bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of lansoprazole, famotidine, roxatidine and rebamipide administration on the urea breath test for the diagnosis of Helicobacter pylori infection
Authors: ADACHI KYOICHI , FUJISHIRO HIROFUMI , MIHARA TAKAFUMI , KOMAZAWA YOSHINORI , KINOSHITA YOSHIKAZU
Published: March 2003

Background and Aim:  The sensitivity of the urea breath test (UBT) has been reported to be influenced by the administration of omeprazole, lansoprazole and ranitidine. However, it is unclear whether other H2 receptor antagonists (H2RA), except ranitidine, and rebamipide, a mucosal protective agent, affect UBT sensitivity. The aim of this study is to clarify the effects of lansoprazole, famotidine, roxatidine and rebamipide administration on UBT sensitivity.

Methods:  Subjects comprised 30 volunteers with Helicobacter pylori infection. All subjects were examined by the 13C‐UBT on four occasions: (i) without medication (control); (ii) after the administration of 30 mg lansoprazole (u.i.d) for 14 days; (iii) after the administration of 100 mg rebamipide (t.i.d) for 14 days; and (iv) after the administration of 20 mg famotidine or 75 mg roxatidine (b.i.d) for 14 days. In the H2RA study, individuals were randomized into two groups of 15 subjects and were administered either famotidine or roxatidine.

Results:  Five of the 30 cases administered lansoprazole and one of the 15 cases given roxatidine gave a false‐negative UBT result. No negative UBT results were observed in patients administered famotidine or rebamipide.

Conclusion:  Patients showing negative UBT results during the administration of proton pump inhibitors and H2RA should be re‐examined after the cessation of these drugs to confirm the true negativity of H. pylori infection.
Interobserver reliability of the click test: A rapid bedside test to determine surfactant function
Authors: OSBORN DA , LOCKLEY C , JEFFERY HE , LLOYD J , LAZARUS And R
Published: March 2003

Objective:

To determine the interobserver reliability of the click test, a rapid bedside test of surfactant function.

Methodology:

One hundred samples (48 amniotic fluid, 28 gastric aspirates, 24 tracheal aspirates) were obtained from pregnant women, term and preterm infants managed at two perinatal centres. Gestational ages of the pregnancies or infants at time of sampling ranged from 24 to 40 weeks (mean±sd: 31±5). The click test was performed independently by two observers, with differing levels of experience, and blinded to each other’s results. Interobserver reliability was determined for samples classified as negative (no clicking bubbles), equivocal (a few clicking bubbles seen after 2 min of looking), and positive (clicking bubbles seen easily on first look). As negative and equivocal test results suggest surfactant dysfunction, these results were also combined to provide a dichotomised result.

Results:

For samples classified as negative, equivocal and positive the interobserver agreement was 0.83, with agreement beyond chance shown by a quadratic weighted Kappa of 0.74 (95% CI=0.62–0.86). When negative and equivocal results were combined, the simple Kappa was 0.73 (95% CI=0.59–0.87).

Conclusions:

The click test has a high level of interobserver reliability. It is rapid, simple, accurate and able to be taught to medical and nursing staff with appropriate training. It has many potential applications including the prediction of fetal lung maturity in women with premature rupture of membranes, and in term and preterm infants who require the bedside testing of surfactant function.
Hospital admissions in the first year of life in very preterm infants
Authors: Elder DE , Hagan R , Evans SF , Benninger HR , French NP
Published: March 2003

Objective: To analyse hospital readmissions to 1 year in infants <33 weeks’ gestation.

Study design: Cohort of very preterm infants born in Western Australia.

Methods: Parental social class, history of asthma, race, gestational age, birthweight, sex, severity of respiratory disease and oxygen requirement at 28 days chronic lung disease (CLD), 36 weeks and term, maternal smoking, cohabitation with siblings, breast‐feeding duration and hospital readmissions were recorded prospectively.

Results: Data were available for 538 of 560 (96%) infants discharged. Eight died in the first year. Two hundred and twenty‐five infants (42%) had 443 readmissions, of which 370 were medical and 73 surgical. Risk factors for medical readmission were Aboriginal race, male sex and CLD. Breast‐feeding was protective. Risk factors for surgical admission were male sex, lower gestation, severe hyaline membrane disease, severe CLD and birthweight <10th centile.

Conclusions: Readmission is common after very preterm birth. Risk factors for medical and surgical admission differ with CLD being the only perinatal factor associated with both medical and surgical admission.
The influence of growth on development outcome in extremely low birthweight infants at 2 years of age
Authors: Connors JM , O'Callaghan MJ , Burns YR , Gray PH , Tudehope DI , Mohay H , Rogers YM
Published: March 2003

Objective: To determine if weight <3rd and <10th centile at 2 years in extremely low birthweight (ELBW) infants is associated with problems of development and motor skills, and whether this association is explained by perinatal risk status.

Methodology: One hundred and ninety‐eight of 226 (88%) surviving ELBW infants born between January 1987 and December 1992 were assessed at 2 years corrected age. Children were classified as being at low perinatal risk (n = 128) or high perinatal risk (n = 70) for adverse developmental outcome based on perinatal risk factors. Weight at 2 years was classified as <3rd, 3rd–9th or ≥10th centile for age and gender. Development was assessed using the Griffiths Mental Development Scales and motor skills using the Neurosensory Motor Developmental Assessment (NSMDA).

Results: For the total study group weight centile was strongly related to General Quotient (GQ) and motor abilities. For children <3rd percentile (n = 48) mean (GQ) was 90.4 (SD, 15.9), for children between the 3rd–9th percentile (n = 49) 91.5 (SD, 17.9), and for children ≥10th percentile (n = 99) mean GQ was 99.8 (SD, 8.6). The association with mean GQ and NSMDA category occurred for the high‐risk subgroup and became non‐significant in the low‐risk subgroup if neurologically abnormal children were excluded. Other perinatal risk factors, exposure to breast milk, level of maternal education, marital status and history of feeding problems or infections over the 2 years did not confound this association.

Conclusion: Low weight percentile at 2 years was related to adverse developmental outcome in ELBW infants at high perinatal risk or with neurological impairment, though minimal association was present for neurologically normal infants at low perinatal risk.
Angel trumpet lily poisoning in five adolescents: Clinical findings and management
Authors: Francis PD , Clarke CF
Published: March 2003

Objective: To describe clinical features and management of Angel trumpet lily poisoning in adolescents.

Methodology: Case notes of five adolescent males who presented to the emergency department of a teaching hospital were reviewed.

Results: All five boys ingested a mixture of coca‐cola and a brew prepared by boiling the leaves and flowers of the plant. They presented to the emergency department with various degrees of agitation and confusion and specific clinical signs. All were treated with charcoal and cathartics and discharged after 36 h.

Conclusions: Due to its hallucinogenic effects, abuse of Angel trumpet lily is not uncommon and should be suspected in adolescents presenting with altered mental state and hallucinations in conjunction with other anticholinergic symptoms and signs.
Duration of breast‐feeding and Bayley's Mental Developmental Index at 1 year of age
Authors: Paine BJ , Makrides M , Gibson RA
Published: March 2003

Objective: To examine the association between duration of exclusive breast‐feeding and developmental indices in initially breast‐fed infants at 1 year of age.

Methodology: A cohort of 96 healthy term infants, aged between 10 and 14 months, were recruited from public immunization clinics and child care centres in southern metropolitan Adelaide. Infants were assessed using the Bayley Scales of Infant Development (Mental and Psychomotor Developmental Indices) within 2 weeks of enrolment. Information regarding duration of breast‐feeding was provided retrospectively by the mothers of the infants. Duration of exclusive breast‐feeding and socio‐demographic variables were used as independent variables to determine their effects on development.

Results: Due to a significant interaction between duration of breast‐feeding and gender on mental development scores, separate regression models for boys and girls were explored. Duration of breast‐feeding significantly predicted mental development scores for boys (partial r2 = 0.14, P < 0.005), but not for girls. Duration of breast‐feeding did not predict psychomotor development scores.

Conclusions: These findings deserve further examination in large, prospective studies.
Bronchiectasis and bronchiolitis obliterans post respiratory syncytial virus infection: Think again
Authors: Massie RJH , Armstrong DS
Published: March 2003

Abstract: Respiratory syncytial virus (RSV) lower respiratory tract infections are common, yet long‐term sequelae in previously healthy infants and children are rarely reported. We report a child who developed bronchiectasis and bronchiolitis obliterans following an RSV lower respiratory tract infection but in whom adenovirus was detected on stored serum. Co‐infection with adenovirus is the likely cause for the bronchiectasis and bronchiolitis obliterans.
The effect of draw‐up volume on the accuracy of electrolyte measurements from neonatal arterial lines
Authors: Davies M.W , Mehr S , Morley C.J
Published: March 2003

Objectives: Contamination by infusate of blood samples withdrawn from arterial lines has been recognized but not well documented for neonates. The aim of this study was to investigate, using in vitro and in vivo studies, the effects of different draw‐up volumes (withdrawn from the line prior to the sample being taken) on the concentration of sodium.

Methods: In‐vitro study: The tip of an umbilical artery catheter (dead space 0.6 mL), infused with half normal saline containing 1 unit/mL of heparin was placed in a beaker of normal saline. The line was flushed with 1 mL of this infusate just before each sample was taken. Volumes from 0.5 mL to 2.0 mL of infusate/normal saline were withdrawn in 0.1 mL increments from a three‐way tap and discarded. A sample was then taken from the line into a blood gas syringe for analysis of the sodium concentration by the 860 Blood Gas Analyzer (Chiron Diagnostics, Bayer, Scoresby). Control samples were taken from the beaker. In‐vivo study: A 22 gauge intravenous catheter was inserted into a vein of an adult male volunteer. The dead space was also 0.6 mL. The line was flushed with 5 mL of half‐normal saline immediately before sampling. Draw‐up volumes of 0.6, 0.9, 1.3, and 1.6 mL were withdrawn and discarded. 10 mL was used as a control. A 0.5‐mL blood sample was then taken and the electrolyte concentrations analysed immediately.

Results: In‐vitro: A minimum draw‐up volume of 1.3 mL was required before the sodium concentration was not significantly different from the control samples. In‐vivo: A minimum draw‐up volume of 1.6 mL was required before the sodium concentration was not significantly different from the control samples. There were similar trends in the effect of draw‐up volume for glucose, calcium, potassium, chloride and lactate.

Conclusion: A minimum volume of 1.6 mL should be withdrawn from neonatal arterial lines (dead space 0.6 mL) before taking blood for analysis.
Elevated aminotransferase as a presenting finding in a patient with occult muscle disease
Authors: Begum T , Oliver MR , Kornberg AJ , Dennett X
Published: March 2003

Abstract: We report a patient with occult muscle disease who presented with raised serum aminotransaminases. This case report emphasises the importance of considering muscle disease in the differential diagnosis of raised serum aminotransaminases, as it may negate the need for invasive investigations such as liver biopsy.
Postnatal corticosteroids in preterm infants: Systematic review of effects on mortality and motor function
Authors: Doyle LW , Davis PG
Published: March 2003

Background: Postnatal corticosteroid therapy has been proved in randomized controlled trials to reduce ventilator dependence and the rate of chronic lung disease in preterm infants with few serious short‐term side effects. However, there are other consequences that might follow postnatal corticosteroid therapy that are more important, including mortality or cerebral palsy.

Objectives: To review the evidence from reported randomized controlled trials on the effects of postnatal corticosteroid on long‐term mortality and motor dysfunction, including cerebral palsy.

Methods: The methods involved a meta‐analysis of reported randomized controlled trials, following guidelines of the Cochrane Collaboration, including calculation of event rate differences (ERD) and 95% confidence intervals (CI).

Results: The mortality rate difference was non‐significant both statistically and clinically (ERD – 0.1% favouring corticosteroids, 95% CI –2.9% to 2.8%). There were no subgroups in which a beneficial effect of postnatal corticosteroids on survival could be demonstrated. The rate of motor dysfunction in survivors was significantly higher in survivors from the postnatal corticosteroid group (ERD 11.9% favouring controls, 95% CI 4.6% to 19.2%). The rate of survival, free of motor dysfunction, was significantly lower in the postnatal corticosteroid group (ERD 7.8% favouring controls, 95% CI 0.5% to 15.1%).

Conclusions: Although postnatal corticosteroids have short‐term benefits, they do not increase the survival rate, and they may cause motor dysfunction in survivors. A large‐scale, placebo‐controlled randomized trial, with survival free of sensorineural impairments and disabilities as the major endpoint, is urgently needed.
Clinical markers of serious illness in young infants: A multicentre follow‐up study
Authors: Hewson P H , Poulakis Z , Jarman F , Kerr J F , McMaster D , Goodge J , Silk G
Published: March 2003

Objective: To perform a multicentre follow‐up study to determine if previously identified markers of serious illness in early infancy were robust and statistically reliable.

Methods: Infants aged 1 week to 26 weeks presenting to the Emergency Departments of the Royal Children’s Hospital and two Melbourne metropolitan hospitals were seen over a 12‐month period. Eleven clinical markers as well as their temperature were documented by nursing staff and resident medical officers. Serious illness was defined if infants had a positive body fluid bacterial culture, a positive chest X‐ray or if significant treatment was required in hospital. The predictive values, sensitivity and specificity for the individual and the best combination of clinical markers were determined.

Results: Assessments (3806) were performed with 312 infants being assessed as seriously ill (8.2%). The combination of either drowsiness on history or examination, pallor on history or examination, breathing difficulty (chest wall recession), temperature above 38°C and a lump being present, identified 82.5% of all babies deemed subsequently to be seriously ill. The positive predictive value of an infant who was febrile, drowsy and pale on examination was 70.7% (previous study 74%).

Conclusions: This study confirmed the high individual predictive value of arousal variables, pallor, and chest wall recession, especially when associated with fever, reaffirming their utility in the recognition of serious illness in infants under 6 months of age.
Insulin infusions in the neonatal unit: Delivery variation due to adsorption
Authors: Hewson M P , Nawadra V , Oliver J R , Odgers C , Plummer J L , Simmer K
Published: March 2003

Objective: To assess the extent of the variability in insulin delivery over time, under conditions used in Australian neonatal units, studying the following variables: diluent, preconditioning, flushing, sequential preconditioning and flushing, insulin concentration, flow rate, catheter type, and addition of albumin.

Methodology: A range of simulated insulin infusions was studied. Infusions were run over 22 h, with aliquots of infusate collected at baseline and after 15 min, 30 min, 1 h, 2 h, 6 h and 22 h. Insulin concentration was assayed using a radioimmunoassay.

Results: An infusion of 50 mU insulin/mL at 1 mL/h gave negligible insulin delivery until 22 h. However, after preconditioning and flushing the tubing, consistent insulin delivery was attained by 6 h. An infusion of 200 mU insulin/mL at 1 mL/h did not provide consistent delivery until 6 h. At this concentration and rate, consistent insulin delivery was attained within 30 min of the start of the infusion either by preconditioning and flushing the tubing, or by addition of albumin to the infusate.

Conclusion: Clinically significant variation in intravenous insulin delivery will occur in the neonatal setting unless counter‐measures are taken, such as sequential preconditioning and flushing of the delivery system or the addition of albumin to the infusate.
Determining the best method for first‐line assessment of neonatal blood glucose levels
Authors: Thomas Cl , Critchley L , Davies Mw
Published: March 2003

Objective: To evaluate and compare the accuracy and performance of two electrochemical glucose meters. To determine the user acceptability of these glucose meters and the ABL 620 Blood Gas Analyser (Radiometer, Copenhagen, Denmark) with an electrochemical glucose oxidase electrode for use in a Level 2 special care baby unit.

Methodology: A total of 108 blood samples were collected from 47 babies at risk for hypoglycaemia. The blood glucose level was measured with two glucose meters, the Advantage Glucose Meter (Roche Diagnostics, Castle Hill, Australia) and the Precision‐G Blood Glucose Testing System (Medisense, Melbourne, Australia), and the true blood glucose (TBG) measured with the ABL 620 blood gas analyser. Results from the glucose meters were compared with the TBG (as a percentage of the TBG).

Results: The mean (SD) percentage difference between the Advantage Glucose Meter and TBG was 4.5% (12.5), and Precision‐G Glucose Meter and TBG was 15.4% (12.4). The sample haematocrit did not significantly influence the glucose meter/TBG differences. There was an overall preference by the nursing staff for the Advantage Glucose Meter.

Conclusions: The Advantage Glucose Meter was significantly more accurate than the Precision‐G with similar precision. It was the preferred method of screening for neonatal hypoglycaemia.
Attitudes of neonatal clinicians towards resuscitation of the extremely premature infant: An exploratory survey
Authors: Oei J , Askie Lm , Tobiansky R , Lui K
Published: March 2003

Objective: This study aims to explore the current attitudes of Australian neonatologists and nurses towards the resuscitation of extremely preterm infants.

Methodology: An anonymous questionnaire regarding resuscitation of infants of less than 28 weeks gestation was sent to all neonatologists and three registered nurses in each perinatal centre in Australia.

Results: One hundred and thirty‐three questionnaires were sent. A return rate of 93% and 73% was obtained from neonatologists and nurses, respectively. Twenty‐two per cent of neonatologists would ‘occasionally’ resuscitate at 22 weeks while none of the nurses would. A considerable proportion of neonatologists (23%) but only a few nurses (6%) would ‘quite often’ resuscitate 23‐week infants. The majority of neonatologists (85%) and nurses (88%) would ‘almost always’ resuscitate 24 week infants. More than half of the respondents would ‘occasionally’ resuscitate a 400–499 g infant and most would resuscitate infants weighing more than 500 g. Clinicians were not as optimistic of long‐term outcome as they were for survival. Typically, only 52% of neonatologists and 38% of nurses thought babies of 25 weeks gestation had a greater than 50% chance of survival without major handicap. Parental wishes and the presence of congenital abnormalities were major influences on decision to resuscitate. Hypothetically, most respondents, more doctors than nurses, would consider initiating resuscitation without parental consent at a median gestation of 25 weeks.

Conclusions: The majority of Australian clinicians would resuscitate at a gestation of 24 weeks or greater or at a birth weight of over 500 g despite conservative estimates of intact survival. This survey has brought to light the importance of communication with parents prior to extreme premature birth.
Meningococcal pericarditis in a 2‐year‐old child: Reactive or infectious?
Authors: Beggs S , Marks M
Published: March 2003

Abstract: Pericarditis is an uncommon manifestation of infection of Neisseria meningitidis. Pericarditis may be caused by direct invasion or immune‐complex‐mediated (reactive) inflammation. We outline the case of a two‐year‐old girl with probable reactive pericarditis, review the cases reported in the English literature since 1966 and discuss the pathogenesis of meningococcal pericarditis.
Treatment of pleural empyema
Authors: Chan Pwk , Crawford O , Wallis C , Dinwiddie R
Published: March 2003

Objective: To determine the clinical presentation and treatment strategies for children admitted with pleural empyema.

Methodology: Retrospective review of medical and radiological records of 54 patients admitted with pleural empyema between January 1989 and April 1997.

Results: Fever (98%), cough (83%), chest pain (38%), clinical cyanosis (17%) and abdominal pain (16%) were common clinical features. The causative organism was identified in 17 patients (31%). Intravenous antibiotics were given for a mean of 18.2 ± 7.5 days. Forty‐seven (87%) patients had closed chest tube drainage and 21(39%) patients underwent decortication for unsatisfactory response to medical treatment. The chest tube insertion was more likely to be delayed in patients who required decortication, although the difference was not significant (8.1 ± 5.4 vs 6.3 ± 5.2 days of illness, P = 0.67). All patients were discharged well, with almost complete resolution of the chest radiograph at 6 months.

Conclusions: Intensive medical management with adequate chest tube drainage and appropriate antibiotics will result in full resolution for most patients. Surgical intervention is important in patients who fail to receive adequate treatment early in the disease.
Impact of infant feeding practices on the risk of mother to child transmission of HIV‐1 in Zimbabwe
Authors: Olayinka Ba , Oni Ao , Mbajiorgu Fe
Published: March 2003

Objective: To determine the magnitude of the contribution of infant feeding practices on the risk of mother to child transmission (MTCT) of the HIV‐1 infection.

Methodology: Prospective data from birth until 24 months of age on 236 infants born to HIV‐positive mothers in Harare, Zimbabwe was analysed for this study. However, because only a small proportion of infants (2.1%) were HIV‐1 polymerase chain reaction (PCR) tested shortly after birth, the PCR results for infants at birth were not incorporated into our analyses. The contribution of infant feeding practices on the risk of MTCT of HIV‐1 was assessed using Cox Proportional Hazards Regression Models.

Results: The incidence of HIV‐1 through MTCT was greatest among breastfed (8.33 per 100 child‐months) and mixed fed (8.64 per 100 child‐months) infants by 3 months. After adjustment for maternal age, marital status, education and infant antibody HIV‐1 status, the cumulative relative risk of MTCT of HIV‐1 was 4.19 (95% confidence interval (CI) 3.44, 5.09) among breastfed and 1.10 (95% CI 0.97, 1.25) among mixed fed infants. The overall MTCT rate of HIV‐1 in this study was 40.3%.

Conclusions: Breastfed infants had the greatest cumulative relative risk of MTCT of HIV‐1, followed by mixed fed infants, with the highest incidences occurring within the first 3 months.
Cardiac responses to mild hypoxic hypercapnia in newborn babies: No effect of sleep position
Authors: Naidoo M , Colditz Pb , Browne Ca , Dunster Kr
Published: March 2003

Objective: To evaluate whether cardiac responses to a level of hypoxic hypercapnia that may be observed in rebreathing studies are altered with infant sleep position.

Methodology: Eighteen healthy term infants (< 5‐days‐old) were studied. Heart rate (HR) and HR variability were monitored during air breathing and during 3 min exposure to a mixture of 15% O2/3% CO2 in both the prone and supine positions. Power spectral analysis of HR was performed.

Results: Heart rate was the only measured variable to be significantly changed in response to 15% O2/3% CO2. Hypoxic hypercapnia elicited no significant responses in power spectral HR variables. There was no effect of sleeping position on any of the measured variables.

Conclusions: There are no significant differences in cardiac responses to mild hypoxic hypercapnia between sleep positions and power spectral indices of the autonomic control of HR are not altered by sleep position in newborn babies.
Management of tuberculosis in children
Authors: Voss L M
Published: March 2003

Abstract: This paper provides specific guidelines on the management of tuberculosis infection and disease, covering general principles, recommended drug regimens and discuss the evidence to support these. It also covers use of corticosteroids, intermittent therapy, directly observed therapy and an approach to the management of a patient with drug‐resistant tuberculosis.
Parental attitudes to health of children in child‐care centres and options when children are ill
Authors: Slack‐Smith L M , Read A W , Stanley F J
Published: March 2003

Objective: To determine parental attitudes regarding the health of children attending child‐care centres, to explore concerns when children who normally attend child care are ill, and to investigate options in these circumstances.

Methodology: Focus groups conducted with parents whose children attended child‐care centres. Ten focus groups were conducted.

Results: Many parents encountered difficulty when children who normally attend child care were ill and there was a lack of options for care. Parents were concerned about the spread of infections among children but considered that there were also many health and other advantages for their children in attending child care. Child‐care centres were perceived as providing a valuable support role for families.

Conclusions: Many parents lack adequate options for care when their children are ill. Parents’ concerns regarding health in child care are important in policy decisions regarding the health of children in child care, and the development of alternative care services for children.
Single‐daily ceftriaxone plus amikacin versus thrice‐daily ceftazidime plus amikacin as empirical treatment of febrile neutropenia in children with cancer
Authors: Ariffin H , Arasu A , Mahfuzah M , Ariffin WA , Chan LL , Lin HP
Published: March 2003

Objective: Empirical antibiotic treatment for febrile neutropenic patients has been the mainstay of treatment for many years. Beta‐lactam antibiotics and aminoglycosides have been the most frequently used drug combination. The purpose of this study was to evaluate the efficacy, safety, tolerance and costs of single‐daily ceftriaxone plus amikacin versus thrice‐daily dose of ceftazidime plus amikacin.

Methodology: One hundred and ninety‐one episodes of fever and neutropenia in 128 patients from October 1997 to December 1998 were included in a prospective, open‐label, single‐centre study. Patients were randomly assigned to either treatment group and evaluated as successes or failures according to defined criteria. Daily assessments were made on all patients and all adverse events recorded. Univariate and multivariate analysis of outcomes and a cost analysis were carried out.

Results: There were 176 evaluable patient‐episodes with 51.1% in the single‐daily ceftriaxone–amikacin group and 48.9% in the ceftazidime–amikacin group. There were 50 positive blood cultures: 12 Gram‐positive bacteria, 33 Gram‐negative bacteria and five fungi. Pseudomonas aeruginosa (P. aeruginosa) accounted for 14% of total isolates. The overall success rate was 55.5% in the ceftriaxone group compared to 51.2% in the ceftazidime group (P = 0.56). Mean time to defervescence was 4.2 days in the single‐daily group and 4.3 days in the thrice‐daily group. There were nine infection‐related deaths; five in the single‐daily ceftriaxone group. The daily cost of the once‐daily regime was 42 Malaysian Ringgit less than the thrice‐daily regime. There was a low incidence of adverse effects in both groups, although ototoxicity was not evaluable.

Conclusions: The once‐daily regime of ceftriaxone plus amikacin was as effective as the ‘standard’ combination of thrice‐daily ceftazidime and amikacin with no significant adverse effects in either group. The convenience and substantial cost benefit of the once‐daily regime will be particularly useful in developing countries with limited health resources and in centres with a low prevalence of P. aeruginosa.
Frequency and perception of cough severity
Authors: Chang AB , Phelan PD , Robertson CF , Newman RG , Sawyer SM
Published: March 2003

Objective: The frequency of the common symptom of cough in children is unknown. The aim of this study was to compare cough frequency and perception of cough severity in children with and without recurrent cough.

Methodology: Eighty‐four children with (C) and without (NC) recurrent cough were recruited in the same season. Cough frequency (measured with cough‐meter) and subjective cough severity (measured on parent‐completed and child‐completed diary cards on two subjective systems), were compared between the two groups.

Results: Cough frequency in C (median 65/day) was significantly higher than in NC (10/day). The correlation between daytime and night‐time cough was higher in NC (rs = 0.51, P < 0.00001) than in C (rs = 0.3, P = 0.05). The C group had significantly higher coughs per score than NC, for both subjective methods.

Conclusion: Children with recurrent cough have a higher frequency and different pattern of cough than controls enrolled in the same season. Subjective perception of cough severity is dependent on the population studied.
Putting harm reduction into an adolescent context
Authors: Bonomo YA , Bowes G
Published: March 2003

Abstract: Drug use is now widespread amongst Australian youth. Substance abuse and dependence are becoming increasingly significant health problems. Approximately 50% of 17‐year‐old Australians report regular consumption of alcohol and nearly 30% report tobacco smoking. The age of onset of substance use is reported to be decreasing. Between 1993 and 1995 the proportion of heroin users who had used the drug before the age of 16 years increased from 2% to 14%. The debate about youth substance use tends to be polarized between the views of Zero Tolerance and Legalization of drugs. The harm reduction approach spans between these two extremes. Examples of harm reduction strategies, such as education campaigns on safe injecting and needle exchange programs, have been effective in curbing the spread of blood‐borne viruses such as HIV amongst intravenous drug using youth. The harm reduction approach, taking social context and developmental stage of the individual into account, may also be applied to adolescents at the less extreme end of the substance use spectrum. It is proposed that the harm reduction framework used in this way enables a rational, relevant and consistent response to contemporary youth substance use, aiming to minimize drug related harm.
Slow transit constipation in children
Authors: Hutson JM , McNamara J , Gibb S , Shin Y‐M
Published: March 2003

Abstract: Patients with chronic constipation that fails to respond to treatment remain a challenge for paediatricians and surgeons. Ongoing work in our institution suggests that a number of children with intractable symptoms have slow transit constipation, which has only been described recently in paediatrics. Common features of slow transit are: delayed passage of the first meconium stool beyond 24 h of age, symptoms of severe constipation within a year, or treatment‐resistant ‘encopresis’ at 2–3 years, soft stools despite infrequent bowel actions, and delay in colonic transit on a transit study. A proportion of children with slow transit constipation have an abnormality of intestinal innervation associated with the dysfunctional colonic motility, recognized as intestinal neuronal dysplasia (IND). Intestinal neuronal dysplasia type B, the most common variant of IND, is defined on rectal biopsy by hyperplasia of the submucosal plexus. On laparoscopic colon muscle biopsy, many specimens show reduced numbers of excitatory substance P‐immunoreactive nerve fibres in the circular muscle. Functional markers of the nerves allow new diagnostic criteria to be developed which may also allow a more rational approach to treatment. The aetiology remains obscure and the optimal management poorly defined, although subtotal colectomy, proximal colostomy or appendicostomy (for antegrade enemas) have been tried. Once the anatomy and physiology of the colon in children with slow colonic transit is better understood, we will have defined not only a new form of constipation, but also will be able to consider new therapies.
Duration of antibiotics in children with osteomyelitis and septic arthritis
Authors: Vinod MB , Matussek J , Curtis N , Graham HK , Carapetis JR
Published: March 2003

Objective:  To evaluate the outcomes of children with acute osteomyelitis and septic arthritis at a hospital where short‐duration antibiotic treatment (≤3.5 weeks) was considered routine.

Methodology:  We carried out a retrospective chart review, with telephone interviews to follow up and determine long‐term outcomes. Patients were selected to be at low risk for complications (illness ≤14 days, no underlying disease, uncomplicated presentation).

Results:  Thirty‐two children with osteomyelitis (OM), 34 with septic arthritis (SA) and five with OM and SA (OMSA) were included. Blood cultures were positive (mainly Staphylococcus aureus) in 15% of patients who had not had prior antibiotic treatment, and microbiological confirmation (positive blood culture, Gram stain or culture of surgical specimen) was obtained in 36%. The median duration of antibiotic treatment was 5.4, 4.4 and 5.0 weeks for OM, SA and OMSA, respectively. Only 22% of patients received antibiotics for 3.5 weeks or less. Overall, the recurrence rate was 1.4%. At follow‐up, only two patients had mild occasional pain at the site of the original infection; all patients had normal function.

Conclusions:  Contrary to expectations and local protocols, most patients were treated with conventional long‐duration therapy. Patients treated for short courses had good outcomes. The low rate of complications may make randomized controlled equivalence trials unfeasible. Increasing evidence of the efficacy and safety of short‐duration treatment (3−3.5 weeks) for acute, uncomplicated OM or SA in children suggests that this could be accepted as the standard treatment. However, this should be evaluated prospectively using a register, with at least 12 months’ of follow‐up.
Educational outcome at 8 years for children who were born extremely prematurely: A controlled study
Authors: Bowen JR , Gibson FL , Hand PJ
Published: March 2003

Objective:  To assess the educational outcome and utilization of special education resources at age 8 years in children who were born extremely prematurely, and to compare this outcome with a matched cohort of children born full‐term.

Methods:  All children with gestational age less than 28 weeks or birthweight of less than 1000 g, born at Royal North Shore Hospital from July 1985 through June 1990 were enrolled in a study of long‐term outcome. A cohort of full‐term children matched for age, sex and school with non‐disabled extremely premature children was enrolled at age 8 years. Children were assessed using standardized measures of cognitive and academic achievement. Information was obtained from teachers regarding educational support and academic progress.

Results:  Of 82 extremely premature children assessed at age 8 years, 8 (10%) had a severe disability, 13 (16%) had a mild or moderate disability and 61 (74%) were non‐disabled (IQ ≥ 85, no neurosensory disability). Thirty‐five (43%) required special education support, 22 (27%) were below grade level in reading or mathematics and 25 (30%) were performing at grade level without support. Compared with controls, non‐disabled extremely premature children had lower scores on standardized measures of academic achievement and were more likely to be reported by teachers as falling below grade level in reading (48% vs 13%; P < 0.001), mathematics (48% vs 10%; P < 0.001) and spelling (48% vs 17%; P < 0.002), and to require special education support (25% vs 4%; P = 0.004).

Conclusion:  Parents and professionals caring for extremely premature children need to be alert to the additional support that these children may require at school.
Developmental outcome of preterm infants after surfactant therapy: Systematic review of randomized controlled trials
Authors: Sinn JKH , Ward MC , Henderson‐Smart DJ
Published: March 2003

Objectives:  To review neuro‐developmental outcome at 1 and 2 years of age following randomized controlled trials (RCT) of neonatal surfactant therapy.

Methods:  A systematic review of the MEDLINE, Embase and Cochrane Controlled Trial Register databases, searching for RCT of surfactant replacement therapy with follow‐up outcomes, was carried out. The main outcome measures were severe and mild disability at 1 and 2 years plus composite adverse outcome of death and/or severe disability.

Results:  A meta‐analysis using odds ratios was carried out on 13 RCT. There were a total of 2218 treated and 2090 control infants who underwent follow up at 1 year of age. There were 303 treated and 292 control infants with follow up at between 18 months and 2 years of age. Surfactant therapy was associated with a lower rate of mild disability at 1 year (OR 0.79; 95% CI 0.66−0.95). There was a reduction in the combined adverse outcome (death or severe disability rate) at 1 year (OR 0.8; 95% CI 0.72−0.89). Neither the 1 year nor the 2 year follow‐up examination showed a statistical difference in the severe disability rate between the control and treated group.

Conclusion:  Surfactant therapy increases survival without an increase in subsequent morbidity at 1 and 2 years of age.
Telephone reminders improve adolescent clinic attendance: A randomized controlled trial
Authors: Sawyer SM , Zalan A , Bond LM
Published: March 2003

Objectives: To measure the effect of telephone reminders on adolescent clinic attendance.

Methods: Clinic bookings of adolescents were randomly assigned to either a telephone reminder one day prior to their appointment, or a routine booking (no reminder). The setting was four general adolescent health clinics within a tertiary public adolescent health care service at the Centre for Adolescent Health. The main outcome measures were clinic non‐attendance, reason for non‐attendance, and satisfaction with the booking system.

Results: One hundred and seventy one adolescent appointments were studied. Of these, 51.5% were female, and 25% of bookings were for new, rather than review appointments. One hundred and one adolescents were randomly allocated to the reminder group, of whom 87% were contacted. The use of reminders (intention to treat analysis) significantly reduced the non‐attendance rate from 20% to 8% (odds ratio 0.35; P = 0.03). Non‐attendance was three times more likely for a new appointment than for review appointments. ‘Forgetting’ was the most common explanation given by patients (35%) who did not attend. Seventy‐nine per cent of parents reported telephone reminders were helpful at prompting attendance.

Conclusion: Telephone reminders greatly improved attendance at these adolescent clinics. The background non‐attendance rate and the proportion of high‐risk patients for non‐attendance (new appointments in this setting) will determine whether reminders are more efficiently targeted at specific bookings than used routinely.
Systematic review of rheumatic heart disease prevalence in children in developing countries: The role of environmental factors
Authors: Steer AC , Carapetis JR , Nolan TM , Shann F
Published: March 2003

Objectives:  To consider the worldwide prevalence of rheumatic heart disease in children in developing countries using surveys with uniform methodologies, and to consider the effect of environmental factors including socio‐economic status, overcrowding, urbanization, nutrition and access to medical services on the distribution of rheumatic heart disease in developing countries.

Methods:  Sixty‐one surveys of the prevalence of rheumatic heart disease in developing countries were found using a systematic review of MEDLINE from January 1976 to July 1999. Twenty‐four studies were selected for comparison based on their uniform methodological and diagnostic techniques.

Results:  There is a high prevalence of rheumatic heart disease in the Pacific region with a lower prevalence in the Indian subcontinent, Asian, sub‐Saharan African, Mediterranean, Latin American and Caribbean regions. However, aside from the Indian subcontinent, these regions have not been well studied, and it may be that the true prevalence is actually higher.

Conclusions:  There is a lack of good quality prevalence surveys of rheumatic heart disease in developing countries. It appears that a threshold level where higher socio‐economic status is associated with reduced prevalence of rheumatic heart disease is not reached in developing countries. Therefore, differences in prevalence between socio‐economic groups in the one area cannot be detected. A similar case can be made for overcrowding. Many regions need well‐designed studies of rheumatic heart disease that incorporate assessment of environmental factors as well as the study of the microbiological epidemiology of rheumatic heart disease and group A streptococci.
Towards system‐wide strategies for reducing adverse drug events
Authors: Clark RB , Graham JD , Williamson JA
Published: March 2003

Abstract Despite the best efforts of committed health‐care workers, there are many adverse drug events (ADE). A large proportion of ADE arise from system factors, either directly (e.g. poor equipment design) or indirectly (e.g. inappropriate rostering of staff). This paper represents the proceedings of a workshop focus group that deliberated on priority health‐system issues identified as requiring action in order to minimise the risks of ADE. Major issues canvassed were the gathering of appropriate and useful data about ADE, the dissemination of information to professionals and consumers, and effective communication across groups of professionals, and between professionals and consumers. A number of recommendations were put forward as important first steps in addressing these issues.
Clinicians’ perceptions of placing a fetal oximetry sensor
Authors: East Christine E , Colditz Paul B
Published: March 2003

Abstract The aim of this study was to determine clinicians’ perceptions of placing a fetal oximetry sensor. A survey was developed seeking details of staff category, birth suite experience, previous sensor placement, ease of application and use of epidural analgesia. Following staff feedback, the survey was revised from asking clinicians to rate women’s comfort during sensor placement, to a visual analogue scale (VAS) of the clinician’s assessment of the women’s pain during sensor placement. Survey validity was sought from experts during development and for specific questions using item‐total correlation in this analysis. Ease of sensor placement (n = 131) was rated as good or excellent 71% of the time. Clinicians rated women’s comfort during sensor placement as good or excellent in 90% of cases. Median pain VAS was 0 (range 0–7.5). Item‐total correlations of survey questions were all significant. Fetal oximetry sensor placement was rated well by clinicians in this purpose‐designed survey.
A 30‐month study of patient complaints at a major Australian hospital
Authors: Anderson Kathryn , Allan Deidre , Finucane Paul
Published: March 2003

Abstract Health practitioners often regard complaints about the quality of patient care in a negative light. However, complaints can indicate strategies to improve care. Therefore, an audit was undertaken of all formal complaints about patient care at a major Australian hospital over a 30‐month period. The profile of complainants, the reasons for complaints, and the outcome were analysed. A total of 1308 complaints, concerning the care of 1267 patients, were received. The complaint rate was 1.12 per 1000 occasions of service. In all, 57% of complaints were lodged by advocates and 71% of complaints related to poor communication or to the treatment provided. In 97% of occasions, an explanation and/or an apology resulted. To date, no complaint has proceeded to litigation. Complaints are potentially useful quality assurance tools and can identify remediable system flaws. Health professionals and employers should understand why patients complain and be able to respond appropriately.
Phosphate inactivation with iron chloride during sediment resuspension
Authors: Wísniewski Ryszard
Published: March 2003

The present study undertook laboratory and in situ experiments in two hypertrophic lakes in order to determine the possibilities for the effective PO4 precipitation by means of FeCl3, applied directly to organic sediments (at a specific depth) previously subject to resuspension. The study also aimed to test, modify and improve a device constructed previously. This made the direct application of FeCl3 to organic sediments possible, while generating resuspension in the surface layer of sediments to a specified thickness. The results of both laboratory and field experiments, and tests of the prototype device, showed that linking a dosage of FeCl3 with the initiation of controlled resuspension led to a decrease of seven‐fold in the concentration of PO4 in interstitial water, and changed other physical and chemical parameters in the water only slightly. The effectiveness of PO4 precipitation relied mostly on initial conditions in the interface of water–organic sediment phases, and especially on the sorption capacity of sediments for phosphates, on the gradient of PO4 concentration, and on the concentration of oxygen in the layer of water above the sediment. It could be an effective method of over‐eutrophied lakes reclamation, and an alternative to the expensive removal of sediments.