Search PubMed⌕ Search

Biomedical subjects

A R Watson

Publications and source records attributed to A R Watson.

At least 19 recordsLinked to original sources
PubMed2006

The impact of laparoscopic bariatric workshops on the practice patterns of surgeons.

BACKGROUND: This study was designed to evaluate the impact of a 2-day laparoscopic bariatric workshop on the practice patterns of participating surgeons. METHODS: From October 1998 to June 2002, 18 laparoscopic bariatric workshops were attended by 300 surgeons. Questionnaires were mailed to all participants. RESULTS: Responses were received from 124 surgeons (41%), among whom were 56 bariatric surgeons (open) (45%), 30 advanced laparoscopic surgeons (24%), and 38 surgeons who performed neither bariatric nor advanced laparoscopic surgery (31%). The questionnaire responses showed that 46 surgeons (37%) currently are performing laparoscopic gastric bypass (LGB), 38 (31%) are performing open gastric bypass, and 39 (32%) are not performing bariatric surgery. Since completion of the course, 46 surgeons have performed 8,893 LGBs (mean, 193 cases/surgeon). Overall, 87 of the surgeons (70%) thought that a limited preceptorship was necessary before performance of LGB, yet only 25% underwent this additional training. According to a poll, the respondents thought that, on the average, 50 cases (range, 10-150 cases) are needed for a claim of proficiency. CONCLUSION: Laparoscopic bariatric workshops are effective educational tools for surgeons wishing to adopt bariatric surgery. Open bariatric surgeons have the highest rates of adopting laparoscopic techniques and tend to participate in more adjunctive training before performing LGB. There was consensus that the learning curve is steep, and that additional training often is necessary. The authors propose a mechanism for post-residency skill acquisition for advanced laparoscopic surgery.

Bariatric Surgery↗
PubMed2005

Ethics support in clinical practice.

Ethical considerations have long been a part of clinical decision making. However, just as doctors and healthcare professionals are being increasingly challenged about the evidence base for their practice, there is increasing focus on the ethical dimension of clinical care.

Decision Making↗
PubMed2003

Clinical agreement between automated and calculated ultrasound measurements of bladder volume.

Non-invasive urine volume measurement is an important tool in the management of dysfunctional and neuropathic bladders in children. Ultrasound imaging devices have been used for many years for this purpose. An automated scanner (Bladderscan) is now available and has been recommended by a number of authors, but there is conflicting evidence in the literature regarding the accuracy and appropriate clinical application of the device. We aimed to assess the level of clinical agreement between the two methods. 36 urine volume measurements were made on 11 children using both instruments. Although there was a good correlation between the methods (r=0.97), the clinical agreement was poor (limits of agreement +/-77 ml). 13 voided volumes were directly measured and compared with the difference between pre- and post-void ultrasound measurements. The systematic errors were small but the mean absolute errors were 54 ml and 23 ml, respectively, for the automated and ultrasound imaging methods. If used correctly, ultrasound imaging provides more accurate results and can compete with the cost, convenience and ease of use of the automated method. Low cost, highly portable ultrasound imaging devices are now available and should be used in preference to the Bladderscan.

Automation↗
PubMed2001

Do gastrostomies close spontaneously? A review of the fate of gastrostomies following successful renal transplantation in children.

Previous published data have shown the benefit of nutritional support delivered via a gastrostomy button (GB) for children on chronic dialysis. The use of the GB is suspended following renal transplantation (RT) in most children and it is usually removed 2-3 months later together with the chronic dialysis catheter when the child is on alternate-day steroids. We reviewed the outcome of gastrostomies following successful RT in children. The gastrostomies were created by an open technique (Stamm) with the child under general anaesthesia, usually at the time of insertion of a chronic dialysis catheter. Growth data and complications of the GB were collected in a prospective registry. Following RT, the GB was removed with the expectation that the tract would close spontaneously. Those in whom a gastrocutaneous fistula persisted underwent formal surgical closure. A total of 18 children have had gastrostomy buttons removed: 11 gastrostomies (61%) closed spontaneously, but 7 (39%) required operative closure at a median of 2 months (range 3 weeks-4 years) post-removal. The need for formal closure was significantly related to the duration that the gastrostomy had been in situ pre-transplant (non-parametric statistics, 0.05 > p > 0.01). Although nearly two-thirds of gastrostomies in this study closed spontaneously following RT, less than one-half of those that had been in situ for more than 1 year did so. We thus recommend formal closure of all gastrostomies that have been in situ for more than 1 year. This can be done at the same operation as the removal of the chronic dialysis catheter.

Adolescent↗
PubMed2001

Snapshots of five clinical ethics committees in the UK.

Each of the following papers gives an account of a different UK clinical ethics committee. The committees vary in the length of time they have been established, and also in the main focus of their work. The accounts discuss the development of the committees and some of the ethical problems that have been brought to them. The issues raised will be relevant for other National Health Service (NHS) trusts in the UK that wish to set up such a committee.

Committee Membership↗
PubMed2000

Gastrostomy buttons for nutritional support in children with cystinosis.

Poor growth in children with cystinosis may be a combination of sub-optimal nutritional intake, gastrointestinal dysfunction and polypharmacy. We report our experience with gastrostomy buttons (GBs) in five children (4 male) with cystinosis treated at a median age of 3 years (range 1.4-8.8 years). All children received overnight GB feeding for a mean duration of 27 months (range 7-42 months). During 135 patient-months of observation, the mean life of the GB was 5.7 months (range 3-7.7 months), with a mean of 3.4 GB changes (range 1-6) per patient. An average of five (range 3-7) medications were administered daily via the button. The mean energy intake achieved was 118% of the estimated average requirement (range 86%-183%), with 58% of total energy and 55% of protein intake being delivered via the GB during the study period. Mean height standard deviation score (SDS) was -3.79 at the start of GB feeding and -3.08 at the end of the study period, with mean weight SDS of -3.79 and -2.17 (P=0.042), respectively. The buttons have been welcomed by the families and should be considered as a treatment option for providing the nutritional prescription and administering medications.

Child↗
PubMed2000

Nutrition and growth in relation to severity of renal disease in children.

Practical joint medical/dietetic guidelines are required for children with chronic renal insufficiency (CRI). Nutritional status and growth were compared in 95 children (59 male) > 2 years age with CRI, grouped following [51Cr]-labelled EDTA glomerular filtration rate (GFR, ml/min/1.73 m2) estimations into 'normal' kidney function [GFR > 75 (mean 104 (SD 18.9), n = 35], mild (GFR 51-75, n = 23), moderate (GFR 25-50, n = 19) and severe CRI (GFR < 25, n = 18). Anthropometry [weight (wt.), height (ht.), and body mass index (BMI)], laboratory investigations and a 3-day dietary record were obtained. All anthropometric indices deteriorated with worsening renal function, from mean SD scores for wt., ht. and BMI in 'normal' children of 0.32 (SD 1.2), 0.4 (SD 1.0) and 0.1 (SD 1.3), respectively, to values of -1.28 (SD 1.1; P < 0.001), -1.52 (SD 1.1; P < 0.001) and -0.42 (SD 1.1; NS) in severe CRI. Mean total energy intake decreased from 103% (SD 17) estimated average requirement (EAR) in 'normal' children to 85% EAR (SD 27; P = 0.004) in severe CRI. Mean serum PTH concentrations (normal laboratory range 12-72 ng/l) were higher in moderate [67 ng/l (SD 58), P < 0.001] and severe CRI [164 ng/l (SD 164), P < 0.001] and mean serum phosphate concentrations were higher in severe CRI (1.54 mmol/l (SD 0.17), P = 0.009) compared to 'normal'. Disturbances in nutritional intakes, bone biochemistry and growth occur early in CRI and suggest the need for joint medical/dietetic intervention in children with mild and moderate CRI, in addition to those with more severe CRI.

Adolescent↗
PubMed2000

Non-compliance and transfer from paediatric to adult transplant unit.

Adolescents and young adults appear to be a particularly high-risk group for problems of non-compliance and associated graft loss. We reviewed the progress of 20 young adults (9 female) who had been transferred to three different adult centres at a mean age of 17.9 years (range 15.7-20.9 years) having been transplanted at a mean age of 14.3 years (range 9.6-18.1 years) in the paediatric unit. Eight transplants failed within 36 months of transfer, and in 7 of 20 (35%) the transplant failure was unexpected (3 < 12 months, 3 12-24 months, 1 31 months post transfer). Although many of the patients had recognised problems in family dynamics, only 1 had had a major rejection episode prior to transfer due to admitted non-compliance. In 3 others low cyclosporin levels had been noted. Two young men had been transplanted preemptively in the paediatric unit at 15.3 and 16.7 years, and 3 patients had been transferred to the adult unit via the recently established transition clinic. The results suggest that close attention needs to be paid to this group of patients who require ongoing education and support. Improved dialogue between staff of the paediatric and adult units about transition issues is also essential.

Adolescent↗
PubMed2000

Unilateral multicystic dysplastic kidney disease: defining the natural history. Anglia Paediatric Nephrourology Group.

Controversy exists as to what is the optimal management of antenatally detected multicystic dysplastic kidney disease (MCDK): conservative or operative. We report 70 (31M, 39F) children with unilateral MCDK in whom the initial micturating cystourethrography revealed vesicoureteric reflux into the contralateral kidney in 16/63 (25%). Involution of the MCDK kidney was noted at birth in 4 and occurred by 2 y of age in 11/46 (24%), with 16/46 (35%) showing a significant reduction in size. Of 21 children followed to 5 y, the MCDK had disappeared in 3 (14%) and 8 (38%) had shown a further reduction in size. No child has developed hypertension or proteinuria. Four children had urinary tract infections with lower tract symptoms, but no scarring of the normal hypertrophied kidney. We conclude that conservative management of unilateral MCDK is justified with long-term follow-up consisting of annual clinical review and ultrasound evaluation at 2, 5 and 10 y.

Anti-Bacterial Agents↗
PubMed1999

Provision of dietetic care in children on chronic peritoneal dialysis.

OBJECTIVE: To estimate the provision of dietetic care necessary to manage and support children receiving chronic peritoneal dialysis (CPD) with/without nutritional support via a gastrostomy button (GB) and their families. DESIGN: Three-year prospective, longitudinal study documenting dietetic contacts (direct: inpatient/outpatient, telephone, home, school, and family practitioner visits; and indirect: with other health professionals). SETTING: Regional Pediatric Renal Unit. PARTICIPANTS: Thirteen children (7 male; 5 <5 yrs of age) commenced CPD at a mean age of 7.7 years (range, 0.2 to 8.5 years). Eight children received tube feeding (7 GB, 1 nasogastric [NG]) in combination with CPD at a mean age of 4.3 years (range, 0.2 to 8.2 years). MAIN OUTCOME MEASURES: Quantitative data regarding dietetic contacts and growth parameters. RESULTS: Seven hundred eighty-one dietetic contacts were recorded during 182 patient months of observation, with a mean of 5.9 (standard deviation [SD] 1.9) contacts per patient, per month in children <5 years of age, compared with 3.1 (SD 1.6) contacts in children >5 years of age. Eighty-two percent of contacts were with children receiving nutritional support via a GB. Telephone contact accounted for 41% of all contacts in the less than 5 years of age group, compared with 7% in children greater than 5 years of age. Mean standard deviation scores (SDS) for height and weight at the start of the study were -1.2 and -1.32, and at the end were -1.14 and -0. 73. Body mass index (BMI) SDS significantly improved from -0.91 to 0. 17 (P = 0.03). CONCLUSION: This study illustrates the number and nature of dietetic contacts that we felt were required to support children and families on CPD. Attempts to achieve adequate nutritional intakes for growth require frequent adjustments of nutritional prescriptions, particularly in preschool children.

Adolescent↗
PubMed1999

Comparison of lignocaine-prilocaine cream and amethocaine gel for local analgesia before venepuncture in children.

The efficacy of lignocaine-prilocaine cream (EMLA) and amethocaine gel (Ametop) in reducing the pain and distress of venepuncture was compared in a single-blind randomized study of 34 children aged 1-14 y. The influences of age, anxiety and past experience were also investigated. Pain was assessed by the researcher using the Observation Scale of Behavioural Distress, and by the parent, doctor and child (if old enough) using a 10-cm, 100-point Visual Analogue Scale (VAS). Doctors also completed a simple rating scale for difficulty of venepuncture. Compared to older children, infants had significantly more anxious parents and were more distressed when being held still. Anticipatory anxiety correlated with higher pain ratings. No differences in the analgesic effect of the two preparations were found. We conclude that whilst EMLA and Ametop are equally effective at reducing the pain of needle puncture, under some circumstances the use of Ametop may be more advantageous.

Adolescent↗
PubMed1999

Hemolytic uremic syndrome: defining the need for long-term follow-up.

BACKGROUND: Diarrhea-associated (D+) hemolytic uremic syndrome (HUS) is a common cause of acute renal failure in children. Progressive renal insufficiency has been documented on prolonged follow-up of selected patients. However, it is uncertain whether all children recovering from varying degrees of HUS require long-term follow-up. PATIENTS AND METHODS: We reviewed the outcome of 114 patients with D+ HUS presenting to a regional pediatric unit between January 1986 and December 1996. Yearly clinical review post illness included measurement of blood pressure and urinalysis for proteinuria with planned GFR assessments by 51Cr EDTA slope clearance at 1 and 5 years. RESULTS: Treatment of the HUS was conservative in 27%, by peritoneal dialysis in 62%, hemodialysis in 4% and both peritoneal and hemodialysis in 7%. Ninety-two patients were assessed at 1 year - of these, 1 remained on chronic peritoneal dialysis, 5 (5%) had moderate to severe chronic renal failure (CRF) (GFR 25 - 50 ml/min/1.73 m2), 20 (22%) had mild CRF (GFR 50-80) and 66 (72%) had normal renal function (> or =80 ml/min/1.73 m2). Forty patients have had GFRs performed at 1 and 5 years. Of the 28 patients with a normal GFR at 1 year, 3 deteriorated into mild CRF at 5 years. One patient has a single kidney and one had significant proteinuria at 1 year, factors which would have led to long-term follow-up. There was a negative correlation between number of days of dialysis and GFR at 1 year with a Pearson's correlation coefficient of -0.453 (p<0.01). CONCLUSION: We conclude that renal function at I year following HUS cannot be predicted with any certainty from the initial illness and should be formally assessed. However, renal function was within normal limits and remained stable between 1 and 5 years following HUS in most children. The results suggest that longer-term follow-up can probably be restricted to those with proteinuria, hypertension, abnormal ultrasound and/or impaired GFR at 1 year.

Child↗
PubMed1998

Antenatally detected urinary tract abnormalities: changing incidence and management.

UNLABELLED: To define the incidence of urinary tract abnormalities detected by antenatal ultrasound and assess changes in postnatal management we conducted a retrospective survey using data bases of the nephro-urology unit, obstetric ultrasound and perinatal pathology departments. The birth population (105,542) of the two Nottingham teaching hospitals between January 1984 and December 1993 was divided into two 5-year cohorts, 1984-1988 and 1989-1993. Detailed fetal scanning at 18-20 weeks gestation was introduced in 1989. During this 10-year period, 201 abnormalities of the urinary tract were noted with a 2:1 male to female ratio. The incidence of abnormalities in the first 5 years was 1 in 964 compared to 1 in 364 in the last 5 years. There was a significant increase in the number detected before 20 weeks gestation (12% in 1984-1988 compared to 62% in 1989-1993). Despite the increased incidence of abnormalities detected, the termination rate remained static between the two 5-year cohorts. Only 3 fetuses had intra-uterine intervention and 173 were live-born. Eight infants subsequently died in association with other major congenital abnormalities. The incidence of transient abnormalities (antenatal dilatation with no abnormality noted on postnatal ultrasound) increased from 6% in 1984-1988 to 18% in the 1989-1993 cohort. A more conservative approach to postnatal management is reflected by 71% of infants having operations between 1984 and 1988 compared to 35% in 1989-1993. CONCLUSION: The advent of detailed fetal scanning at 18-20 weeks gestation has significantly increased the detection rate of urinary tract abnormalities with no significant increase in pregnancy termination rates. The need for antenatal intervention is a rare event and most problems can be managed conservatively both pre- and postnatally.

Abortion, Induced↗
PubMed1998

Listeria monocytogenes meningitis in a penicillin-allergic paediatric renal transplant patient.

Currently in many centres the extended spectrum cephalosporins (e.g. cefotaxime and ceftriaxone) are being used empirically for patients with suspected bacterial meningitis. We present a case of meningitis in a penicillin allergic paediatric renal transplant patient from whose cerebrospinal fluid (CSF) Listeria monocytogenes was cultured, despite four days of cefotaxime therapy. The patient was successfully treated with meropenem but required neuro-endoscopic intervention for hydrocephalus.

Amoxicillin-Potassium Clavulanate Combination↗