bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determination of the Full Dose–Response Relation of Intrathecal Bupivacaine, Levobupivacaine, and Ropivacaine, Combined with Sufentanil, for Labor Analgesia
Authors: Van de Velde Marc , Dreelinck Rebekka , Dubois Jasperina , Kumar Ariane , Deprest Jan , Lewi Liesbeth , Vandermeersch Eugene 
Published: March 2007

Background
Ropivacaine and levobupivacaine are local anesthetics that produce less motor block and greater sensory-motor separation when compared with equal milligram doses of bupivacaine. Although minimum local analgesic concentration studies suggested that they are less potent than bupivacaine, full dose-response studies have not been performed. The current trial describes the dose-response relation of levobupivacaine, ropivacaine, and bupivacaine, combined with sufentanil, when used for intrathecal labor analgesia.

Methods
Four hundred fifty term parturients in active labor were included in this double-blind, randomized trial. Combined spinal-epidural anesthesia was performed, and ropivacaine, levobupivacaine, or bupivacaine was intrathecally administered in a dose of 1.0, 1.5, 2.0, 2.5, 3.0, or 3.5 mg, always combined with 1.5 microg sufentanil. Patients were considered responders to spinal analgesia if the visual analog scale score for pain was less than 25 mm within 15 min and the visual analog scale score remained less than 25 mm for 45 min. Patient demographics, obstetric data, maternal side effects, and fetal and neonatal well-being were noted. Group-specific dose-response curves were constructed using a probit regression model.

Results
The ED95 of bupivacaine was 3.3 mg (95% confidence interval, 2.9-4.1). The ED95s of ropivacaine and levobupivacaine were 4.8 mg (95% confidence interval, 4.0-6.7) and 5.0 mg (95% confidence interval, 4.1-7.0), respectively. Racemic bupivacaine was significantly more potent than ropivacaine (P=0.0027) and levobupivacaine (P=0.0006). Ropivacaine and levobupivacaine were of similar potency (P=0.91).

Conclusions
This full dose-response study suggests that ropivacaine and levobupivacaine are of similar potency, whereas bupivacaine is more potent than both other drugs.
Automated Documentation Error Detection and Notification Improves Anesthesia Billing Performance
Authors: Spring Stephen F. , Sandberg Warren S. , Anupama Shaji , Walsh John L. , Driscoll William D. , Raines Douglas E. 
Published: March 2007

Background
Documentation of key times and events is required to obtain reimbursement for anesthesia services. The authors installed an information management system to improve record keeping and billing performance but found that a significant number of their records still could not be billed in a timely manner, and some records were never billed at all because they contained documentation errors.

Methods
Computer software was developed that automatically examines electronic anesthetic records and alerts clinicians to documentation errors by alphanumeric page and e-mail. The software's efficacy was determined retrospectively by comparing billing performance before and after its implementation. Staff satisfaction with the software was assessed by survey.

Results
After implementation of this software, the percentage of anesthetic records that could never be billed declined from 1.31% to 0.04%, and the median time to correct documentation errors decreased from 33 days to 3 days. The average time to release an anesthetic record to the billing service decreased from 3.0+/-0.1 days to 1.1+/-0.2 days. More than 90% of staff found the system to be helpful and easier to use than the previous manual process for error detection and notification.

Conclusion
This system allowed the authors to reduce the median time to correct documentation errors and the number of anesthetic records that were never billed by at least an order of magnitude. The authors estimate that these improvements increased their department's revenue by approximately $400,000 per year.
Superposed deformation in turbidites and syn‐sedimentary slides of the tectonically active Miocene Waitemata Basin, northern New Zealand
Authors: Spörli K. B. , Rowland J. V. 
Published: March 2007

ABSTRACTThe Miocene Waitemata Basin was deposited on a moving base provided by the Northland Allochthon, which was emplaced in the Late Oligocene, as a new convergent plate boundary was established in northern New Zealand. The basin experienced complex interaction between tectonic and gravity‐driven shallow deformation. Spectacular examples of the resulting structures exposed on eastern Whangaparaoa Peninsula 50 km north of Auckland provide a world‐class example of weak rock deformation, the neglected domain between soft‐sediment and hard rock deformation. Quartz‐poor turbidite sequences display a protracted sequence of deformations: D1, synsedimentary slumping; D2, large scale deeper‐seated sliding and extensional low‐angle shearing, associated with generation of boudinage and broken formation; D3, thrusting and folding, indicating transport mostly to the SE; D4, thrusting and folding in the opposite direction; D5, further folding, including sinistral shear; D6, steep faults. The deformation sequence suggests continuous or intermittent southeastward transport of units with increasing sedimentary and structural burial. By phase D3, the rocks had passed from the soft‐sediment state to low levels of consolidation. However, with a compressive strength of ∼5 MPa they are weak rocks even today. Such weak‐rock deformation must be important in other sedimentary basins, especially those associated with active convergent plate boundaries and with immature source areas for their sediments.
Dipyridamole enhances ischemia‐induced reactive hyperemia by increased adenosine receptor stimulation
Authors: Meijer P. , Riksen N. , Scheffer G.‐J. , Smits P. , Rongen G. A. 
Published: March 2007

Introduction:  Dipyridamole enhances post‐occlusive reactive hyperemia (PORH) in the human forearm. The mechanism of this potentiation remains to be elucidated. We hypothesize that dipyridamole augments PORH by increasing interstitial adenosine and subsequent stimulation of adenosine receptors. To test this hypothesis, the effect of caffeine (an adenosine A1 and A2 receptor antagonist) on dipyridamole‐induced augmentation of PORH was explored.Methods:  Eight healthy volunteers (6 female; age 19–24 year) abstained from caffeine intake for at least 24 hours. The brachial artery was cannulated for drug infusion. After forearm circulation had been occluded for 5 minutes and starting immediately upon reperfusion, forearm blood flow was measured for 5 minutes using venous occlusion mercury‐in‐silastic strain gauge plethysmography. At least one hour after reperfusion, this procedure was repeated during intra‐arterial infusion of dipyridamole (7.4 nmol/min/dl forearm). At least two weeks later, this whole procedure was repeated, but now in the presence of caffeine (0.46 μmol/min/dl forearm).Statistics:  For each subsequent minute, forearm blood flow was averaged to one value. An ANOVA for repeated measures was performed with caffeine, dipyridamole and reperfusion time as within‐subject factors. Results are expressed as mean ± SEM.Results: FBF: forearm blood flowP < 0.05 for the effect of dipyridamole on PORHP > 0.5 for the effect of caffeine on PORHP < 0.01 for the interaction between caffeine and dipyridamole.Conclusions:  Caffeine abolishes the augmenting effect of dipyridamole on PORH. This indicates that adenosine receptors are involved in the dipyridamole‐induced augmentation of PORH.
Child adjustment in high conflict families
Authors: Smith J , Berthelsen D , O'Connor I 
Published: March 2007

SummaryChildren exposed to spousal violence are at risk for social‐emotional problems. This research investigated a number of family and child factors which might influence the effects of witnessing spousal violence on young children. Fifty‐four mothers who had at least one child in the age range of 3 to 6 years participated in the study. These women had left a violent relationship 12 to 24 months prior to their participation in the study and were not in a new relationship. Information was collected through a structured interview which included the administration of a standardized family violence measure (conflict tactics scale) and child adjustment profile (child behaviour checklist). Forty‐two per cent of the children exhibited a level of behavioural problems which would warrant clinical intervention. The amount of violence that the children witnessed, the children's responses when the violence occurred and whether the child copied the violent partner's behaviour, were associated with the children's behavioural adjustment scores. Maternal parenting style was not found to have a significant effect on behavioural adjustment. The study provided important quantitative and qualitative data on the nature of parent‐child relationships and children's adjustment in families where there is spousal violence.
Depiction of pain in the self‐drawings of children with sickle cell disease
Authors: Stefanatou Athena , Bowler Dermot 
Published: March 2007

SummaryIn an attempt to explore the perception of pain in children, 30 children with sickle cell disease were asked to make two drawings; one of themselves and one of themselves in pain. It was hypothesized that the cognitive ability and the emotional state of the child would be affected by the pain experience. Children and their parents were interviewed on the incidence of pain and on the child's control over it. The cognitive ability of the child was related to the kind of control he/she exercised over the pain. An analysis of the drawings concerning their thematic representations, colour and size is also presented. The mental age of the child dropped in the drawing of pain as compared to the non‐pain drawing but it was found to be irrelevant to the kind of control the child exercised on the pain.
Variations in take‐up off the Family Fund
Authors: Hirst M A 
Published: March 2007

SummaryThis paper investigates geographical variations in successful and unsuccessful applications to the Family Fund Trust which provides grants to families with severely disabled children. A new measure of take‐up is developed which takes account of demographic differences between local social services authorities and relates local take‐up levels to national rates. The take‐up of grants varies more than twofold across local authorities but is generally higher in deprived areas, suggesting that the help available from the fund is targeting those most in need. Nonetheless use of the fund is less than expected in metropolitan areas characterized by rented accommodation, high rise dwellings and minority ethnic groups. Ethnic monitoring and other measures to promote equal opportunities have recently been introduced. If take‐up were uniformly high across England and Wales the current caseload and budget would increase by more than half. Local authorities where renewed efforts might be most effectively targeted to encourage families to apply for a grant can be identified but any publicity would need to ensure that inappropriate applications are kept to a minimum.
Preventing suicide in young people: what is known and what is needed
Authors: Williams K. 
Published: March 2007

SummaryIn the UK the suicide rate for male adolescents has nearly doubled since 1975. With a similar increase reported from other countries it is not surprising that preventing suicide in young people has become a priority for many health professionals and policy makers. Unfortunately despite advances in our understanding of suicide in young people there are still deficiencies and inconsistencies in our knowledge. There are also problems in transforming our knowledge of suicide and suicidal behaviour in young people and our understanding of theoretically possible approaches to prevention into effective suicide prevention strategies. To increase the chance of preventing suicide in young people we need to be aware of the problems of putting theory into practice and evaluate all interventions that are undertaken to determine their appropriateness and effectiveness.
Ten steps for successful breast‐feeding: assessment of hospital performance, its determinants and planning for improvement
Authors: Gökçay G , Uzel N , Kayatürk F , Neyzi O 
Published: March 2007

SummaryThis paper discusses results from a project which aims to document the maternity hospital practices in Istanbul within the context of Ten Steps for Successful Breastfeeding. Instruments developed for use in hospital level implementation of the WHO/UNICEF baby friendly hospital initiative were used in five hospitals (two public and three private). No hospital was implementing all Ten Steps. A core hospital team on lactation management and a sufficient number of health personnel skillful in breastfeeding counselling and adequate delivery room conditions are required to implement the Ten Steps. It is very difficult to provide these conditions in public hospitals with an excessive patient load. On the other hand, the fee for service system and the policy of changing practices according to the wishes of the clients can also become barriers to successful breastfeeding, as may occur in some private hospitals.
Parental separation: effects on children; implications for services
Authors: Holroyd R , Sheppard A. 
Published: March 2007

SummaryIt Is commonly assumed that the children of separated or divorced parents are disadvantaged financially and In terms of social development. A small‐scale study was designed involving 14 volunteer parents who were separated from their spouses/partners and their 28 children, ranging in age from 5 to 12 years. Structured interviews examined the families’attitudes and feelings about the separation, the mental health of the parents, the emotional and behavioural reactions of the children, and the families’use of services. The results suggested that over 60% of the girls showed internalizing, and over 60% of the boys displayed externalizing behavioural difficulties. About 40% of the children suffered psychosomatic disorders. Nearly 75% of the parents suffered depression before and after separation. Depression, itself, may act to exacerbate children's emotional and behavioural difficulties. Although all the parents had received medication for their depression, few of the children had received any help for their difficulties. The urgent need for services to help such children Is discussed.
Peer relations and friendship in physically disabled children
Authors: Mulderij K J. 
Published: March 2007

SummaryThis article presents the results of a literature study and qualitative fieldwork Into the way physically disabled children experience friendship. We discuss literature on how children make contact with peers, on the nature of their friendship and on what It is like to be excluded. Some aspects are complemented with information from the children themselves. Peer relations and friendship are the very essence of a happy childhood. This article therefore closes with a number of recommendations to improve peer relationships.
A re‐appraisal of screening for colour vision impairments
Authors: Holroyd E , Hall D M B 
Published: March 2007

SummaryScreening for colour vision Impairments (CVI) has been carried out In schools in the UK since 1934, but little is known about Its yield or value. A survey was conducted among Sheffield schoolboys, school nurses and optometrists to determine the benefits of CVI screening. The results Indicated that between 4.2 and 5.2% of boys had been identified as having a CVI, compared with the expected prevalence of 8% Boys were ill‐informed about the significance of CVI for careers planning but recognized the potential importance of having this information before making decisions about choice of subjects and examinations. Possible reasons for the low yield of screening are reviewed and alternative strategies are discussed.
Evaluation of a cancer‐based coping and caring course used in three different settings
Authors: Cleave H , Charlton A 
Published: March 2007

SummaryCancer in the family may affect the psycho‐social adjustment of the children involved. Children who have survived childhood cancer or with a parent or sibling with cancer, may find protection from the risk of emotional and behavioural difficulties from effective external support systems. A training course was developed by the Cancer Research Campaign to help professionals who make up potential external support systems, cope with children experiencing cancer‐related life crises. The course was offered to, and evaluated with, practising teachers, student teachers and Cancer Aid and Listening Line workers. Results from interviews and pre and post course questionnaires indicated that after the course all three groups felt more confident in dealing with children under stress. Participants felt that specific skills such as‘attentive listening’had increased as a result of the course. Of the three groups the practising teachers have found the course the most useful in their work and have been able to disseminate their newly acquired skills throughout their schools. Teachers are expected to cope with students’various life crises as they arise in schools. Basic counselling skills training for teachers could help them cope with these in a more confident manner, thereby reducing the risk of emotional and behavioural difficulties and contributing towards a Health Promoting School ethos.
Perceptions of the risk of child abduction or loss and the utility of child electronic security devices
Authors: Dixon R M , Pasnak R. 
Published: March 2007

SummaryPerceptions of the susceptibility of young children to becoming lost or being abducted, and of the potential usefulness of child electronic security devices, were examined via a questionnaire. Data were provided by 41 volunteers, most of them from a local government office centre. The questionnaire asked for demographic data, and then for the risk of a child being abducted or lost when under the supervision of different caregivers and in different situations. The probable effectiveness of three common abductor ploys was also addressed. The questionnaire concluded with 10 questions about child electronic security devices. Respondents viewed mothers, fathers, and grandparents as equally responsible caregivers and young adults/babysitters as the least responsible. These effects diminished as the age of the children increased. The garden at home was Judged to be the most secure environment for children of all ages, while an amusement park was judged the least secure environment. Children were perceived to be more at risk of an abduction when a stranger asked for physical assistance or to take them to the hospital because their parents were hurt, than when asked for directions. Furthermore, the respondents expressed a moderately strong need for child electronic security devices, and viewed parents who use them as more responsible than those who do not.
The parent between the child and the professional — some ethical implications
Authors: Kristensson‐Hallström I , Nilstun T 
Published: March 2007

SummaryIn this paper ethical implications of parental participation in paediatric care are discussed. The paper is based on interviews with 20 parents, whose children were admitted and operated on at a paediatric surgery department In Sweden. In one part of the interview the parent was invited to speak about situations experienced as problematic during the hospitalization. Three different types of situations were described by the parents as especially problematic. In the first situation the parents’ability to influence their own situation was limited. Parents got upset when staff did not treat them as autonomous persons. In the second type of situation things‘had to be done’to the child, for example the surgery, the anaesthesia, removing an indwelling catheter and giving an enema. The parents understood and accepted this, but the child was sometimes unable to agree usually because of anxiety and fear. In the third type of situation parents felt that professionals did not take them or their child seriously. In order to avoid or alleviate such situations, the professionals ought to mediate a permissive attitude to the expressions of concern. Thus, when the parents worry, the professionals ought to listen more attentively and, whenever possible and adequate, respect their concerns.
Speech perception and speech comprehension investigations of pre‐term newborns and high‐risk neonates of pre‐school age
Authors: Beke A. , Gósy M 
Published: March 2007

SummaryThe purpose of this study is to establish whether there is any connection between neonatal morbidity and speech perception and comprehension In children of pre‐school age who have previously been treated as newborn infants In an intensive care unit. The test applied is a method invented in Hungary for the analysis of global hearing, speech perception and comprehension. The authors summarize the results of their follow‐up studies of 52 children with respiratory disorders as newborns, some of whom were born as pre‐term and some as full‐term newborns with asphyxia. The children have been put into three groups according to their maturity and their birthweight. Newborns with hearing loss and mental retardation were excluded from this study. Of the various neonatal factors the results show: complications of delivery, birthweight, hypoxia, persistent ductus arteriosus, duration of ventilation and complications of respiratory treatment are found to be correlated to perception and comprehension. Incidences of poor achievement obtained in the most characteristic subtests have been compared among the different groups of newborns. The intelligence level of pre‐school children is found to be closely correlated to speech perception and comprehension.
Choice of medical investigations for developmental delay: a questionnaire survey
Authors: Gringras P 
Published: March 2007

SummaryThe aim of this study was to describe the range and cost of investigations ordered by paediatricians for children with mild to moderate developmental delay. A total of 79 consultants on the Thames Regions Consultant Community Paediatricians database were sent a faxed questionnaire and 86% of the paediatricians responded. The number of tests ordered by each paediatrician ranged from none to 15; 26 different medical investigations were selected. The four most common tests were chromosomes for karyotyping, fragile X testing, thyroid function testing and metabolic studies which each appeared in over half of the responses. The median cost of the investigations chosen was 386 with a range from 0‐E1181. This study revealed marked variations in clinical practice when paediatricians investigate a developmentally delayed child. This was found to reflect both personal bias and a lack of consensus in the medical literature. There is a need for accurate community based prevalence data on causes of developmental delay, and critical appraisal of the available diagnostic tests.
The piloting of a group for the fathers of children with Down syndrome
Authors: West A 
Published: March 2007

SummaryThe health services often struggle in their attempts to engage and support fathers. This paper describes the piloting of a small group for the fathers of children with a disability, in this case Down Syndrome. The group is described from conception to conclusion and limitations of the study are discussed. The group approach meets a need for a proportion of fathers who prove able to explore their experiences and feelings.