bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of a CT‐guided fine needle aspirate in infants with lung abscess
Authors: Levison J , Van Asperen P , Wong C , Harvey J , Halliday R 
Published: July 2004

Objective:  To describe the range of pathogens isolated from a lung abscess in infants less than one year of age. To assess the role of direct culture from the abscess.Methods:  The two index cases were managed in 2002. An institution‐based review was conducted of all infants up to one year of age diagnosed with a lung abscess between 1989 and 2002. Data sources were hospital's disease index and Neonatal Intensive Care Unit Audit database using ICD9 and ICD10 diagnostic codes for ‘lung abscess’.Results:  Five infants, under the age of one year, were treated for a lung abscess. In the one case where the abscess was left‐sided it was associated with a congenital cystic adenomatoid malformation of the lung. Pathogens were isolated following direct culture of the abscess in four cases. In three cases a single pathogen was isolated: pseudomonas aeruginosa, staphylococcus aureus and haemophilus influenzae. In one case a mixture of escherichia coli, streptococcus milleri and an anaerobe, propionibacteria, were cultured. Antibiotic therapy was directed at the identified pathogen(s) in all four cases. There was no mortality or recurrence.Conclusion:  Predisposing factors for a lung abscess in infancy include prematurity, assisted ventilation, congenital lung anomaly and aspiration. Given the range of potential pathogens, direct culture by CT‐guided fine needle aspiration is recommended to direct appropriate intravenous medical therapy provided the abscess is located peripherally.
Development and use of a portable paediatric resuscitation card
Authors: McCallum Z , South M 
Published: July 2004

Objectives:  Inaccuracy and delay in decision making in paediatric resuscitation has been previously demonstrated and may result in preventable death. We assessed several domains of paediatric resuscitation knowledge amongst a sample of tertiary hospital paediatric doctors, developed a portable aide‐memoire reference card containing reference normal values, including an algorithm for recognition and management of the seriously ill/arrested child, and assessed the ability of medical staff to use this card to obtain accurate information.Methods:  A convenience sample of 46 members of the Royal Children's Hospital medical staff completed a questionnaire. Knowledge deficits identified were used to create a 9 × 6 cm, name tag sized, laminated card providing physiological parameters and information required for paediatric resuscitation. The card was then distributed to all medical staff. A sample of 18 doctors completed an identical questionnaire 4 months after introduction of the card. Pre‐ and post‐card results were analysed across a range of knowledge domains.Results:  Basic calculations were incorrect in over 40% of all pre‐card responses. Seniority did not predict more correct answers. The post‐card group obtained significantly more correct answers than the pre‐card group.Conclusion:  Medical staff wore, and were able to use the card to provide the correct values for paediatric resuscitation parameters. The use of a card significantly improved knowledge of the correct values for resuscitation data. This project has resulted in the card being issued to all medical and nursing staff and is now accessible via the Royal Children's Hospital internet at http://perseus.rch.unimelb.edu.au/genmed/resuscardontheweb.htm
Adoption of laparoscopic technique for radical prostatectomy in a district hospital in Hong Kong
Authors: Chan Steve Wai‐Hee , Yung Max Yee‐Ping , Que Manuel Bon‐We , Mah Ida Soo‐Fan , Man Chi‐Wai 
Published: July 2004

Objective:  To investigate the feasibility of adopting laparoscopic radical prostatectomy in treating organ‐confined adenocarcinoma of the prostate in a low volume urology centre.Methodology:  We applied the technique to 21 patients with early prostate cancer from March 2002 to July 2003. Modifications of the technique were described. Methods to shorten the learning time were discussed.Results:  Operative time and blood loss improved after the first 10 cases and were averaged at 260 min and 650 mL, respectively, in the last 10 cases. Two patients required re‐operation for complications. A total of 14.7% of specimens showed positive surgical margin. Only one of the 15 patients needed to wear a pad for incontinence. Two of the eight patients regained the ability to have an erection after attempts of nerve sparing. A longer follow‐up was required for the evaluation of oncological control.Conclusion:  Adoption of the technique was feasible for an Asian centre with a caseload of approximately 20 cases per year.
Heart valve surgery in the modern era: Towards zero operative mortality in the developing area
Authors: He Guo‐Wei 
Published: July 2004

Objective:  Despite modern technology, heart valve replacement still carries significant operative mortality, ranging from 2 to 10% in most cardiac centres.Methodology:  From December 1999 to January 2003, more than 150 heart valve operations on mitral valve (MV)/aortic valve (AV) or double valve replacement (DVR) were performed at the cooperative heart institutes with no operative mortality (defined as either in‐hospital or postoperative 30‐day death). The present study analyses the data of the 109 patients among this group who were operated on by a single surgeon (the author).Results:  There were 49 male and 60 female patients with an average age of 41.6 ± 1.2 years old (range: 7–69 years). All patients had a certain degree of heart failure and most had cardiothoracic ratio increased, with the largest being 99%. The operations performed were: MV replacement (41); AV replacement (21; five patients had concomitant repair of rupture of the aneurysm of sinus of Valsalva); double valve replacement/intervention (46); MV repair ± annuloplasty ring (3); concomitant coronary artery bypass grafting (5) and tricuspid valve annuloplasty (2). There were no operative deaths. The prostheses used were: St. Jude (86); Sorin (10); Monostrut (24) and China Langzhou (29). One patient died of bleeding and infectious complications 5 months after the operation.Conclusions:  We conclude that in the modern era, valve replacement can have superior results even in a developing area. The commonly used prostheses have similar results. Particular attention should be paid to proper preoperative preparation, operative details, and postoperative care.
Tailor‐Made Pharmacotherapy: Future Developments and Ethical Challenges in the Field of Pharmacogenomics
Authors: Van Delden Johannes , Bolt Ineke , Kalis Annemarie , Derijks Jeroen , Leufkens Hubert 
Published: July 2004

ABSTRACTPharmacogenomics is the study of the myriad interactions between genes and pharmacotherapy. Developments in pharmacogenomics have changed and will affect pharmaceutical research, drug development and the practice of medicine in a significant way. In this article, we make an inventory of the ethical implications that might arise as a result of possible developments in pharmacogenomics and investigate whether the present ethical framework will be able to adequately answer arising questions.We think that many of the questions related to the consequences of pharmacogenomics are answerable along the lines of present ethical thinking. We also believe, however, that many ‘changes of degree’ may result in a ‘change of kind.’ We therefore think that pharmacogenomics may potentially have such a profound influence on scientific research and the pharmaceutical industry, the practice of medicine and society at large, that this will generate its own unique dynamic, which will require new ethical research. We suggest that the notion of ‘responsibility’ will be a major focus of such research.
Tailored Medicine: Whom Will it Fit? The Ethics of Patient and Disease Stratification
Authors: Smart Andrew , Martin Paul , Parker Michael 
Published: July 2004

ABSTRACTA key selling point of pharmacogenetics is the genetic stratification of either patients or diseases in order to target the prescribing of medicine. The hope is that genetically ‘tailored’ medicines will replace the current ‘one‐size‐fits‐all’ paradigm of drug development and usage. This paper is concerned with the relationship between difference and justice in the use of pharmacogenetics. This  new  technology,  which  facilitates  the  identification and use of difference, has, we shall argue, the potential to lead to injustice either by the inappropriate use of difference or through the inappropriate failure to use difference. We build on empirical data from a detailed study of the range of options for the development of pharmacogenetics to present a consideration of the ethical issues that surround patient and disease stratification. In it we explore the ways in which the use of pharmacogenetics may lead to the creation of new, genetically stratified, forms of difference and new forms of injustice based on these divisions. We also examine the ways in which existing forms of difference and social stratification may interact with the use of pharmacogenetics. In conclusion, we suggest how an understanding of these ethical issues could usefully inform future policy discussions.
Pharmacogenetic Testing, Informed Consent and the Problem of Secondary Information
Authors: Netzer Christian , Biller‐Andorno Nikola 
Published: July 2004

ABSTRACTNumerous benefits for patients have been predicted if prescribing decisions were routinely accompanied by pharmacogenetic testing. So far, little attention has been paid to the possibility that the routine application of this new technology could result in considerable harm to patients. This article emphasises that pharmacogenetic testing shares both the opportunities and the pitfalls with ‘conventional’ disease‐genetic testing. It demonstrates that performing pharmacogenetic tests as well as interpreting the results are extraordinarily complex issues requiring a high level of expertise. It further argues that pharmacogenetic testing can have a huge impact on clinical decisions and may influence the therapeutic strategy as well as the clinical monitoring of a patient. This view challenges the predominant paradigm that pharmacogenetic testing will predict patients’ responses to medicines, but that it will not provide any other significant disease‐specific predictive information about the patient or family members. The article also questions published proposals to reduce the consent procedure for pharmacogenetic testing to a simple statement that the physician wishes to test a sample of the patient's DNA to see if a drug will be safe or whether it will work, and presents an alternative model that is better suited to protect patients’ interests and to obtain meaningful informed consent. The paper concludes by outlining conditions for the application of pharmacogenetic testing in clinical practice in a way that can make full use of its potential benefits while minimising possible harm to patients and their families.
Ethical Implications of Pharmacogenetics – Do Slippery Slope Arguments Matter?
Authors: Schubert Lilian 
Published: July 2004

ABSTRACTPharmacogenetics is a rapidly expanding area of research exploring the relationship between inter‐individual genetic variation and drug response, with the goal of developing genetically optimised therapies. Slippery slope arguments claim that a particular action should be rejected (or supported) because it might be the first step onto a slippery slope leading to undesirable (or desirable) consequences. In this article, several slippery slope arguments relevant to the context of pharmacogenetics are evaluated under consideration of underlying reasons for their popularity. The author concludes that although the examined arguments are unconvincing as slippery slope arguments, they do matter in this context. While positive slippery slope arguments serve as a driving force to fuel the development of pharmacogenetics, their negative counterparts play an important role to sensitise policy makers and the public to potential problems.
Impaired disengagement of attention in young children with autism
Authors: Landry Reginald , Bryson Susan E. 
Published: July 2004

Background: The present study examined the disengage and shift operations of visual attention in young children with autism.Methods: For this purpose, we used a simple visual orienting task that is thought to engage attention automatically. Once attention was first engaged on a central fixation stimulus, a second stimulus was presented on either side, either simultaneously or successively. Latency to begin an eye movement to the peripheral stimulus served as the main dependent measure. The two stimulus conditions (simultaneous and successive) provided independent measures of disengaging and shifting attention, respectively. Performance of children with autism was compared to that of children with Down syndrome and a normal group.Results: The main finding was that relative to both comparison groups, children with autism had marked difficulty in disengaging attention. Indeed, on 20% of trials they remained fixated on the first of two competing stimuli for the entire 8‐second trial duration. Evidence is also provided for a more subtle problem in executing rapid shifts of attention.Conclusions: Our findings on disengagement in autism parallel those reported in normal 2‐month‐olds, in whom attention has been described as ‘obligatory’. Discussion focuses on the potential role of general versus domain‐specific processes in producing some of the core features of autism.
Comparison of ADHD symptom subtypes as source‐specific syndromes
Authors: Gadow Kenneth D. , Drabick Deborah A.G. , Loney Jan , Sprafkin Joyce , Salisbury Helen , Azizian Allen , Schwartz Joseph 
Published: July 2004

Background:  This study examines differences between the three subtypes of attention‐deficit/hyperactivity disorder (ADHD), inattentive (I), hyperactive‐impulsive (H), and combined (C), in a heterogeneous sample of 248 boys (ages 6 to 10 years) with emotional and behavioral problems who were recruited for participation in a diagnostic study.Method:  The boys and their mothers participated in an extensive evaluation that involved multiple assessments of cognitive, behavioral, academic, and family functioning. ADHD subtypes were defined on the basis of teacher alone, mother alone, and mother/teacher ratings of DSM‐IV symptoms.Results:  Results indicated ADHD symptom groups showed a differential pattern of impairment socially (H,C>I) and cognitively (I,C>H). The C and H groups were the most and least impaired overall, respectively, and all subtypes were differentiated from the nonADHD clinical control or NONE (N) group in a manner consistent with the primary findings. External validation of group differences was limited, and there were marked inconsistencies in the pattern of findings depending on how groups were defined. For the most part, although the mother/teacher grouping strategy (compared with either alone) captured a greater diversity of differences between subtypes, it also obscured some.Conclusions:  Observed findings are consistent with the notion that mothers and teachers interpret symptom statements in terms of behaviors that are most relevant for their daily concerns.
Psychopathology in female juvenile offenders
Authors: Dixon Angela , Howie Pauline , Starling Jean 
Published: July 2004

Background:  The aim was to document the spectrum of present and lifetime psychological disorders in female juvenile offenders, and to examine the relations between mental health status and socio‐demographic, family and trauma variables.Method:  One hundred juvenile offenders were matched with a comparison group of 100 females on age and socioeconomic status (SES). Psychological profiles and trauma histories of both groups were assessed using the Schedule for Affective Disorders and Schizophrenia for School‐Age Children – Present and Lifetime Version (K‐SADS‐PL) and family functioning was assessed with the Family Adaptability and Cohesion Scale II (FACES II) self‐report measure.Results:  Rates of psychopathology were higher for offenders than non‐offenders (p < .001), with particularly high levels of conduct disorder (91% v.1%, p < .001), substance abuse disorders (85% v. 5%, p < .001), depression (55% v. 25%, p < .001) and posttraumatic stress disorder (37% v. 4%, p < .001). In the offenders, 78% met the criteria for three or more diagnoses. The number of psychiatric diagnoses was the most significant factor associated with offender status (OR = 21.26, p < .001).Conclusions:  There is a high prevalence of psychological disorder in females in juvenile justice custody and this has a very strong association with offender status. Because these co‐morbid disorders are treatable, there is a clear opportunity to intervene to decrease psychological distress.
The prediction of disruptive behaviour disorders in an urban community sample: the contribution of person‐centred analyses
Authors: Burt Keith B. , Hay Dale F. , Pawlby Susan , Harold Gordon , Sharp Deborah 
Published: July 2004

Background:  Variable‐ and person‐centred analyses were used to examine prediction of middle childhood behaviour problems from earlier child and family measures.Method:  A community sample of 164 families, initially recruited at antenatal clinics at two South London practices, was assessed for children's behaviour problems and cognitive ability, maternal mental health, and the family environment when the children were 4 years old. At age 11, children, mothers, and teachers reported the child's disruptive behaviour, and mothers and children were interviewed to identify cases of disruptive behaviour disorders (DBD).Results:  Neither social class nor ethnicity predicted the child's disruptive behaviour at age 11. Rather, path analyses and logistic regression analyses drew attention to early behavioural problems, maternal mental health and the child's cognitive ability at 4 as predictors of disruptive behaviour at age 11. Cluster analysis extended these findings by identifying two distinct pathways to disruptive symptoms and disorder. In one subgroup children who showed intellectual difficulties at 4 had become disruptive by 11. In a second subgroup mothers and children both showed psychological problems when the child was 4, and the children were disruptive at age 11. The person‐centred approach also revealed a high‐functioning group of cognitively able 4‐year‐olds in supportive environments, at especially low risk for DBD.Conclusions:  Combining variable‐ and person‐centred analytic approaches can aid prediction of children's problems, draw attention to pertinent developmental pathways, and help integrate data from multiple informants.
Parent–child dyadic mutuality and child behavior problems: an investigation of gene–environment processes
Authors: Deater‐Deckard Kirby , Petrill Stephen A. 
Published: July 2004

Background: Parent–child mutuality is comprised of emotional reciprocity, co‐responsiveness, and cooperation, which together represent aspects of co‐regulation of emotion and behavior that may be important in the etiology of children's behavior problems. Furthermore, individual differences in children's mutuality and behavior problems involve transactions between genetic and environmental influences. Behavioral genetic designs are useful for elucidating these processes.Methods: The sample included 396 children in adoptive families (53% female, ageM = 8.16 years), of whom 244 were siblings (122 pairs). All of the siblings were genetically unrelated. In some families, one child was adopted but the other child was a biological child of the adoptive parents. We observed mother–child dyadic mutuality (a composite score including responsiveness, interaction reciprocity, and cooperation) during videotaped in‐home observations. In addition, child behavior problems were assessed and represented as a composite score including observers’ ratings of noncompliance, and parents’ ratings of aggression and conduct problems.Results: Greater mutuality was associated with lower levels of child behavior problems, both between families and within families (i.e., sibling differences). The sibling intra‐class correlation for mutuality with the same parent was near zero in this sample of genetically unrelated siblings. The correlation between child behavior problems and dyadic mutuality did not vary as a function of mother–child genetic similarity.Conclusions: Mother–child mutuality is child specific within families, a finding that is consistent with theories regarding bi‐directional parent and child effects in socialization. In addition, there was no evidence of passive gene–environment correlation, suggesting that the link between lower levels of maternal mutuality and higher levels of childbehavior problems is not only reflecting overlapping genetic influences on parent and child behavior.
Annotation: Deconstructing the attention deficit in fragile X syndrome: a developmental neuropsychological approach
Authors: Cornish K.M. , Turk J. , Wilding J. , Sudhalter V. , Munir F. , Kooy F. , Hagerman R. 
Published: July 2004

Background: Fragile X syndrome is one of the world's leading hereditary causes of developmental delay in males. The past decade has witnessed an explosion of research that has begun to unravel the condition at its various levels: from the genetic and brain levels to the cognitive level, and then to the environmental and behavioural levels. Our aim in this review is to attempt to integrate some of the extensive body of knowledge to move the research a step closer to understanding how the dynamics of atypical development can influence the specific cognitive and behavioural end‐states frequently observed in children and adolescents with fragile X syndrome.Methods: We conducted a review of the current neuropsychological and neuropsychiatric approaches that have attempted to delineate the pattern of ‘spared’ and ‘impaired’ functions associated with the phenotype.Results: The profile of findings suggests that fragile X syndrome should not be viewed merely as a catalogue of spared and impaired cognitive functions or modules. Instead, there appears to be a process of almost gradual modularisation whereby cognitive mechanisms become domain specific as a function of development itself (Karmiloff‐Smith, 1992). The results of a decade of intense research point towards an early weakness in one or more components of executive control rather than single, static higher‐level deficits (e.g., spatial cognition, speech processing). This weakness affects both the development of more complex functions and current performance.Conclusions: The prevailing tendency to interpret developmental disorders in terms of fixed damage to distinct modular functions needs to be reconsidered. We offer this review as an example of an alternative approach, attempting to identify an initial deficit and its consequences for the course of development. Through better definition of the cognitive and behavioural phenotype, in combination with current progress in brain imaging techniques and molecular studies, the next decade should continue to hold exciting promise for fragile X syndrome and other neurodevelopmental disorders.