bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative evaluation of the cervical spine in children with Trisomy‐21: results of a questionnaire study
Authors: LITMAN RONALD S. , ZERNGAST BENJAMIN A. , PERKINS FREDERICK M. 
Published: February 2007

SummaryAtlantoaxial subluxation (AAS) is a form of cervical spine instability predominantly found in persons with Trisomy‐21. Several case reports describe the occurrence of acute AAS in the perioperative period. Some authors have recommended cervical spine radiographs prior to elective surgery in all children with Trisomy‐21. The objective of this study was to determine practice patterns of North American members of the Society of Pediatric Anesthesia with regard to the perioperative evaluation and management of potential cervical spine instability in patients with Trisomy‐21. Of 171 respondents, a minority of respondents (18%) obtain preoperative radiographs and/or subspecialty consultation (9%) in asymptomatic children with Trisomy‐21. For symptomatic children the majority of respondents would obtain radiographs (64%) and/or preoperative consultation (74%). Approximately half of the respondents would attempt to maintain the head and neck in a neutral position for either asymptomatic (42%) or symptomatic (55%) patients. We conclude that the majority of respondents base their preoperative evaluation of the cervical spine on the signs and symptoms of the patient. This is supported by the literature reviewed, but is contrary to the recommendations made in some case reports.
Posttonsillectomy vomiting. Ondansetron or metoclopramide during paediatric tonsillectomy: are two doses better than one?
Authors: ROSE JOHN B. , MARTIN THALIA M. 
Published: February 2007

SummaryThis randomized, double blinded, placebo controlled, prospective study compared the antiemetic efficacy of one preoperative dose of metoclopramide 0.25 mg·kg−1 intravenously or ondansetron 0.15 mg·kg−1 intravenously with two doses of the same drugs (second dose administered one h postoperatively) in 200 preadolescent children undergoing tonsillectomy with either isoflurane or propofol anaesthesia. The incidence of posttonsillectomy vomiting was significantly reduced (P < 0.005) by two doses of either metoclopramide or ondansetron (18% and 8%, respectively) compared with placebo (50%). No difference in posttonsillectomy vomiting exists between the children who received isoflurane and those who received a propofol infusion. Our results suggest that two doses of metoclopramide 0.25 mg·kg−1 intravenously, like two doses of ondansetron 0.15 mg·kg−1, are effective in reducing vomiting after tonsillectomy in children who have received either isoflurane or propofol anaesthesia.
Clonidine‐mepivacaine mixture vs plain mepivacaine in paediatric surgery
Authors: IVANI G. , MATTIOLI G. , REGA M. , CONIO A. , JASONNI V. , DE NEGRI P. 
Published: February 2007

SummaryIn a double‐blind study, 42 children, aged 1–10, undergoing general subumbilical surgery, were randomly allocated to two groups; they received, via caudal extradural, 1% mepivacaine 7 mg·kg−1 and normal saline 1 ml (Group 1) and a mixture of 1% mepivacaine 7 mg·kg−1 plus clonidine 2 μg·kg−1 and normal saline up to 1 ml (Group 2) respectively. No significant difference was noticed in age, weight, duration of surgery and onset time of anaesthesia, blood pressure, heart rate and oxygen saturation. Mean duration of analgesia (evaluated with ‘Broadman objective pain scale') was 143 min for Group 1 and 218 min for Group 2 (P < 0.05); the time of sedation (evaluated with a sedation score) was statistically longer in Group 2 (172 min vs 89 min in Group 1). This longer sedation is due both to the longer analgesia and partially to a side effect of clonidine. In conclusion the addition of 2 μg·kg−1 of clonidine to mepivacaine prolongs the duration of caudal analgesia in children.
A double‐blind comparison of morphine infusion and patient controlled analgesia in children
Authors: BRAY R.J. , WOODHAMS A.M. , VALLIS C.J. , KELLY P.J. , WARD‐PLATT M.P. 
Published: February 2007

SummaryThe analgesia provided after major abdominal surgery in 30 children by continuous morphine infusion and patient controlled analgesia, also using morphine, was compared using a double‐blind, double‐dummy design. The groups of children were comparable in age, weight, duration of operation and sex ratio. Pain assessment was carried out by a single observer using a visual analogue scale and the Poker Chip Tool. Assessments took place during two four‐hour periods, one on the day of operation and one the following day. Children aged between nine and 15 years achieved better pain relief with patient controlled analgesia. No difference could be shown in children aged between five and eight years.
Parental presence during induction of anaesthesia: practice differences between the United States and Great Britain
Authors: KAIN Z.N. , FERRIS C.A. , MAYES L.C. , RIMAR S. 
Published: February 2007

SummaryA questionnaire was sent to 1353 paediatric anaesthetists in Great Britain and the United States. Nineteen questions were asked about attitudes toward parental presence during induction of anaesthesia and the prevalence of such practice. Overall, respondents from Great Britain support parental presence more than the United States respondents. For example, 82% of the Great Britain respondents, vs 64% of the United States respondents thought that parental presence during induction decreases the anxiety (P= 0.001) and increases the cooperation of the child (P= 0.001). Most United States respondents (58%) allow parental presence in less than 5% of their cases, but most Great Britain respondents (84%) allow parental presence in more than 75% of their cases. We conclude that in contrast to the respondents from Great Britain, the majority of the United States sample does not feel that parental presence is useful and so does not routinely use this technique in their practice.
Postoperative pain in children: a survey of parents' expectations and perceptions of their children's experiences
Authors: RØMSING JANNE , WALTHER‐LARSEN SØREN 
Published: February 2007

SummaryParental expectation and participation in postoperative analgesia is very important in paediatric practice. In order to improve postoperative pain management in children, the parents of 31 elective surgical children, three months to 15 years of age, were asked preoperatively about their expectations regarding their children's postoperative pain and pain relief. At 24 h after surgery, the parents were asked about their perceptions of their children's pain and pain control. The survey indicates that the parents had high expectations of good pain relief. They wanted effective analgesia administered promptly when the children had some pain. However, current practice in controlling pain after surgery is still not optimal. Nine (29%) of the children experienced severe or unbearable pain or experienced pain for the whole of the 24 h after surgery. An approach to improve pain management in children could be for the hospital staff to reorganize and to develop an ‘acute pain service’. A pain service may not require new technology, but instead be based on more effective communication and skill in utilizing the traditional systems.
Nasal mask positive pressure ventilation in paediatric patients with type II respiratory failure
Authors: HERTZOG JAMES H. , COSTARINO ANDREW T. 
Published: February 2007

SummaryWe report our experience with nasal mask ventilation in children and adolescents with type II respiratory failure admitted to the paediatric intensive care unit (PICU) over an 18‐month period. Seven patients were treated with nasal mask ventilation during part of their PICU stay. All showed significant improvement in arterial pH, PaCO2, and PaO2/FiO2 from presentation to discharge, although at discharge PaCO2 and PaO2/FiO2 fell outside of the normal range. Complications occurred in four patients. When compared to 11 patients with type II respiratory failure not treated with nasal mask ventilation, the nasal mask ventilation group had a similar PICU length of stay and incidence of complications. We conclude that nasal mask ventilation may be useful in maintaining near normal alveolar ventilation in selected children with type II respiratory failure and that a prospective study of this technique is indicated.
Anaesthesia and the Beckwith‐Wiedemann syndrome
Authors: SUAN CRISTINA , OJEDA RAFAEL , GARCÍAPERLA J.L. , PÉREZ‐TORRES M.C. 
Published: February 2007

SummaryInfants with Beckwith‐Wiedeman syndrome usually present different abnormalities which may require surgical correction. Anaesthetic management may be complicated by abnormal airway anatomy, congenital heart disease and severe hypoglycaemia. Careful preoperative evaluation, perioperative monitoring and suitable choice of anaesthetic technique are required for a successful outcome. We report the perioperative management of a patient with Beckwith‐Wiedemann syndrome presenting for omphalocoele surgery on his first day of life and for bilateral inguinal hernia repair four months later.
Anaesthetic management of the Kenny‐Caffey syndrome using the laryngeal mask
Authors: JANKE E.L. , FLETCHER J.E. , LEWIS I.H. 
Published: February 2007

SummaryWe report the anaesthetic management of a nine‐year‐old, 6.8 kg, 75 cm tall female with the Kenny‐Caffey syndrome presenting for strabismus surgery. Dysmorphic features in our patient included a hypoplastic mandible. A neonatal (size 1) laryngeal mask was successfully used for management of the airway whilst providing surgical access. The general features of this rare syndrome are presented and the literature reviewed.
A comparison of sevoflurane to halothane in paediatric surgical patients: results of a multicentre international study
Authors: KATARIA B. , EPSTEIN R. , BAILEY A. , SCHMITZ M. , BACKUS W.W. , SCHOECK D. , HACKL W. , GOVAERTS M.J.M. , ROUGE J.C. , KERN C. , VAN ACKERN K. , HATCH D.J. 
Published: February 2007

SUMMARYInduction, emergence and recovery characteristics were compared during sevoflurane or halothane anaesthetic in a large (428) multicentre, international study of children undergoing elective inpatient surgical procedures. Two hundred and fourteen children in each group underwent inhalation induction with nitrous oxide/oxygen and sevoflurane or halothane. Incremental doses of either study drug were added until loss of eyelash reflex was achieved. Steady state concentrations of anaesthesia were maintained until the end of surgery when anaesthetic agents were terminated simultaneously. Time variables were recorded for induction, emergence and the first need for analgesia in the recovery room. In addition, in 86 of the children in both groups, venous blood samples were drawn for plasma fluoride levels during and after surgery. There was a trend toward smoother induction (induction of anaesthesia without coughing, breath holding, excitement laryngospasm, bronchospasm, increased secretion, and vomiting) in the sevoflurane group with faster induction (2.1 min vs 2.9 min, P= 0.037) and rapid emergence times (10.3 min vs 13.9 min, P= 0.003). Among the children given sevoflurane, 2% developed bradycardia compared with 11% in the halothane group. Postoperatively, 46% of the children in the halothane group developed nausea and or vomiting versus 31% in the sevoflurane group (P= 0.002). Two children in the halothane group developed cardiac dysrhythmia and were dropped from the study. In addition, a child in the halothane group developed malignant hyperthermia, received dantrolene, and had an uneventful recovery. Mean maximum inorganic fluoride concentration was 18.3 μM˙l−1. The fluoride concentrations peaked within one h of termination of sevoflurane anaesthetic and returned rapidly to baseline within 48 h. This study suggests that sevoflurane may be the drug of choice for the anaesthetic management of children.
Pressure support ventilation increases cardiac output in neonates and infants
Authors: GULLBERG NINNA , WINBERG PER , SELLDÉN HANS 
Published: February 2007

SUMMARYFifteen neonates and infants were investigated during pressure controlled ventilation (PCV) and pressure support ventilation (PSV) on a Servo 300 ventilator. Changes in cardiac output (aortic mean blood flow velocity) were assessed with the Doppler technique. During PSV cardiac output increased by 16% (P<0.01) compared with PCV with equal ventilation. Mean airway pressure decreased significantly during PSV compared with PCV, which may explain the increased cardiac output. During PSV, when inspiratory/expiratory (I:E) relations are dependent on the patient, we found a lower I:E ratio compared with PCV. It can be assumed that at least part of the decreased mean airway pressure is caused by the lower I:E ratio. As the heart rate was unchanged, the variations in cardiac output were caused by alterations in stroke volume. It is concluded that a patient triggered mode should be preferred providing that the neonate/infant has the ability to elicit the ventilator's triggering system.
Expression pattern of genes in peripheral blood mononuclear cells in diabetic nephropathy
Authors: Moczulski D. K. , Fojcik H. , Wielgorecki A. , Trautsolt W. , Gawlik B. , Kosiorz‐Gorczynska S. , Oczko‐Wojciechowska M. , Wiench M. , Strojek K. , Zukowska‐Szczechowska E. , Grzeszczak W. 
Published: February 2007

AbstractAims  Only one‐third of Type 1 diabetes patients develop diabetic nephropathy, and a genetic predisposition is postulated. To obtain more insight into processes that lead to diabetic nephropathy, messenger RNA expression profiles of peripheral blood mononuclear cells from patients with and without diabetic nephropathy were compared.Methods  We studied seven male patients with Type 1 diabetes and proteinuria and 12 male patients with Type 1 diabetes and normoalbuminuria after at least 20 years of diabetes duration. The expression of genes was examined using the microarray method with Human Genome U133A Arrays (Affymetrix, Santa Clara, CA, USA). We analysed the expression of all candidate genes suggested to be involved in the pathogenesis of diabetic nephropathy in previously published articles. Altogether, expression of 198 genes was analysed.Results  We found that thrombospondin 1 (THBS1) and cyclooxygenase 1 (COX1) genes were over‐expressed in patients with diabetic nephropathy, and matrix metalloproteinase 9 (MMP9) and cyclooxygenase 2 (COX2) genes had lower expression in diabetic nephropathy. For other genes, we did not observe different expression between patients with and without diabetic nephropathy, or the expression was too low for analysis.Conclusions  The different gene expression pattern in peripheral blood mononuclear cells in patients with diabetic nephropathy might indicate an important pathway in the pathogenesis of this complication.
Metformin improves skin capillary reactivity in normoglycaemic subjects with the metabolic syndrome
Authors: Kraemer de Aguiar L. G. , Laflor C. M. , Bahia L. , Villela N. R. , Wiernsperger N. , Bottino D. A. , Bouskela E. 
Published: February 2007

AbstractAims Insulin resistance and a parental history of diabetes mellitus are independently associated with endothelial dysfunction. Oxidative stress has a pivotal role in the pathophysiology of vascular injury. Metformin, in addition to its glucose‐lowering properties, has vasculoprotective effects. We investigated whether metformin has beneficial effects on the nutritive skin capillary circulation and deceases oxidative stress in a group at high risk for Type 2 diabetes mellitus (T2DM) and cardiovascular disease.Methods Thirty normoglycaemic subjects with the metabolic syndrome (MS), who had first‐degree relatives with T2DM, participated. The mean age was 39.1 ± 8.4 years and body mass index (BMI) 35.7 ± 4.8 kg/m2(mean ±sd). Subjects were randomized 1 : 1 to receive placebo (n = 14) or metformin (n = 16; 1700 mg/day) in a double‐blind study. At baseline and post treatment, blood and urine samples were collected for biochemical and 8‐epi‐prostaglandin F2α(8‐epi‐PGF2α) analysis, respectively. Microcirculation was assessed by nailfold videocapillaroscopy, analysing afferent (AF), efferent (EF) and apical (AP) diameters of capillary loops, functional capillary density (FCD), red blood cell velocity at rest (RBCV), after 1 min arterial occlusion (RBCVmax) and time (TRBCVmax) taken to reach it.Results Groups did not differ significantly in anthropometric, clinical, laboratory or microvascular measurements at baseline. In the metformin group, weight, BMI, systolic blood pressure and fasting plasma glucose fell, and lipid profile and microcirculatory parameters FCD, AF, EF, AP, RBCVmaxand TRBCVmaximproved (allP < 0.01). No relationship between clinico‐laboratory parameters and microvascular reactivity was observed, except for changes in total and low‐density lipoprotein‐cholesterol and RBCVmax. 8‐epi‐PGF2αdid not change significantly in either group.Conclusions Metformin improved skin capillary reactivity in normoglycaemic MS subjects independently of significant changes in 8‐epi‐PGF2αlevels.
Sheltered Employment Strategies In Five Countries
Authors: Moores Ken , Booth Peter , Duncan Keith R. 
Published: February 2007

AbstractThe paper outlines sheltered employment strategies drawn from five countries (USA, Sweden, The Netherlands, Britain, and New Zealand) with a view to articulating policy options. The focus for the study was at the level of individual organizations in each country and personnel at all managerial levels were interviewed to ascertain their orientation with respect to the organisation of sheltered employment at three individual, yet interdependent structural levels: the national industry, the individual enterprise, and work itself. Work activity was observed and official documentation was studied to strengthen the validity of interview data. The results indicate that successful workshops were not only well informed of the dominant industry philosophy but also had their own clearly articulated interpretation of that philosophy. A number of policy options were seen to emerge from the patterns observed.
Decentralization & Local Government
Authors: Stoker Gerry 
Published: February 2007

AbstractCriticism of the achievements of the Welfare State have led to more emphasis on the role of local government in providing new styles of welfare services. This has presented a challenge to Labour party authorities in Britain and can be seen as an aspect of conflict with Conservative party central government. The article analyses the effect of placing more emphasis on local service delivery to which much publicity has been given. Voluntary agencies have also been given an increased role, for a variety of motives. This raises questions about local democracy, answerability, and user‐control, which go beyond mere party polemics and involves fresh discussion of the future role of local government.
Rent Control: its Costly Repercussions
Authors: Albon Robert , Stafford David C. 
Published: February 2007

AbstractThis article examines the theory and practice of rent control in the UK and elsewhere in order to contribute to the important debate on the future of the private rental sector in the UK. Our opposition to rent and eviction controls is unequivocal. We shall show that wherever rent control has been imposed the effects have been, at best, adverse and at worst, appalling. The effects on the quantity and quality of a housing stock can be so devastating that one Swedish socialist economist, Assar Lindbeck (1967) concluded: “In many cases rent control appears to be the most efficient technique presently known to destroy a city — except for bombing.” Controls which lead to an excess demand for housing foster unfortunate practices such a discrimination on various grounds other than willingness and ability to pay rent, and the creation of a black market. Rent and eviction controls also have a major impact on the mobility of labour. The encouragement to immobility can lead to the perpetuation of structural imbalances in an economy prompting rigidities which can have considerable economic and social costs.
Deregulation, markets and the 1988 Housing Act
Authors: Kemp Peter 
Published: February 2007

ABSTRACTThis paper looks at the deregulation of private sector rents. It examines two recent articles on this topic published in Social Policy and Administration, which take very different positions on the need for and desirability of rent deregulation, one very pro‐market the other very anti‐market in outlook. It is argued here that both articles hold idealized views of ‘the market’, though for different reasons, and that a less partisan view of the arguments and the evidence would suggest that deregulation of relettings, as provided by the Housing Act 1988, will be neither so significantly beneficial nor so deleterious in its effects as these two articles respectively would suggest.
Citizens Advice Bureaux: Problems of an Emerging Service in Rural Areas
Authors: Blacksell Mark , Clark Andrew , Economides Kim , Watkins Charles 
Published: February 2007

ABSTRACTNineteen eighty nine marked the Golden Jubilee of the CABx in the UK. Over the past 50 years it has established itself nationally as the prime provider of generalist advice, but there are special problems associated with delivering the service in rural areas. These include: the logistical difficulties of serving remote communities with small and scattered populations; maintaining the independence of bureau, especially from the local authorities that mainly fund them; and matching the professional standards now demanded by NACAB. These issues are examined with reference to a questionnaire survey of bureaux managers in Cornwall and Devon carried out as part of the AJRBP project at the University of Exeter.
Mental & Social Diagnosis and the English Prison Commission 1914–1939
Authors: Forsythe Bill 
Published: February 2007

ABSTRACTIn this article the author argues that there was a strengthening optimism about the value of psychological treatment between 1914 and 1939 amongst medical personnel employed by the English Prison Commission. This optimism contrasted with the pessimistic eugenic notion that there was an increasing and unreformable underclass which transmitted its inferior mental and physical characteristics biologically. Prison Commission medical staff became openly critical of eugenic proposals during the interwar years and, advised by a number of its medical personnel such as medical inspector and later Medical Commissioner William Norwood East, the Prison Commission was influenced towards the mental hygienism advocated by a growing number of American and British clinicians. Fherefore the Commission initiated a number of experiments in psychological treatment and psychoanalysis in English prisons.
Mental Health Policy in Northern Ireland
Authors: Prior Pauline 
Published: February 2007

AbstractMental health policy in Northern Ireland has moved through a number of phases during the past seventy years. This article examines some of the developments during each of these phases in the context of political factors which had an effect on policy formation and implementation. The services which existed in 1921 were deeply rooted in the lunacy legislation and provision of nineteenth century Ireland. The political uncertainty and financial stringency, which characterized the following two decades, resulted in a situation of almost complete stagnation in those services. The contribution of Northern Ireland during the Second World War guaranteed a financial commitment by Britain to the building of a comprehensive health service in the post‐war era. The expansion in mental health services was unprecedented. The relative stability of this era was shattered by the political “troubles” of the 1970s and the imposition of “direct rule” from Westminster. Though advantageous to health service development at first, this has now led to tighter central controls and the further loss of local autonomy. In policies dictated from Westminster, Area Boards moved towards a reduction in psychiatric beds to 1,500—the level of provision in 1870. History tells us that the needs of mentally ill people have not had a significant impact on services in the past. Will the future be any different?