bluuebunny/crossref_metadata_2025_split huggingface dataset:
Depth from the skin to the thoracic paravertebral space in infants and children
Authors: LÖNNQVIST P.A. , HESSER U. 
Published: February 2007

SummaryThe actual depth from the skin to the paravertebral space (S‐PVS depth) was determined in twenty paediatric ASA 1 patients (age range: 1‐175 months, weight range: 3.8‐61.0 kg) receiving a thoracic paravertebral block for renal surgery or cholecystectomy. The S‐PVS depth correlated well to patient weight (r= 0.94) and the S‐PVS depth can be predicted by the following equation: S‐PVS depth (mm) = 21.2 + 0.53 × (weight in kg). Our previously reported equation for the prediction of the S‐PVS depth, derived from computed tomography scans, was found to significantly (P= 0.0023) differ from the regression line generated in the present study and will underestimate the S‐PVS depth by approximately 2.5‐3.0 mm compared to the present results. The reader is, thus, recommended to use the new equation for a more accurate prediction of the S‐PVS depth when performing a thoracic paravertebral blockade in children.
Paediatric admissions to a district general hospital intensive care unit
Authors: MILLS GARY H. , KIRKPATRICK TERENCE 
Published: February 2007

SummaryThe characteristics of all the paediatric admissions made to a district general hospital over a three‐year period were analysed in this study. Paediatric admissions averaged 23 per year (10% of the total admissions to the unit over that time). The mean age was six years, median age was four years. Sixty‐two per cent were medical admissions and 38% surgical. Forty‐seven per cent of the surgical admissions involved head injuries. Seventy‐four per cent of medical admissions were directly related to upper and lower airway problems. Mean total admission time was six days, with a median of two days. Fifty‐nine per cent (40) of all cases required intubation for a mean period of five days (median = three days). All cases were PRISM scored (Pollack, Ruttimann & Getson 1988). The mean score was 8. Ninety‐four percent of admissions surviving to go home. There were a total of four deaths over the three‐year period. The PRISM scores of those who died had a mean of 30, which was significantly different (P < 0.05) from the survivors who had a mean PRISM score of six and a median of four. The organs of one of the nonsurvivors were transplanted. Currently there is considerable interest in the feasibility of transferring all paediatric intensive care patients to a regional centre, the consequences of such a policy must be carefully assessed if its implementation is to be a success.
Exposure of operating personnel to inhalational anaesthetics in paediatric surgery
Authors: WEBER GUENTHER 
Published: February 2007

SummaryHigh flows of halothane and N2O are commonly used in children during induction of anaesthesia. We prospectively evaluated the efficiency of a double mask system in children, during inhalational induction with photoacoustic infrared spectroscopy. Thirty‐two children 5 days to 8.5 years of age were studied. Anaesthesia was induced with inspired halothane concentrations of 2–3% and N2O 50–70% in 6–8 litres of freshgas flow via a Jackson‐Rees breathing system. Children were randomly assigned into two groups. Anaesthesia was induced in group 1 using a Rendell‐Baker mask with a regular scavenging device (25 1·min−1). In group II a double‐mask system was connected to an active scavenging system (580 1 min−1). Halothane and N2O were measured at 10 cm below the chin of the anaesthesiologist. We could demonstrate that the use of double‐mask system with a regular scavenging device substantially reduced the exposure of the anaesthesiologist to halothane by 89% and to N2O 80% respectively during inhalational induction.
Desflurane in paediatric anaesthesia
Authors: MANNION D. , CASEY W. , DOHERTY P. 
Published: February 2007

SummaryDespite the low blood‐gas coefficient of desflurane, inhalational induction is delayed by airway complications in paediatric practice. A slow induction technique reduces airway complications in adults. The aim of this study was to examine the use of desflurane for paediatric anaesthesia and to reduce airway complications with a slow induction technique. Sixty children (age range, 1 month to 12 years) were anaesthetized with 3% desflurane, increased by 1% every minute until anaesthesia was adequate for tracheal intubation. Anaesthesia was maintained with oxygen, nitrous oxide, and desflurane delivered by mechanical ventilation. During induction of anaesthesia, the incidence of moderate to severe coughing was 20%, breath‐holding 14%, and laryngospasm 31%. Blood pressure fell significantly (P < 0.05) from baseline after induction of anaesthesia and remained at this level during anaesthesia. Heart rate was stable in children less than six years, but increased significantly in older children. There were no significant airway problems during recovery from anaesthesia. Recovery time was rapid: the time to awakening was 10.2 min and to discharge from the recovery room, 29.2 min. Although desflurane is not an ideal anaesthetic agent for inhalational induction in children, it maintains stable anaesthesia and provides rapid smooth recovery.
Paediatric laparoscopic surgery: anaesthetic management
Authors: IVANI G. , VAIRA M. , MATTIOLI G. , CAGNAZZO A. , CAFFARENA P.E. , JASONNI V. 
Published: February 2007

SummaryTotal intravenous anaesthesia (TIVA) has been performed in 54 paediatric patients undergoing laparoscopic surgery. A loading dose of propofol 2.5 mg·kg−1 and fentanyl 2 μg·kg−1 were used for induction while a continuous infusion of propofol 9 mg·kg−1·h−1 and atracurium 0.5 mg·kg−1·h−1 in O2/Air were used for maintenance. Intraoperative cardiorespiratory stability, prompt recovery, painless postoperative period show that TIVA is a valid and safe technique for laparoscopic surgery in children.
Caudal analgesia with buprenorphine for postoperative pain relief in children
Authors: KAMAL R.S. , KHAN F.A. 
Published: February 2007

SummaryCaudal buprenorphine was investigated as a postoperative analgesic in a randomized double blind study in thirty children aged 5–12 years undergoing lower abdominal and lower limb surgery. Comparison was made between two groups of patients, one group receiving plain bupivacaine and the other a combination of plain bupivacaine with buprenorphine. Postoperative analgesia was assessed using a linear analogue scale, and by the response to direct questioning of children using an illustration of sequence of faces. Any untoward side effects and the need for additional analgesics were recorded. The degree and duration of analgesia was far superior in the buprenorphine group and there was a highly significant difference in the requirement of postoperative analgesia between the two groups. There were no major adverse side effects and no motor weakness in either groups, however the incidence of nausea and vomiting was higher in the buprenorphine group. It is concluded that a combination of bupivacaine with buprenorphine administered through the caudal epidural space is a safe and reliable means of providing postoperative pain relief in children for up to 24 h.
Anaesthetic management of bone marrow transplant recipients less than two years of age
Authors: BEEBE DAVID S. , URBAN MALATI , BELANI KUMAR G. 
Published: February 2007

SummaryThe charts and anaesthetic records of 97 infants less than two years of age who underwent bone marrow transplantation at the University of Minnesota from 1978–1992 were retrospectively reviewed. These infants underwent 564 general anaesthetics. There were 48 perioperative complications, most (39) involving the airway. There were 20 difficult intubations occurring in 13 patients. The causes of the difficult intubations were anatomical abnormalities (12), mucositis (4), pharyngeal oedema (3) and emesis upon induction of anaesthesia (1). Four intraoperative deaths occurred. The deaths were caused by haemorrhage (2), pulmonary embolism (1) and myocardial ischaemia (1). Four patients died within 72 h of surgery; one from cerebral oedema following an intraoperative cardiac arrest, one from fungal septicaemia, one from haemorrhage and one from multiple organ failure following an intracerebral haematoma. Infants undergoing bone marrow transplantation are at high risk for perioperative morbidity and mortality, particularly from complications involving the airway, bleeding or sepsis.
Anaesthetic considerations for the patient with cri du chat syndrome
Authors: BRISLIN ROBERT P. , STAYER STEPHEN A. , SCHWARTZ ROY E. 
Published: February 2007

SummaryCri du chat syndrome is an inherited disease affecting multiple organ systems. Most characteristic is the anatomical abnormality of the larynx resulting in a cat‐like cry. Issues important in developing an anaesthetic plan include: anatomical abnormalities of the airway, congenital heart disease, hypotonia, mental retardation, and temperature maintenance. We report the case of a 33‐month‐old patient with cri du chat syndrome undergoing patent ductus arteriosus (PDA) ligation and discuss the anaesthetic issues.
Postoperative morphine requirements, nausea and vomiting following anaesthesia for tonsillectomy. Comparison of intravenous morphine and non‐opioid analgesic techniques
Authors: MATHER STEPHEN J. , PEUTRELL JANE M. 
Published: February 2007

SummaryNonsteroidal anti‐inflammatory drugs (NSAIDs) have been shown to be as effective as opioid analgesia following tonsillectomy in children. Opioids are still frequently used but tonsillectomy is associated with a high incidence of vomiting. This study has attempted to assess postoperative analgesic consumption and nausea and vomiting after general anaesthesia for tonsillectomy using either paracetamol premedication, paracetamol plus a NSAID or intravenous morphine to provide postoperative analgesia. Some children required a rescue dose of morphine in the recovery room, including some who had received intravenous morphine at induction. Least supplementary morphine was required by those who had received paracetamol plus ketorolac. Postoperative nausea and vomiting was significantly less in the two groups which were not given intraoperative morphine. The number of vomiting incidents was also much less. We conclude that the preoperative administration of paracetamol alone provides satisfactory analgesia in many children but that supplementary analgesia is still required for some.
Down's syndrome and anaesthesia
Authors: MITCHELL V. , HOWARD R. , FACER E. 
Published: February 2007

SummaryDown's syndrome is a common congenital abnormality associated with characteristic morphological features, impaired intellectual development and disorders of many organ systems with a broad spectrum of severity. Many of these, including defects in cosmetic appearance, are amenable to surgical correction. The risks of anaesthesia are increased in these children. In this article the anaesthetic implications of the syndrome are reviewed and the principles of perioperative management discussed.
Variation in opioid use during PCA in adolescents
Authors: TYLER DONALD C. , POMIETTO MAUREEN , WOMACK WILLIAM 
Published: February 2007

SummaryThe objective of this investigation was to determine if the variability in the use of opioids for pain following surgery is related to variability in blood concentration of opioids used for pain relief. We measured morphine use and morphine blood concentration in a group of otherwise healthy adolescent girls following spinal surgery. There was considerable variability in morphine use and morphine blood levels as indicated by a large range of values and a moderately large standard deviation. Morphine blood concentration correlated with morphine use. Neither morphine use nor morphine concentration correlated with pain scores. The data indicate that there is considerable variability among patients in the amount of opioid needed to achieve comfort and in the blood concentration associated with comfort. The cause of this variability does not appear to be related to metabolism of opioid, but may be related to psychological differences, differences in pain tolerance and threshold, or differences in the way patients use PCA.
Behavioural changes following routine ENT operations in two‐to‐ten‐year‐old children
Authors: KOTINIEMI LEENA H. , RYHÄNEN PAULI T. , MOILANEN IRMA K. 
Published: February 2007

SummaryBehavioural changes in 85 two‐to‐ten‐year‐old children were evaluated by the parents one day, one week and one month after a routine ENT operation. Twenty (23%) children showed no changes. Behavioural problems at least once during the observation time were seen in 52 (61%) and improvements in 28 (33%) children, 15 (17%) had both. There was no statistically significant difference between the children treated as day cases and those hospitalized for one or two nights, or between the girls and the boys. The proportion of children showing behavioural problems decreased from 59% at 1 day to 32% at 1 month after the operation. The highest incidence of problematic changes occurred in children aged 3, 5 years or younger (79%), and the incidence was lowest in the 5.0–6.9‐year‐olds (43%). The most common changes were an increase in seeking attention from the parents (in 34% of the children), temper tantrums (25%), waking up at nights (16%) and problems in eating (16%).
Sevoflurane in paediatric anaesthesia: effects on respiration and circulation during induction and recovery
Authors: MORI NAOHISA , SUZUKI MASAHIRO 
Published: February 2007

SummaryThis study examined induction and recovery times and respiratory and cardiovascular changes during induction and recovery in paediatric patients undergoing anaesthesia under spontaneous respiration induced with sevoflurane (S group, n= 10) and halothane (H group, n= 9) at 2.4 MAC. FET/FI increased more rapidly, the incidence of breath holding and coughing was less and the recovery time was shorter in the S group compared with the H group. During induction with sevoflurane at 2.4 MAC, min vol/bodyweight decreased due to reduced tidal vol/bodyweight despite increased respiratory frequency, as with halothane at the same MAC. Slight decrease in blood pressure was observed during induction in the S group, while the circulatory depression was not observed during induction in the H group. These results suggest that sevoflurane is a suitable agent for induction under spontaneous respiration with higher concentrations in paediatric anaesthesia.
Management of complex pelvic floor disorders in a multidisciplinary pelvic floor clinic
Authors: Kapoor D. S. , Sultan A. H. , Thakar R. , Abulafi M. A. , Swift R. I. , Ness W. 
Published: February 2007

AbstractObjective  To identify symptom clusters, management strategies and survey patient satisfaction in our combined multidisciplinary pelvic floor clinic (PFC).Method  Retrospective cohort study, patient satisfaction questionnaire. Sample: Secondary and tertiary referrals with complex pelvic floor disorders. Main outcome measures: symptom clusters and treatment received; patient satisfaction.Results  A total of 113 new cases over a 3‐year period. There were two main symptom clusters: (i) obstructed defaecation with rectoceles (n = 55); of these, 23 had abdominal sacrocolpopexy with rectopexy, six had transvaginal rectocele repairs; and (ii) of the 33 with double incontinence, 10 had anal sphincter repairs, five had tension‐free vaginal tapes and two had colposuspensions. Patient satisfaction audit: 73% found the care to be excellent/good, 12% satisfactory and 6% unsatisfactory.Conclusion  Combined PFCs led to a more pragmatic approach in treating patients’ symptoms. Combined surgery was undertaken in one‐fourth of patients and is associated with cost savings and a single recuperation period. Overall, patients rated this service very highly.
Relationship between maternal glycaemia and birth weight in glucose‐tolerant women from different ethnic groups in New Zealand
Authors: Simmons D. 
Published: February 2007

AbstractAim  The aim of this study was to compare the population attributable fraction (PAF) for a large baby (≥ 4 kg) due to glycaemia, weight and smoking in glucose‐tolerant women from different ethnic groups.Methods  A retrospective review of screening for gestational diabetes (GDM) and associated birth weight was undertaken in New Zealand European (n = 529), Maori (n = 540) and Pacific (n = 916) women. The proportion with a large baby was compared by 1‐h post 50‐g glucose challenge test tertile and maternal weight tertile.Results  Large babies were more common from Pacific and European than Maori women (24.3%, 18.8%, 8.9%, respectively; P < 0.001). Birth weight increased significantly with increasing glucose among Pacific women (P < 0.001) even after adjusting for maternal weight and other confounders. The risk of having a large baby was 2.56 (1.82–3.60)‐fold greater in women in the highest maternal weight tertile (≥ 84 kg), with a significantly greater PAF in Pacific women (27.2%, 12.9%, 16.4%, respectively; P < 0.001). The odds ratio (OR) of having a large baby increased with even mildly elevated maternal 1‐h glucose concentrations [OR for 5.6–6.2 mmol/l: 1.54 (1.11–2.14); for ≥ 6.3 mmol/l: 2.06 (1.50–2.82)], with no ethnic differences in PAF (11.1–11.8%, 16.7–18.7%, respectively). Smoking and being Maori were associated with smaller babies.Conclusions  Increased maternal weight and glycaemia are associated with a greater proportion of large babies among glucose‐tolerant women. Growth of Pacific babies may be more sensitive to a higher maternal glucose when the mother is obese.
The Reform of Housing Benefit
Authors: Kemp Peter 
Published: February 2007

AbstractThe housing benefit scheme has been the subject of considerable change and reform. This article looks at the system of income‐related assistance with housing costs that existed prior to the introduction of housing benefit, and examines the reasons for the introduction of the scheme in 1982/83. It then goes on to examine why the Housing Benefit Review was set up less than one year after the “full start” to the scheme. Finally, the new housing benefit scheme provided by the Social Security Act 1986 is assessed.
The Management of Clinicians in the National Health Service
Authors: Scrivens Ellie 
Published: February 2007

AbstractThe Griffiths Report recommended that doctors be looked on as natural managers in the National Health Service, and recommended that general managers should make renewed attempts to bring clinicians into the management process. Many attempts had been made in the past to commit doctors to management. A survey was conducted of District General Managers in England to find out what mechanisms they are devising to encourage clinicians to become involved in management. The survey results indicate that two mechanisms dominate general management thinking. One method is to increase clinician participation and involvement in discussions of policy and resource use. The other is to allocate budgets to clinicians and to encourage them to become financially accountable for their actions. The latter view is the most commonly held, though it is not clear what precise purpose the budgets are to serve. The paper concludes that the success of devolved budgets as a management tool will depend upon understanding the factors which motivate clinicians.
Decentralizing Social Services in Israel
Authors: Cnaan Ram A. 
Published: February 2007

AbstractThis paper describes an attempt by the Israeli government to decentralize social services. Special attention is focused on the initiation of this planned effort of a highly centralized state. First, the Israeli culture is analyzed in terms of the delegation of authority and empowerment of citizens. Second, the principles of this planned change are summarized and results of two evaluation studies are presented. Several possible causes for the lack of success in decentralizing social services are suggested, followed by comments on the future of decentralization of social services in Israel.
The Social Security Advisory Committee
Authors: Logie James 
Published: February 2007

AbstractThis article examines the work of the Social Security Advisory Committee, whose main role as the ‘eyes, ears and heart’ of the Department of Social Security is explained. The work of the Committee shows that it has taken a keen interest in the effects of changes in benefit entitlement on claimants. Its recommendations attempt to mitigate the worst effects of changes on the most vulnerable benefit claimants. While some pressure groups have expressed disappointment with the SSAC's work, there are grounds for a more positive evaluation of it.
Forms of ignorance and their role in the joint planning process
Authors: Nocon Andrew 
Published: February 2007

AbstractThe Care in the Community initiative has given a new lease of life to joint planning between health and local authorities. The planned closures of psychiatric and mental handicap hospitals offer a new opportunity for these agencies to collaborate in the planning of alternative provision.All too often, though, considerable ignorance impedes their joint efforts. This ignorance relates to the scope of the exercize, the precise nature of the required services, and agencies’ knowledge of their different organizational systems, political ideologies and professional cultures. Such ignorance is built into the system, and it can serve agencies’ political purposes and offer them a means of attaining desired goals.The sociological literature offers a number of insights into relations between organizations. The concept of ignorance, however, has received little attention, yet it is one of the most striking aspects of joint planning.
Working for Patients? The Right Approach?
Authors: Barr Nicholas , Glennerster Howard , Le Grand Julian 
Published: February 2007

This paper is a slightly revised version of a Memorandum requested by the House of Commons Social Services Select Committee to assist the Committee in its analysis of the White Paper Working for Patients (Cm 555). It was submitted to the Committee on 28 February 1989. The paper follows up the authors’earlier study of the reform of the NHS (Barr, Glennerster and Le Grand, 1988), prepared at the request of the Select Committee prior to the publication of the White Paper.The success or failure of the White Paper depends crucially on the precise details of the way in which its proposals are implemented. The Working Papers, although providing some more information as to how the White Paper's proposals will be implemented, do not in the main address the issues that concern us here.Given the inescapable tension between cost and quality, quality control will be absolutely critical if the incentives to economize on the use of resources are not on occasion to lead to unacceptable reductions in quality — reductions which might well apply differentially by socioeconomic group.
Charles Booth: the examination of poverty
Authors: Spicker Paul 
Published: February 2007

AbstractCharles Booth's studies of poverty are widely misrepresented in the literature of social policy. His work is commonly bracketed with Rowntree's, but his methods were quite different. His definition of poverty was explicitly relative; he based the description of poverty on class, rather than income. He did not attempt to define need, or to identify subsistence levels of income on the basis of minimum needs; his “poverty line” was used as an indicator of poverty, not a definition. His approach was to identify the sorts of conditions in which people were poor, and to describe these conditions in a variety of ways. To this end, he used a wide range of qualitative and quantitative methods in an attempt to add depth and weight to his descriptions of poverty. He is described by Beatrice Webb, with some justice, as “the boldest pioneer … in the methodology of the social sciences of the nineteenth century”.