bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and clinical outcome of icteric type hepatocellular carcinoma
Authors: HUANG JEE‐FU , WANG LIANG‐YEN , LIN ZU‐YAU , CHEN SHINN‐CHERN , HSIEH MING‐YUH , CHUANG WAN‐LONG , YU MING‐LUNG , LU SHENG‐NAN , WANG JING‐HOUNG , YEUNG KWOK‐WAN , CHANG WEN‐YU
Published: March 2003

Background To elucidate the incidence of the rare cases of icteric type hepatocellular carcinoma (IHCC), we conducted a retrospective study. The clinical outcomes of IHCC cases were also analyzed.

Methods From January 1986 to December 1997, newly diagnosed HCC cases were evaluated and reviewed from an admission registration database in a medical center. Patients who had HCC tumors which were located within biliary tracts, and caused obstructive jaundice as the initial clinical manifestation of HCC, were defined as cases of IHCC. Besides clinical manifestations, the outcomes and survival times of various treatment strategies among the IHCC cases were compared retrospectively.

Results The incidence of IHCC was 0.53% (10/1897). The median age of the 10 IHCC patients (seven men, three women) was 56.1 years (range = 41–72 years). Most primary HCC lesions (80%) were of expansive type: either single nodular type or multinodular type. All the patients eventually died of cholangitis and sepsis. Besides biliary drainage, seven patients of moderate to good liver reserve function received transarterial chemoembolization (TACE) for palliative treatment, and three of these received additional radiotherapy (R/T) because of the limited effect of TACE (total dosage ranged from 1600 to 5000 cGy). One patient received only radiotherapy (total dosage 1600 cGy) because of having a single tumor and poor liver reserve function. The median survival time among those eight patients who received palliative treatment was 13.4 months (range = 8–26 months), which was significantly longer than for the other two patients without treatment (2 and 4 months).

Conclusions Icteric type hepatocellular carcinoma (IHCC) is a rare presentation of HCC. Palliative treatment strategies, including TACE and/or R/T showed a beneficial effect in improving the survival time.
Strongyloides stercoralis infestation associated with septicemia due to intestinal transmural migration of bacteria
Authors: GHOSHAL UDAY C , GHOSHAL UJJALA , JAIN MANOJ , KUMAR ARVIND , AGGARWAL RAKESH , MISRA ASHA , AYYAGARI ARCHANA , NAIK SUBHASH R
Published: March 2003

Abstract 
Strongyloides stercoralis
infestation is common in the tropics and is usually asymptomatic. Patients with immunocompromised states may develop hyperinfection and fulminant disease. It has been suggested that bacteria accompany
S. stercoralis
during its passage across the bowel wall, resulting in systemic sepsis. Herein is a report on a 30‐year‐old man with
S. stercoralis
infestation and small bowel bacterial overgrowth presenting as malabsorption syndrome. He developed extensive duodenojejunal ulceration, septicemia and fatal hypokalemia. Blood and jejunal fluid grew
Escherichia coli
with the same antibiotic sensitivity patterns. This supports the hypothesis of migration of bacteria from the intestinal lumen as a cause of septicemia in patients with fulminant
S. stercoralis
infestation
.

© 2002 Blackwell Publishing Asia Pty Ltd
Influences of Helicobacter pylori on gastric angiogenesis and ulcer healing in mice
Authors: Gunawan Edhi , Tsuji Shingo , Tsujii Masahiko , Kimura Arata , Sun Wei‐Hao , Sawaoka Hitoshi , Sasayama Yoshiaki , Sasaki Yutaka , Kawano Sunao , Hori Masatsugu
Published: March 2003

Background and Aims: Helicobacter pylori
infection is associated with peptic ulcers; however, it is unclear whether the bacterium delays ulcer healing. We investigated the influence of
H. pylori
on ulcer healing in mice. We also examined the influence of
H. pylori infection on angiogenesis.

Methods: An acetic acid ulcer was made in male BALB/c mice. Three days later (day 0), the animals were inoculated with H. pylori SS1 strain. The healing process of the ulcer was examined macroscopically and microscopically on days 0, 6 and 9. The index of angiogenesis was also determined using carmine dye injection.

Results: On day 0, angiogenesis began at the ulcer margin while the mucosal epithelia had not yet regenerated. On days 6 and 9, angiogenesis and epithelial regeneration developed and ulcer size reduced. These phenomena were significantly suppressed in mice infected with H. pylori.

Conclusion: Helicobacter pylori
infection significantly suppressed angiogenesis and delayed ulcer healing. These results indicate that
H. pylori plays an important role in ulcer healing.

© 2002 Blackwell Publishing Asia Pty Ltd
Gastric fundic gland polyps in south‐east Scotland: Absence of adenomatous polyposis coli gene mutations and a strikingly low prevalence of Helicobacter pylori infection
Authors: Shand Alan G , Taylor Andrew C , Banerjee Mala , Lessels Alastair , Coia John , Clark Caroline , Haites Naiva , Ghosh Subrata
Published: March 2003

Background and Aim:
Fundic gland polyps (FGP) were originally described in association with familial polyposis syndromes, but it is now accepted that the majority of FGP are picked up incidentally in up to 1.9% of routine endoscopies in dyspeptic patients. The familial adenomatous polyposis phenotype arises from germline mutations of the adenomatous polyposis coli (APC) gene. We aimed to see if there was any association between the presence of FGP, Helicobacter pylori, and two common APC gene mutations.

Methods:
From a search of histopathology records in our unit, 85 consecutive patients were identified with a definite histological diagnosis of FGP between 1989 and 1997. Case notes could be retrieved in 48 cases to show the indication for endoscopy and endoscopic findings. Twenty‐six patients (mean age 61 years, range 40–83 years) were tested for H. pylori status, and for the 1306 and 1061 bp deletions of the APC gene by the use of an enzyme‐linked immunoassay and polymerase chain reaction techniques, respectively.

Results:
Eighty‐nine percent of patients underwent an endoscopy because of dyspepsia; 4.2% were anaemic, 4.2% had hematemesis and 1.2% had dysphagia. Only one patient was seropositive for H. pylori and no patient carried either APC gene deletion.

Conclusions:
This genetic information on those with FGP confirms previous phenotypic studies in that the majority of FGP are not associated with familial polyposis syndromes. The significance of such a strikingly low incidence of H. pylori infection in a dyspeptic population remains unclear.

© 2002 Blackwell Publishing Asia Pty Ltd
Cost of community gastroenteritis
Authors: HELLARD MARGARET E , SINCLAIR MARTHAI , HARRIS ANTHONY H , KIRK MARTYN , FAIRLEY CHRISTOPHER K
Published: March 2003

Background and Aim: Gastroenteritis is a common illness that causes considerable morbidity in developed countries. Endemic gastroenteritis that is not associated with outbreaks causes the greatest number of cases, but information is limited about the burden of this disease, and the resources required to manage its impact on society. In the present study, we estimated the rate of endemic gastroenteritis, the number of visits to the local doctor, use of medication, and the cost of gastroenteritis in Australia.

Methods: Data from a community‐based study of gastroenteritis, a general practice surveillance network, the Australian Bureau of Statistics and the Health Insurance Commission were used to measure endemic gastroenteritis and other study outcomes. The results were then extrapolated to the Australian Community.

Results: There were an estimated 0.8 cases of gastroenteritis per person per year in Australia. This equated to 15 173 430 cases of gastroenteritis in Australia annually. The age‐standardized estimate of the total number of visits to the general practitioner (GP) for gastroenteritis was 1024 214 at a cost of A$26 722 691. The average cost of prescribed medication per visit was A$6.83; the estimated total cost of prescribed medication was A$6995 381. The estimated cost of over‐the‐counter medication was A$14 587 477. It was estimated that people working full or part‐time had 0.13 days‐off per person per year because of gastroenteritis, at a cost of A$137 924 170. The estimated total cost of endemic gastroenteritis in Australia was A$342 855 616 of which $75 908 274 was direct medical costs and $266 947 342 was time costs and the costs for time off work to care for a sick family member.

Conclusions: Endemic gastroenteritis is an important illness in both developed and developing countries. Although in developed countries, the majority of individual cases are mild to moderate in their severity; the overall costs are significant. The results highlight the need for ongoing research to identify the main causes of endemic gastroenteritis.
Cardiopulmonary resuscitation in the newborn intensive care unit
Authors: BARR P , COURTMAN SP
Published: March 2003

Objectives:

To determine the outcome for cardiopulmonary resuscitation (CPR) following cardiac arrest, and the predictors of response to CPR, in newborn infants with a diverse range of medical, surgical and cardiological problems cared for in a tertiary level newborn intensive care unit (NICU).

Methodology:

Infants who had suffered a cardiac arrest and received CPR were identified by retrospective review of the NICU medical records.

Results:

Thirty‐five (1%) of 3624 infants admitted to the NICU during a six‐year period received CPR because of a cardiac arrest. Twenty (57%) of the infants did not respond to CPR and died within 2.5 h (non‐responders), eight (23%) responded to CPR but died before discharge from hospital (short‐term responders), and seven (20%) responded to CPR and were discharged from hospital (long‐term responders). The arterial pH was significantly lower in non‐responders to CPR compared with responders. Non‐responders to CPR were not significantly different from responders with regard to gestational age, birth weight, age at arrest, systolic blood pressure, blood gases, severity of respiratory failure, or renal function. In 24 infants (68%), the precipitating cause for the cardiac arrest was either irreversible (20), or not known (4) and all died prior to discharge from hospital. In 11 infants (32%), the cardiac arrest was considered to have been precipitated by an acute and reversible event, and seven (64%) survived to discharge from hospital. All six infants with septicaemic shock were non‐responders to CPR. Three of 15 infants with complex congenital heart disease were long‐term responders to CPR but none survived without a major physical and psychomotor disability.

Conclusion:

The present study offers support for the recommendation that CPR may be withheld in infants who do not have a reversible cause for their cardiac arrest but are dying or will die soon from the inexorable progress of their illness.
Clonidine overdose in childhood: Implications of increased prescribing
Authors: KAPPAGODA C , SCHELL DN , HANSON RM , HUTCHINS P
Published: March 2003

Objective:

To highlight the increase in the number of cases of clonidine overdose admitted to a specialist paediatric hospital, with particular reference to the clinical features, clinical course and circumstances surrounding the incident.

Methods:

Cases of clonidine overdose were identified by review of the emergency department attendance register, the intensive care unit database and inpatient statistics collection. Case notes were reviewed to determine the clinical features, history and clinical course in each case.

Results:

Fifteen patients experienced 16 overdoses during the period 1990–97 inclusive. Only one case occurred before 1994. Depressed level of consciousness and bradycardia were the most common clinical manifestations, and were observed in 75 and 88% of cases respectively. There were no fatalities. Five patients received naloxone. Other treatment modalities included gastrointestinal decontamination, atropine, ventilation and inotropic support. Fourteen cases occurred in association with medication prescribed for attention‐deficit hyperactivity disorder (ADHD).

Conclusion:

Clonidine overdose is a potentially serious condition, often requiring intensive care management. Our experience suggests that it is a growing problem, related in part to its increased use in the treatment of ADHD. Preventive strategies, including raising the level of awareness of risks, changes to packaging and appropriate selection of patients for treatment, need consideration if further overdoses are to be prevented.
The value of parents’ concerns to detect and address developmental and behavioural problems
Authors: Glascoe FP
Published: March 2003

Abstract: Half of all children with disabilities are not identified before school entry. This precludes their participation in early intervention programs that have known benefit. Although screening tests can greatly improve detection rates, these have not been popular in primary care due to test length and time constraints, and difficulty managing children's behaviour. An alternative is to rely on information from parents. This review describes existing research on parents’ concerns about children's development and behaviour.

Hand‐ and electronic‐searches were made of journals indexed in the EMBASE, Medline and Psych‐lit data bases between 1980 and 1998. Key words included ‘parents’ concerns’ and ‘parents’ complaints’. These terms were intersected with ‘development’ and ‘behaviour’.

The search identified 30 articles which were grouped into the following categories: frequency of concerns, concerns about development/behavioural/emotional status, the meaning of concerns, influences on concerns including children's ages, health, and parents’ mental health status, eliciting concerns, how parents’ respond to concerns questions, and the accuracy of parents’ concerns.

Parents, regardless of differences in education, socioeconomic status, and child‐rearing experience, are able to raise concerns that accurately reflect children's developmental and behavioural status. However, concerns must be carefully and systematically elicited and interpreted according to available evidence. When this occurs, concerns have a high degree of accuracy in detecting developmental and behavioural problems and do so at levels that represent a substantial improvement over disability detection rates usually found in medical settings.
Respiratory morbidity of hospitalized children with Trisomy 21
Authors: Hilton JM , Fitzgerald DA , Cooper DM
Published: March 2003

Objective: To review the respiratory morbidity in children with Trisomy 21 admitted to a teaching hospital.

Methodology: A retrospective chart review of 232 admissions to John Hunter Children’s Hospital during a 6.5‐year period (1991–98). The primary outcome measures included: (i) primary reason for admission, (ii) concomitant respiratory pathology, (iii) admission to the Intensive Care Unit (ICU), (iv) length of stay and (v) costs of admission.

Results: Fifty‐four per cent of admissions were primarily for respiratory tract pathology, dominated by pneumonia, bronchiolitis and croup. Admission to the ICU was required for 10% of admissions, most commonly for pneumonia (10/23). Congenital heart disease (CHD) was present in 33% of patients. The median length of stay and cost of admission for a child with Trisomy 21 (without CHD) with common respiratory conditions such as bronchiolitis, asthma or pneumonia was two to three times greater than in patients without Trisomy 21.

Conclusions: Lower respiratory pathology is most common cause for acute hospital admission in children with Trisomy 21. The presence of CHD did not influence admission rates to hospital. However, patients with CHD had longer lengths of stay, appeared to have more severe illness, were more likely to require admission to an ICU and were more likely to require ventilatory support.
Suffocation, shaking or sudden infant death syndrome: Can we tell the difference?
Authors: Byard RW , Krous HF
Published: March 2003

Abstract: Given that the diagnosis of sudden infant death syndrome (SIDS) remains one of exclusion, problems still exist in distinguishing possible cases from those where the deaths were due to accidental or inflicted suffocation. The term ‘SIDS’ cannot be used unless a complete autopsy examination has been performed, augmented by review of the clinical history and examination of the death scene. In the absence of a cause of death, a more suitable designation in the presence of inflicted injury is ‘undetermined’ rather than ‘SIDS’. Use of standard autopsy and death scene protocols that have been endorsed by professional bodies will improve the investigation of unexpected infant death and will increase the likelihood of diagnosing subtle disorders that may be confused with SIDS.
Survival, cranial ultrasound and cerebral palsy in very low birthweight infants: 1980s versus 1990s
Authors: Doyle LW , Betheras FR , Ford GW , Davis NM , Callanan C
Published: March 2003

Objective: To determine the changes in the rates of survival, cranial ultrasound abnormalities and cerebral palsy in very low birthweight (VLBW) (birthweight 500–1499 g) infants between the early 1980s and the early 1990s.

Methodology: A cohort study of consecutive VLBW live births in one tertiary perinatal hospital during two distinct eras was performed at The Royal Women’s Hospital, Melbourne, a level‐III perinatal centre. Consecutive VLBW infants born over the 18‐month period from 1 October 1980 (n = 222), and over the 12‐month period from 1 January 1992 (n = 202) were identified. The main outcome measures were the proportions of live births surviving to 5 years of age, rates of cranial ultrasound abnormalities, and rates of cerebral palsy at 5 years of age.

Results: Over the 18 months from 1 October 1980, 68% (150/222) VLBW live births survived to 5 years of age. The survival rate rose substantially to 82% (165/202) during 1992 (odds ratio 2.1, 95% confidence interval 1.4–3.2). The survival rate increased over time more for those of 500–999 g birthweight than for those of 1000–1499 g birthweight. The rates of cerebroventricular haemorrhage (CVH) were similar in live births and survivors from both eras, as were the rates of cerebral palsy (7.5% in 1980–82; 7.8% in 1992) in survivors seen at 5 years of age. The positive predictive value of CVH for cerebral palsy was low, but cystic periventricular leucomalacia was followed by cerebral palsy in seven of eight survivors from the 1992 cohort.

Conclusions: Despite the increasing survival rate with improvements in perinatal care, including more antenatal steroid therapy and the introduction of exogenous surfactant, the rates of CVH and of cerebral palsy in survivors have not diminished.
Disclosure of developmental disability: A study of parent satisfaction and the determinants of satisfaction
Authors: Hasnat MJ , Graves P
Published: March 2003

Objective: To investigate the level of parent satisfaction with the first communication of a diagnosis of developmental disability in their child (‘disclosure’) and the determinants of this satisfaction.

Methodology: Interviews with parents of children with developmental disabilities regarding their experiences at the time of disclosure and their level of satisfaction with the process were carried out.

Results: Parent satisfaction with disclosure overall was found to be high (82.6%). Parents were more likely to be satisfied if they received a large amount of information. Parent satisfaction was found to be higher when the disclosing professional communicates well with the parents, has an understanding of parental concerns, and is direct in manner. Having both parents, the child or support people present were not found to have any significant relationship to parent satisfaction.

Conclusions: The high level of satisfaction with disclosure in this study supports the claim made by earlier researchers that parental dissatisfaction with the disclosure process is not inevitable. The major determinants of parental satisfaction with disclosure are directness, understanding of parental concerns and good communication on the part of the disclosing professional, and receiving a large amount of information.
Non‐accidental fractures in infants: Risk of further abuse
Authors: Skellern C Y , Wood D O , Murphy A , Crawford M
Published: March 2003

Objectives: To look for features of non‐accidental fractures in infants aged under 1 year and assess the risk of subsequent morbidity and mortality.

Methodology: A retrospective analysis of 99 children aged under 1 year who presented to the Mater Children’s Hospital, Brisbane, between January 1990 and December 1993, and were found to have a fracture. The 99 infants were divided into non‐accidental and accidental groups. Comparison was made between the two groups for age, sex and type of fracture. Deaths, subsequent injuries and child protection notifications until March 1997 were compared between groups.

Results: Of the 99 infants with fracture (64 males, 35 female), the skull and femur were the most prevalent sites of fracture. Twenty‐six infants had fractures assessed as non‐accidental. This group was younger but did not differ significantly in gender or site of fracture. Infants aged under 4 months had a significantly greater risk of their fracture being non‐ accidental (P = 0.0007). Subsequent substantiated child protection notifications occurred in nine of the non‐accidental group and in one of the accidental group (P = 0.000001). There was no significant difference in the rate of subsequent notifications between those infants with abuse who were removed from their carers and those not removed. Subsequent injuries presenting to hospital occurred in 17 of the accidental group and three of the non‐accidental group (P = 0.20). There were no deaths.

Conclusion: Infants aged under 1 year with fractures have a high prevalence of abuse. The risk of abuse as cause for the fracture is greater in those aged under 4 months. Infants with non‐accidental fractures have a high risk of further abuse even with intervention.
Fracture of the first rib as a consequence of pertussis infection
Authors: Prasad S , Baur LA
Published: March 2003

Abstract: We report the first described case of a first rib fracture secondary to pertussis infection. An 11‐year‐old boy presented with sudden onset of severe right‐sided pleuritic chest pain on a background of a 6 week history of a coughing illness and considerable weight loss. Pertussis was clinically suspected and proven on serology. A cause for the severe pain was initially difficult to confirm, causing some concern regarding possible underlying pathology, but was later demonstrated to be due to a first rib fracture. The anatomy of the first rib, and the biomechanical forces placed upon it that are exacerbated during a coughing illness are described.
Indomethacin treatment of infantile cortical periostosis in twins
Authors: Couper RTL , Mcphee A , Morris L
Published: March 2003

Abstract: Twin girls presented with infantile cortical periostosis (Caffey's disease) at 2 and 3 weeks of age, respectively. This disorder initially involved their upper and lower limbs and resulted in fever, irritability and tenderness. X‐rays showed extensive periosteal new bone formation. Multiple relapses occurred in the first year of life and during some of these relapses mandibular and clavicular involvement was noted. Prednisolone, 1 mg/kg per day, was used to treat relapses until 9 months of age. Indomethacin therapy at this age at a dose of 3 mg/kg per day allowed the cessation of prednisolone therapy and disease flares were thereafter infrequent and responsive to indomethacin.
Childhood infections in the tropical north of Australia
Authors: Currie BJ , Brewster DR
Published: March 2003

Abstract: In the tropical north of Australia there are high rates of infections in Aboriginal children living in remote communities. In addition to the burden of respiratory infections, diarrhoeal disease and skin sepsis, there are high rates of acute rheumatic fever, outbreaks of poststreptococcal glomerulonephritis and gonococcal conjunctivitis, endemic trachoma and various intestinal parasites. A number of infections generally restricted to the tropics are also present and can cause disease in both indigenous and non‐indigenous children. These include melioidosis, Murray Valley encephalitis and dengue on the east coast. With global warming, these infections may become more common and more widespread within Australia and the potential for establishment of introduced infections such as Japanese encephalitis and malaria may increase.
Continuous intrathecal baclofen infusion for children with cerebral palsy: A pilot study
Authors: Scheinberg AM , O'Flaherty S , Chaseling R , Dexter M
Published: March 2003

Objectives: To determine whether continuous intrathecal baclofen infusion (CIBI) would decrease spasticity and improve function in children with spastic cerebral palsy.

Design: Prospective study with measurement of changes from baseline assessed at regular intervals for 6 months following the intervention.

Patients: Two subjects aged 8 and 9 years with cerebral palsy. Inclusion criteria included severe spasticity and age greater than 4 years.

Study centre: Department of Rehabilitation, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.

Results: Both subjects had clinically significant reductions in lower limb spasticity from a single intrathecal dose of baclofen (screening procedure), and had intrathecal pumps implanted. An intensive physical therapy programme was provided for both subjects in the 1–3‐month period after commencing CIBI, in order to maximize functional gains. Modified Ashworth Scale scores remained reduced during the 6‐month study period. There was a clinically significant increase in upper limb function for Subject 1. Gross Motor Function Measure scores decreased from 22% to 19% for Subject 1, and increased from 6% to 10% for Subject 2 over the study period. Paediatric Evaluation of Disability Inventory scores for Subject 1 showed a reduction in the level of caregiver assistance required, while Subject 2 showed significant improvement in the functional mobility domain. The major changes noted in the parent questionnaires were reduction in tone, increased range of motion and reduced time taken helping with activities of daily living such as toilet and dressing. No significant side‐effect was seen after the screening procedure or after continuous intrathecal infusion. Both subjects’ parents felt their child was improved following the intervention.

Conclusions: Children with spastic cerebral palsy can have their spasticity effectively reduced with CIBI. In this study of two children, the clinical improvements were encouraging, and it is proposed that CIBI may be of benefit to those patients whose level of spasticity severely interferes with function. Further studies using multidimensional assessment approaches, with larger numbers of children, are warranted.
Is the practice of paediatric inpatient medicine evidence‐based?
Authors: Moyer VA , Gist AK , Elliott EJ
Published: March 2003

Objective:  To determine whether management provided to paediatric inpatients in general units was supported by high‐level evidence.

Methods:  A retrospective review was carried out of all patients (n = 142) admitted during one calendar month to two general paediatric units in the USA and Australia. For each patient, the primary diagnosis and primary treatment were determined. A literature review was performed to determine whether the therapy used was evidence‐based. The main outcome measure was the level of evidence supporting the primary intervention for the primary diagnosis of each patient.

Results:  Level I evidence (at least one randomized trial) supported the primary intervention used in 31% of paediatric admissions and level II evidence (convincing non‐experimental evidence) supported the primary intervention in 44% of admissions. Primary interventions were not supported by evidence (level III) in only two patients. The remaining 24% of patients were admitted for observation or evaluation only, and received no primary medical or surgical intervention. Most patients whose interventions were supported by randomized trials were admitted with either asthma or appendicitis.

Conclusions:  Most primary interventions (75%) in paediatric inpatients were supported by high‐level published evidence (level I or II). A large number of patients were admitted for evaluation or observation only, and received no therapeutic intervention. Evidence to support this action is not available.
Comparative immunogenicity of hepatitis B vaccine administered into the ventrogluteal area and anterolateral thigh in infants
Authors: Cook IF , Murtagh J
Published: March 2003

Objective:  To compare the immunological response of hepatitis B vaccine given by intramuscular injection into the anterolateral thigh and ventrogluteal site of infants up to 10 months old at initiation of vaccination.

Methods:  An open, randomized study of 200 healthy infants recruited from a single practice in a small regional town in New South Wales was carried out. Infants were vaccinated with hepatitis B vaccine (Engerix‐B 10 µg) using a 0 months, 1 month, 6 months regimen, with venous blood being collected from children 4−6 weeks after the last dose of vaccine for quantitative determination of hepatitis B surface antibody (anti‐HBs) titre. Infants with anti‐HBs titre ≥ 100mIU/mL were considered to be ‘good’ responders and were unlikely to acquire clinically significant hepatitis B infection. Infants with anti‐HBs titre < 100mIU/mL were considered to be ‘poor’ responders and were given a booster dose of Engerix‐B 20 µg; serology was repeated for anti‐HBs titre 2−3 months after this injection.

Results:  Quantitative anti‐HBs titre was obtained from 177 infants: 171 4−6 weeks after the last dose of vaccine; 87 at the ventrogluteal site (46 boys, 41 girls); and 84 at the anterolateral thigh site (38 boys, 46 girls). Good antibody response (anti‐HBs titre ≥ 100mIU/mL) was not significantly different for the two sites (ventrogluteal 96.6%, anterolateral thigh 93.2%), and antibody geometric mean titres (GMT) for anti‐HBs were comparable for the two sites (ventrogluteal 2071.2 ± 5.8mIU/mL, anterolateral thigh 2073.2 ± 5.2mIU/mL).

Conclusion:  The ventrogluteal and anterolateral thigh vaccination sites in infants are immunologically comparable for hepatitis B vaccine. Presumably the variance of this study with studies of adults reflected the uniform injection of vaccine antigen into muscle tissue in infants.
Anti‐oxidant vitamins and steroid responsive nephrotic syndrome in Indian children
Authors: Mathew JL , Kabi BC , Rath B
Published: March 2003

Objective:  In recent years, it has been proposed that nephrotic syndrome is a consequence of an imbalance between oxidant and anti‐oxidant activity. In the present study, the levels of micronutrient anti‐oxidant vitamins (vitamin E, vitamin C, carotene and riboflavin) in Indian children with steroid responsive nephrotic syndrome were investigated. Their levels were measured during the acute proteinuric phase of the disease, as well as during clinical recovery (remission), in order to understand the possible role of nutritionally modifiable anti‐oxidants in the aetiopathogenesis of the disease.

Methods:  The study was a hospital based, prospective cohort study. Serum and erythrocyte vitamin E, leucocyte vitamin C, serum carotene, erythrocyte riboflavin activity and serum malonyldialdehyde (MDA) levels were measured in 30 consecutive cases of children with nephrotic syndrome (International Study of Kidney Diseases in Children (ISKDC) criteria) during the proteinuric phase of the disease and at 4 weeks after remission was induced by steroid therapy. The same biochemical parameters were measured in healthy siblings (controls) of the 30 patients.

Results:  Mean vitamin E (serum and erythrocyte), vitamin C and carotene were significantly lower during the proteinuric phase of the disease, and there was decreased erythrocyte riboflavin activity. There was significant elevation in the serum level of MDA during this phase. In addition, all these parameters tended to improve during remission, although complete normalization did not occur.

Conclusion:  These vitamins were active in performing their anti‐oxidant function, as indicated by significant depression in their levels during the acute (proteinuric) phase, followed by partial recovery during remission. It may be concluded that steroid responsive nephrotic syndrome in children is associated with oxidative stress.
Professional telephone advice to parents with sick children: Time for quality control!
Authors: Andrews JK , Armstrong KL , Fraser JA
Published: March 2003

Objective: To assess the quality of professional telephone advice given to parents with sick children.

Methods: All hospitals with an emergency department and a paediatric ward and a designated child health telephone advice line in the greater Brisbane region were invited to participate in the study. Case scenarios involving a febrile baby, a 14‐month‐old with gastroenteritis and an 18‐month‐old with a head injury were used three times with each institution. Each of the cases should have elicited a response indicating the need for urgent medical attention. A research assistant presented the symptoms in accordance with the questions of the telephone advice‐giver. Aspects of the call were recorded, including time between call made and access to advice‐giver, profession of advice‐giver, identifying details sought by advice‐giver, questions asked about the case presented, length of call, and advice‐given.

Results: Of the 10 hospitals asked, six agreed to participate. Included in the study were two paediatric hospitals, two general public hospitals, one private hospital, and a Statewide‐designated child health telephone advice line. Calls were generally attended to promptly. Only 37 (68.5%) of the advisers recognized the urgency of the case scenarios, with the febrile infant having the least likelihood of eliciting the correct advice (39%). Doctors gave more reliable advice than nurses in the fever scenario, but not in the other cases.

Conclusions: Telephone advice to parents with sick children is easily accessible, but is often dangerously inappropriate. There is a need for tighter quality control and/or for a centralised telephone advice line to prevent inappropriate advice being given to parents.
Eating behaviour of children 1.5–3.5 years born preterm: Parents’ perceptions
Authors: Cerro N , Zeunert S , Simmer KN , Daniels LA
Published: March 2003

Objective: To investigate parents’ perceptions of the eating behaviour of toddlers born preterm.

Methods: A mailed, self‐administered questionnaire was sent to parents of infants born between July 1994 and July 1996 with gestational ages less than 32 weeks who had been admitted to the Neonatal Unit at Flinders Medical Centre.

Results: Responses were received for 95 subjects (response rate 70%)
with a mean ± SD gestational age of 29.2 ± 2.1 weeks, birthweight
of 1243 ± 296 g and median corrected age of 134 weeks (range 84–185
weeks) at the time of study. Seventy‐eight per cent of parents were concerned about
the quality of food intake and 45% wished to change their child’s
eating behaviour. Although only 20% of parents identified their toddlers
as being fussy eaters, food refusal was reported by 58% of respondents, and
51% and 69% used food rewards or coaxing, respectively, to encourage
intake. Parents of toddlers who had received home gavage feeding (n = 5) or
had a respiratory or neurological disability (n = 16), reported poorer feeding indicators.

Conclusions: Programmes providing information on normal toddler eating behaviour and strategies to promote positive feeding practices may reassure parents and promote development of food preferences and eating behaviours consistent with long‐term healthy eating habits. Special emphasis should be placed on children with a disability or children who have received home gavage feeding.
Polyneuritis cranialis with contrast enhancement of cranial nerves on magnetic resonance imaging
Authors: Morosini A , Burke C , Emechete B
Published: March 2003

The disorder of multiple cranial nerve palsies without spinal cord involvement is referred to as polyneuritis cranialis (PC) and is rare. It is thought to be an acute post‐infective polyneuropathy or a variant of Guillain−Barré syndrome. Electrophysiological evidence of demyelination has been reported, but no radiological abnormalities of the affected cranial nerves have been noted. We report a case of PC where contrast enhanced magnetic resonance imaging (MRI) showed enhancement of the peripheral segments of the oculomotor and abducens nerves. This case illustrates the utility of MRI in the assessment of cranial nerve palsies.
Addressing adverse events through clinical indicators
Authors: Portelli R , Collopy B , Desmond P
Published: March 2003

Abstract In an attempt to improve the reporting rate of adverse drug reactions the Adverse Drug Reaction Advisory Committee approached the Australian Council on Healthcare Standards Care Evaluation Program to develop a set of indicators to improve healthcare standards by heightening awareness amongst clinical staff of the morbidity, mortality and financial implications of adverse drug reactions. Ten clinical indicators addressing: (i) reporting of adverse drug reactions; (ii) adherence to treatment protocols for anaphylaxis; (iii) monitoring of warfarin; and (iv) monitoring of streptokinase, were field tested in ten Australian health‐care organizations, to determine that the data were available, that the indicators were relevant to clinical practice and that the measures were achievable. Based on the results of this field test, six adverse drug reaction clinical indicators will be introduced into the Australian Council on Healthcare Standards Evaluation and Quality Improvement Program from January 1999.
Towards the safer use of warfarin II: Results of a workshop
Authors: Halstead PJ , Roughead EE , Rigby K , Clark RB , Gallus AS
Published: March 2003

Abstract The use of oral anticoagulation therapy (ACT) is expanding. Due to the combination of the narrow therapeutic range and relatively unpredictable pharmacokinetics and pharmacodynamics, there are relatively high risks involved in using this treatment. The purpose of this paper is to present the results of a focus group’s canvassing of ways to improve the management of the use of oral anticoagulants. Recommendations proposed include: (i) better patient selection; (ii) more patient involvement and research into the appropriateness of the current use of ACT in Australia; (iii) increased production, dissemination and implementation of ACT guidelines; (iv) assessment of home and practice ACT monitoring; and (v) research into the effectiveness of academic detailing and the use of management plans by dedicated ACT educators.
Hospital blood pressure measurement: Staff and device assessment
Authors: Carney Sl , Gillies Ahb , Green Sl , Paterson O , Taylor Ms , Smith Aj
Published: March 2003

Abstract Evaluation of the ability of clinical staff to measure blood pressure as well as the functional state of hospital sphygmomanometers has consistently demonstrated marked deficiencies. In this study, the working order of all sphygmomanometers (manual and automated) in a teaching hospital was evaluated. Nursing staff were tested on their knowledge and use of such devices and were also asked to estimate the blood pressure from videotape. The accuracy of a commonly used automated device, Dinamap 8100, was also measured. Of 543 manual sphygmomanometers, 14% were in perfect working order although portable devices were more likely to be functional (47% of 36 units). In contrast, all 135 automated portable devices were in perfect working order although service requirements were seldom met. The mean time since last service was 18 months. There appeared to be an inverse correlation between the availability of automated and manual devices and the maintenance of wall‐mounted bedside sphygmomanometers. Staff knowledge about manual devices was adequate as was their ability to accurately measure blood pressure using standardised videotape. Forty‐two per cent of 31 nurses who completed the test were correct in 9 of 12 blood pressures. A comparison of this result with a comparable group of nurses tested in 1990 did not detect a significant change in competence. Direct evaluation of the commonly used Dinamap 8100 in 47 hospital patients demonstrated a poor correlation with a mercury sphygmomanometer with a D grade (fail) for systolic and a C grade for diastolic pressure. In summary, maintenance of manual sphygmomanometers was very poor, probably due to their lack of use by clinical staff. This was particularly true for units attached to bedside walls. Nursing staff demonstrated significant deficiencies in manual sphygmomanometer use although their skills were similar to those measured several years earlier. Because of the demonstrated inaccuracy of the Dinamap 8100 automated device, the strong trend towards the use of automated devices instead of manual sphygmomanometers within hospitals cannot be supported.
Towards excellence in quality patient care: A clinical pathway for myocardial infarction
Authors: Smith DM , Gow P
Published: March 2003

Abstract A major initiative to implement a clinical pathway for myocardial infarction has provided a model on which to further develop pathways within our organization. Two of the primary objectives were to reduce time to thrombolysis and length of stay. Two years after the implementation of the myocardial infarction pathway there has been a reduction in the thrombolysis times from 80 to 49 min and in length of stay from 7.28 to 6.13 days. These results highlight significant improvements in patient and process outcomes. There is heightened awareness about best practice for patients who have sustained myocardial infarctions.
The systematic assessment of short‐term functional recovery after major joint arthroplasty
Authors: PEERBHOY D , KEANE P , MACIVER K , SHENKIN A , HALL GM , SALMON P
Published: March 2003

Abstract Despite extensive information about long‐term recovery from major joint arthroplasty, little attention has been given to the measurement of functional recovery in the immediate postoperative period. Therefore assumptions about the importance of physical therapy during this period remain untested. We devised a way of recording functional recovery before discharge, based primarily on the achievement of objective milestones. This was incorporated into routine physiotherapy practice and applied to sequential patients undergoing elective hip (n = 163) or knee (n = 66) replacement. Six months later, we followed up 160 patients, of whom 145 completed questionnaires to assess subjective physical and emotional state and functional recovery. The method was sensitive to known influences on pace of recovery, including type of arthroplasty (hip vs knee) and surgeons’ differing requirements for mobilization. In addition, we were able to confirm and quantify sources of variation in functional recovery which previously were suspected but unconfirmed: in particular, the timing of early mobilization. Outcome at 6 months was unrelated to objective functional recovery in hospital, although fatigue and wellbeing at this time were predicted by physiotherapists’ subjective assessment of patients’ motivation before discharge. The findings can be used to inform patients and as a source of comparison data for the assessment of functional recovery in other centres. More importantly, the procedure reported may be applied to quantify functional recovery in routine practice and thereby expose variability in recovery to scientific scrutiny.
Impact of light regimen and self‐shading by algal cells on primary productivity in the water column of a shallow tropical lake (Lake Naivasha, Kenya)
Authors: Hubble D. S. , Harper D. M.
Published: March 2003

Light is the factor that fundamentally determines the level of primary production. Primary productivity is controlled by bottom‐up factors (nutrient levels), with secondary effects due to biological factors (zooplankton grazing). The light regimen experienced by algae is determined largely by mixing of the water column. The processes of photoinhibition and light attenuation combine with the resultant light–dark adaptation to shape the vertical productivity profile and it is important to determine their importance separately because they vary spatially and temporally. Daily variations in productivity can be as large as longer‐term changes and events causing high productivity may not be important in whole‐lake terms. At approximately 0.5 m depth, there is maximal photosynthesis causing depletion of nutrients, but there is vertical homogeneity in productivity control and horizontal similarity in productivity levels. There is zero productivity below 5 m depth due to light attenuation but, if the benthos becomes productive due to an environmental change, such as decreased turbidity, overall productivity may rise appreciably. Self‐shading was investigated by incubating serial dilutions of whole lakewater with filtered water to reduce the density of algal cells. Photosynthetic efficiency was calculated as productivity per unit of chlorophyll a. Self‐shading showed different responses for conditions of ‘low’ and ‘high’ productivity. With low productivity, there was a shading loss of 17%, while for high productivity this was 46%. Thus, self‐shading is seen to have a considerable impact on potential productivity and may affect phytoplankton–cyanobacterial community structure with implications for lake management.
Wetland use and impact on Lake Victoria, Kenya region
Authors: Kairu J. K.
Published: March 2003

This article reports on a study of wetland use and impact on Lake Victoria conducted in March and April 1995. A field survey and interviews were used to study wetland use and their impact on Lake Victoria. This article identifies management issues and establishes a broad vision for the future. It also addresses the need to balance the competing demands for wetland use and development with the need to conserve a healthy and functional Lake Victoria. Investment proposals are made that would minimize destruction of the wetlands and negative impacts on the lake. General recommendations for planning and management issues, as well as suggestions of specific research needs that should form the basis of action and investment initiatives, are given.
Phosphates in Lake Chapala, Mexico
Authors: De Anda J. , Shear H. , Maniak U. , Riedel G.
Published: March 2003

Lake Chapala, the most important lake in Mexico, has suffered from cultural eutrophication problems for many years, manifested by the growth of aquatic vegetation and an increase in primary productivity. It was found that about 70% of the total phosphorus entering Lake Chapala is orthophosphate, thus increasing the biological availability of nutrients in the lake. In addition, the hydrologic imbalance in the lake, caused by the over‐use of water resources along the Lerma–Chapala basin, has significantly increased the hydraulic residence time of the inflow waters, thus increasing the effects of the added phosphorus, and creating conditions that increase the lake’s eutrophication status.

The shallow characteristics of the lake and the action of the wind forces produce rapid changes in water quality, especially in the distribution of phosphate. The focus of this paper is on the development of a historical orthophosphate balance in Lake Chapala, quantifying the main point and non‐point sources that contribute to the enhancement of this nutrient in the lake. The estimation of the amount of phosphate in the lake can be used to determine appropriate management practices to reduce the phosphate loads on the lake.