The median (interquartile range) haematocrit increased from 22.0% (21.3−24.0%) pre‐transfusion to 37.0% (36.0−38.0%) post‐transfusion (P < 0.001). Red‐cell precursors decreased: median (interquartile range) reticulocytes from 3.7% (3.0−7.7%) to 3.7% (2.6−4.1%) (P = 0.03); and median (interquartile range) nucleated red blood cells from 0 G/L (0−0.2 G/L) to 0 G/L (0−0 G/L) (P = 0.03). The mean (SD) platelet count decreased from 420 G/L (154 G/L) to 313 G/L (101 G/L) (P = 0.001). The total white blood cell count and neutrophils did not change significantly; however, median (interquartile range) immature neutrophils decreased from 0.12 G/L (0.06−0.74 G/L) to 0.08 G/L (0.01−0.24 G/L) (P = 0.03). Lymphocytes, eosinophils, basophils and plasma cells remained unchanged. Monocytes increased (P = 0.01).

Conclusions:  Forty‐eight hours after red blood cell transfusion to premature infants, there is an absolute decrease in red blood cell precursors, immature white blood cells and platelets, probably due to erythropoietin‐suppression.
Fundoplication in children with gastro‐oesophageal reflux disease
Authors: Norrashidah AW , Henry RL
Published: March 2003

Objectives: The associations between gastro‐oesophageal reflux (GOR), chronic respiratory symptoms and gastrointestinal complications have been well described. The aim of this study was to compare the characteristics of children in whom the main indication for fundoplication was respiratory disease with children who had gastrointestinal indications for surgery.

Methods: A retrospective review of 79 children who underwent fundoplication between January 1995 and December 1999.

Results: Forty‐nine of the children (62%) had a respiratory indication
for fundoplication. Children with neurological impairment tended to have a respiratory
rather than a gastrointestinal indication for surgery. Congenital anomalies were
present in 47%. Fundoplication in older children was more likely to be for
a gastrointestinal indication. Children with neurological impairment were more likely
to have a gastrostomy compared to children with normal neurological status (P
< 0.01). Children with a respiratory indication were more likely to have three
or more diagnostic investigations (P < 0.001). Ninety‐two per cent of children with a respiratory indication and 90% with a gastrointestinal indication for fundoplication had at least one positive test for GOR (barium meal or 24‐h oesophageal pH monitoring). Oesophagoscopy showed reflux oesophagitis in 46/61. Eighty‐five per cent of the children had complete resolution of their symptoms after fundoplication.

Conclusions: Neurological comorbidity was common in children who had surgery for gastro‐oesophageal reflux disease, whether for gastrointestinal or respiratory indications. The majority of fundoplications were performed for respiratory indications.
Surgical programme at Royal Alexandra Hospital, Sydney, for Papua New Guinea children with congenital heart disease, 1978–1994
Authors: Tefuarani N , Hawker R , Vince J , Sleigh A , Williams GM
Published: March 2003

Objective: To report the history of the Royal Alexandra Hospital for Children (RAHC) Papua New Guinea (PNG) cardiac surgical programme and describe the selection, preoperative clinical features and postoperative outcome of children with congenital heart disease managed by the programme.

Methods: Details for each of the PNG cardiac patients admitted to RAHC following selection by visiting cardiologists between 1978 and 1994 were entered into a database, and analysed and interpreted.

Results: A congenital heart defect was confirmed in 165 of the 170 children selected. The male to female ratio was 1:1 and the mean age on admission to RAHC was 5.5 years. Almost all of the children for whom data were available (98%) had a weight for age and 41% had a height for age less than the 3rd centile. One‐sixth had delayed milestones. A large number were tachypnoeic, in heart failure, or had pulmonary hypertension on admission. Ventricular septal defect and tetralogy of Fallot were the commonest defects, and lesions such as aortic stenosis, coarctation of the aorta and transposition of the great arteries were absent or rare. Thirty‐one (19%) of the children selected initially did not receive surgery because of pulmonary hypertension, or because the lesions did not fall within the programme guidelines for operation. One hundred and twenty‐nine children had corrective and four had palliative procedures. Half of the operated children had postoperative complications. Eight children died, all following open‐heart procedures, giving a case fatality rate of 6%. Preoperative tachypnoea, hepatomegaly, cardiac failure and pulmonary hypertension were strongly associated with poor outcome.

Conclusions: The programme was an arduous exercise for all organizations concerned, but achieved comparatively good short‐term outcomes. The experience gained should assist in planning for similar programmes.
Allogeneic bone marrow transplant improves outcome for juvenile myelomonocytic leukaemia
Authors: Maguire AM , Vowels MR , Russell S , Cohn RJ , Cole C , Saxon B , Alvaro F , Marshall GM
Published: March 2003

Objective: To correlate clinical presentation and therapeutic outcomes in children with a diagnosis of juvenile myelomonocytic leukaemia.

Methods: The medical records of 14 children who fulfilled the International Juvenile Myelomonocytic Leukaemia Working Group Criteria for a diagnosis of juvenile myelomonocytic leukaemia (JMML) presenting to a single institution were reviewed, and their clinical status at September 2000 was documented.

Results: The most common presenting features were hepatosplenomegaly and lymphadenopathy. Fifty per cent of cases presented in the first year of life. Nine of 14 patients initially received chemotherapy otherwise used in the treatment of acute myeloid or lymphoblastic leukaemia with no apparent benefit. All six patients who received conditioning therapy with chemotherapy alone, followed by allogeneic bone marrow transplant (BMT), are in complete remission at a median follow‐up duration of 12 months (range 5–91 months). Five of six patients surviving post‐allogeneic BMT received marrow from an unrelated donor. Only one of seven patients who did not receive BMT survived long‐term.

Conclusion: Children with a diagnosis of JMML should be treated with allogeneic BMT as soon as a suitable donor is found. The role of anti‐leukaemic therapy in this disease, prior to BMT, requires further investigation in the context of a multicentre clinical trial.
Evaluation of laboratory tests in dehydrated children with acute gastroenteritis
Authors: Yilmaz K , Karaböcüoglu M , Çitak A , Uzel N
Published: March 2003

Objective:  The aim of the present study was to demonstrate the utility of laboratory tests in predicting dehydration severity.

Methodology:  We evaluated retrospectively 168 dehydrated children aged 1−21 months with acute gastroenteritis. The degree of dehydration in each patient was calculated as the percentage change in weight from admission to after rehydration. The associations between degree of dehydration, urea, bicarbonate and serum sodium were examined.

Results:  Dehydration severity was significantly related to concentrations
of urea (P < 0.00001) and bicarbonate
(P = 0.01), but not to serum sodium or age. Children were divided into three groups on the basis of blood urea: (i) normal (< 6.7 mmol/L or < 40 mg/dL); (ii) intermediate (6.8−16.6 mmol/L); and (iii) high (≥16.7 mmol/L or ≥100 mg/dL). Groups 1 and 3 had statistically significant associations with the degree of dehydration and combining the urea groups with plasma bicarbonate levels enhanced the accuracy of predictions. Group 1 had only mild to moderate dehydration, but if bicarbonate was 15 mmol/L or higher, there was a positive predictive value (PPV) of 93% for mild dehydration. Group 3 had moderate to severe dehydration, but if bicarbonate was 15 mmol/L or higher, moderate dehydration could be predicted (PPV 100%). Sixty per cent of mildly dehydrated children (32/53) had low bicarbonate, but only 7% (2/29) with bicarbonate 15 mmol/L or higher had severe dehydration. Serum sodium did not have any significant association with the degree of dehydration, or the levels of bicarbonate or urea.

Conclusions:  The results suggest that serum urea and bicarbonate concentrations can be helpful in the estimation of fluid deficit independently from serum sodium concentration, and may be considered to be adjuncts to clinical evaluation in assessing the degree of dehydration.
School‐aged children with Kawasaki disease: High incidence of cervical lymphadenopathy and coronary artery involvement
Authors: Fan PC , Chiu CH , Yen MH , Huang YC , Li CC , Lin TY
Published: March 2003

Objective: We describe 10 school‐aged children with Kawasaki disease (KD) with a high incidence of cervical lymphaden­opathy and coronary abnormality.

Methods: Based on a database of 1002 children with KD in Chang Gung Children's Hospital from January 1983 to March 2001, 10 (1%) school‐aged patients (five boys, five girls) who met the diagnostic criteria of KD were included for analysis.

Results: Cervical lymphadenopathy was noted in all (100%) of these patients. Unilateral neck mass mimicking acute suppurative infections not responding to antibiotic therapy was the initial presentation in nine (90%) of the 10 patients. The mean interval between disease onset and diagnosis was 9.9 ± 3.3 days (range, 6−15 days). Seven (70%) of these patients responded to one course of high‐dose intravenous immunoglobulin (IVIG) therapy (2 g/kg) and oral aspirin (80−100 mg/kg per day), two (20%) required a second course of IVIG, and one (10%) responded to high‐dose aspirin treatment only. Coronary artery abnormality (dilatation or aneurysm) was documented by echocardiography in seven (70%) patients (four boys, three girls). In six patients, the coronary artery abnormalities resolved in 1 year, while one patient had persistent right coronary artery aneurysm, which necessitated continued anticoagulant and low‐dose aspirin therapy.

Conclusion: The incidence of school‐aged children among patients with KD is about 1% in our hospital. These patients are notable for the high incidence of initial manifestations of unilateral neck mass and coronary artery involvement. This disease should be listed as the differential diagnosis in school‐aged children presenting with fever and neck mass that do not respond to antibiotic therapy.
The ACHS Care Evaluation Program: A decade of achievement
Authors: Collopy Brian T , Williams Joanne , Rodgers Lisa , Portelli Rachel , Campbell Jan , Jenner Nicole , Andrews Nicole
Published: March 2003

Abstract In 1989 the Australian Council on Healthcare Standards (ACHS) embarked on a programme to develop acute health care clinical indicators in conjunction with the Australian medical colleges. Through a carefully structured stepwise process this collaboration established a ‘World first’ in 1993 with the introduction of the first set of indicators into the ACHS Accreditation programme. The programme remains unique in the formal involvement of providers in the development process and in the scope of the clinical areas covered in acute health care. From the year 2000 there will be 18 sets (and over 200 indicators) from which health care organisations (HCOs) can choose to monitor the major services they provide. There remains no compulsion to address a specific number of indicators. The growth of the programme has been considerable with more than half of the nations’ acute HCOs reporting their clinical indicator data (twice yearly) and it provides a reflection of the care given for the majority of patient separations in acute care. This reporting process allows HCOs to receive feedback on the aggregate results together with comparative peer group information for each indicator they address. In addition to numerous publications in peer reviewed journals an annual aggregate report, ‘the Measurement of Care in Australian Hospitals’ is published. It reports both qualitative and quantitative data on all indicator sets for the preceding year. Validity of the indicators is strengthened each year with a review process and reliability and reproducibility of the data can now be demonstrated. The clinical response to the indicators has been overwhelming and there is now documented evidence of numerous actions taken by HCOs to improve both the processes and the outcomes of patient care. The nation wide database can be expected to reflect trends in care over the next few years. The process of indicator refinement, however, will continue and it is likely that a reduction in the total number of indicators will occur with a core group of the more ‘robust’ indicators remaining. Further directions in indicator development are likely to be in the area of multidisciplinary care and in the assessment of longer‐term outcomes. In addition to measures of the quality of care, hopefully, in time, health care providers will also take part in the establishment of measures of the appropriateness of that care.
Use of pathology services in re‐engineered clinical pathways
Authors: Board Neville , Brennan Nicholas , Caplan Gideon
Published: March 2003

Abstract A significant proportion of pathology tests ordered in hospital are unnecessary. Specific measures targeting the increasing appropriateness of pathology service use have been shown to decrease overall ordering of laboratory tests. However, it is not clear whether general programmes to improve quality of care will have any impact on the use of pathology services. Use of pathology services was compared within two separate prospective controlled clinical trials of re‐engineered clinical pathways for both elective (surgical) patients and acute unplanned (medical) admissions. Trial One was a controlled trial of a re‐engineered surgical service. Booked patients in the treatment group were admitted on the day of surgery, care was guided by a clinical pathway, and patients were discharged early with domiciliary post‐acute care. Controls were admitted on the day before surgery, treated according to usual practice and discharged according to surgeons’ preferences. In Trial Two, acute medical patients admitted to hospital through the Emergency Department (ED) were randomised into a treatment (Hospital in the Home) or a control (inpatient) care pathway. In both studies, patients on the re‐engineered clinical pathways were well matched demographically and clinically. Health outcomes and satisfaction ratings were comparable. Seventy per cent fewer laboratory tests were ordered in the elective surgery intervention group (P < 0.0001), while the treatment group of the acute medical patients had 25% fewer tests ordered (P = 0.0133). Pooled results also showed a significantly lower rate of test ordering (P < 0.001) for the treatment group (Mann–Whitney U–Wilcoxon ranked sum test). The findings of these audits of controlled, prospective trials suggested overuse of laboratory tests in New South Wales public hospitals, and that savings can be generated by using clinical pathways and applying clinical criteria to the ordering of tests without adversely affecting health outcomes.
‘Quality is everyone’s business’ why this approach will not work in hospitals
Authors: Wilson Lionel
Published: March 2003

Abstract Implementing effective quality management in hospitals requires quite complex micromanagement systems. Health professionals, doctors and nurses do not have the time, skills and in many cases the interest to be responsible for these systems. To state the ‘quality is everyone’s business’ is to use a platitude that seriously understates the difficulty of the exercise.
Hip fracture treatments – what happens to patients from residential care?
Authors: Crotty Maria , Miller Michelle , Whitehead Craig , Krisnan Jegan , Hearn Trevor
Published: March 2003

Abstract Hip fractures are a growing problem and new models of care have been called for. However, patients from residential care are rarely considered in these discussions. Hip fracture is a common serious problem for older people in residential care with profound effects on subsequent mobility and quality‐of‐life. There are no Australian data documenting differences in hospital treatments offered to patients from the community and residential care to inform discussions. In a prospective audit we describe the treatment and 4 month outcomes of patients with fractured hips who were admitted to Flinders Medical Centre in South Australia from the community and residential care between August 1998 and June 1999. Information was collected on prefracture health, types of surgical and rehabilitation treatments and dependency. Of the 215 older adults who were admitted during this time, 183 agreed to participate (119 from community and 64 from residential care). Surgical management of the fracture was not affected by admission accommodation. Those from residential care had short hospital stays, less rehabilitation and access to physiotherapy. Although 61% of those from residential care were classified as independently mobile prefracture, by 4 months this had declined to 32% of survivors. Strategies to improve outcomes in those from residential care include: early identification of those walking independently prefracture with assessment by rehabilitation teams. Inclusion of liaison with community therapists in the clinical pathway and in selected cases use of ‘rehabilitation at home’ services to provide physiotherapy services should be considered.
Prioritising quality
Authors: Ibrahim Joseph E
Published: March 2003

Abstract The deluge of new initiatives, proposals and recommendations for solving the problems required to improve patient safety and quality of health care continues unabated. Implementing the proposed solutions for improving patient safety and quality of care requires setting priorities for action throughout the different levels of the health‐care system. Currently, we face the dilemma of having to set priorities from the plentiful themes that are intuitively sensible and well accepted. There is an increasing number of examples of using systematic processes which contain explicit and transparent criteria for priority setting in patient safety and quality initiatives. These should be more widely adopted and become a key requirement for all future proposals for improving patient safety and quality of health care.
Quality of health services and early postpartum discharge: Results from a sample of non‐English‐speaking women
Authors: Tran Mai , Young Lis , Phung Hai , Hillman Ken , Willcocks Karen
Published: March 2003

Abstract Few studies have explored the knowledge, perceptions and satisfaction of ethnic women in relation to early obstetric discharge. The aim of this study was to form a profile of Vietnamese mothers who opt for early postpartum discharge, and to identify factors associated with those decisions. Focus group discussions, in‐depth interviews and survey questionnaires were utilized to collect information from a sample of 160 mothers. Sixty mothers (38%) opted for early discharge (< 48 h). Factors strongly associated with early discharge were poor comprehension of English (OR = 6.58, 95% CI = 1.81, 24.02), very low level of education (OR = 3.10, 95% CI = 1.55, 6.20) and first time mother (OR = 2.70, 95% CI = 1.15, 4.27). The in‐depth interviews identified further factors driving early discharge, including fear and anxiety when having to approach staff for assistance, and perceptions of disempowerment within culturally unfamiliar hospital surroundings. The findings in this study ought to alert administrators and clinicians to possible negative drivers for the choice of early postpartum discharge by Vietnamese mothers.