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Biomedical subjects

J H Baumer

Publications and source records attributed to J H Baumer.

At least 37 records · Page 2Linked to original sources
PubMed1997

Audit of diabetes care by caseload.

OBJECTIVE: To investigate the relationship between clinic provision, consultant and nursing caseload, and processes and outcomes of diabetes care in children. DESIGN: Retrospective audit in the South Western region of England of 801 children and young people with diabetes; 701 were seen in a designated clinic. Seven of 21 consultants fulfilled the British Paediatric Association (BPA) criteria for a specialist in childhood diabetes. Seventeen nurses provided specialist care. MAIN OUTCOME MEASURES: Glycated haemoglobin, admissions to hospital clinic attendance rates, contacts with a dietitian, measurements of height and weight, and screening rates for hypertension, microalbuminuria, and retinopathy. RESULTS: Children under the care of 'non-specialists' had higher admission rates to hospital with all diabetes related problems and for hypoglycaemia and lower screening rates for microalbuminuria than those under 'specialists'. Children under the care of the two tertiary hospital consultants and lowest glycated haemoglobin results, spent least time in hospital at diagnosis, were most likely to have their heights and weights plotted, and to be screened for microalbuminuria and retinopathy, had higher admission rates, lower clinic attendance rates, and fewer dietitian consultations. Higher nursing caseloads were associated with longer periods of admission at diagnosis, better clinic attendance rates, reduced rates of admission after diagnosis, and less likelihood of having blood pressure measured and being screened for microalbuminuria. Children attending general paediatric clinics were less likely to be seen by a dietitian and to have their height and weight plotted. CONCLUSIONS: The results are consistent with the recommendation of a BPA working party in 1990 that children with diabetes should be cared for by specialist paediatricians with a caseload of more than 40 children, and that children should be seen in a designated diabetic clinic.

Albuminuria↗
PubMed1997

Illness severity measured by CRIB score: a product of changes in perinatal care?

AIM: To determine the perinatal factors associated with initial illness severity (measured by the CRIB (clinical risk index for babies) score) and its relation to survival to discharge. METHODS: A retrospective study was made of intensive care nursing records on 380 inborn babies, of less than 31 weeks gestation or 1501 g birthweight, admitted to one unit between 1984-6 and 1991-4. RESULTS: Between the two time periods mean initial illness severity score increased significantly from 2.8 to 3.9. This was the result of an increase in the maximum appropriate inspired oxygen concentration in the first 12 hours. Risk adjusted survival did not improve over time after accounting for gestation but was significantly greater after accounting for CRIB score. Illness severity score was also significantly inversely associated with gestation and 1 and 5 minute Apgar scores, using multiple regression analysis. Between the two time periods there was also a 92% increase in the admission rate of babies under 31 weeks gestation, higher median 1 and 5 minute Apgar scores (6 vs 5 and 9 vs 8, respectively), more multiple births, and more caesarean section deliveries. CONCLUSIONS: The increase in illness severity score and admission rate may reflect changes in obstetric practice. The increase in illness severity score may also reflect changes in early neonatal care. However, after adjusting for CRIB score, risk adjusted mortality fell significantly, suggesting that neonatal care 12 hours from birth onwards had improved with time.

Apgar Score↗
PubMed1993

Long term trigger ventilation in neonatal respiratory distress syndrome.

Experience of using an SLE 2000 neonatal trigger ventilator as the sole means of ventilation in 68 infants with respiratory distress syndrome was reviewed. No death or complication was seen in 22 infants with a birth weight above 1500 g. Forty five infants under 1500 g birth weight including 18 infants between 23 and 28 weeks' gestation were trigger ventilated throughout. Six infants died, four of whom were under 28 weeks' gestation. Two infants under 1500 g birth weight sustained a pneumothorax while being ventilated. Nine of 61 infants (15%) had radiological evidence of pulmonary interstitial emphysema, which was mild in seven infants. Intraventricular haemorrhage occurred in 10 babies under 1500 g, four of these being grade III or IV. Twenty two (48%) of the babies under 1500 g required added oxygen at 28 days. The preliminary clinical experience of this trigger ventilator suggests that it is capable of providing respiratory support from birth to extubation in even the most immature infants with respiratory distress syndrome. A controlled clinical trial is now required to compare the safety and efficacy of patient triggered ventilation with conventional neonatal ventilation.

Humans↗
PubMed1990

Cryptosporidiosis--an educational experience.

Eleven children aged 7 to 8 years from one school class developed diarrhoea and vomiting after an educational visit to a dairy farm. Three required hospital admission and intravenous fluid replacement for dehydration. Cryptosporidium oocytes were found in the faeces of these three children and from one classmate when the remainder of the class was tested between 16 and 21 days after the visit. At the farm some children tasted pelleted cow feed, silage and dried milk powder. A case-control study showed a significant correlation between diarrhoea and the tasting of silage and pelleted feed. Guidance on the safe conduct of educational visits to farms is given.

Animal Feed↗
PubMed1988

Family recovery after death of a child.

Children from a national birth cohort living in families in which a sibling had died or been stillborn were compared with children living in similarly structured families where no such tragedy had occurred by a number of health, developmental, and behavioural outcomes. Surprisingly little ill effect from a sibling death (occurring either before or after the birth of study children) was apparent at the age of 5 years. Families experiencing a stillbirth or death of a child were socially disadvantaged. Even allowing for this and other likely intervening factors, however, a child whose adjacent sibling had died was significantly more liable to bronchitis or wheezing during the first 5 years. Mothers who had experienced the death of a child since the study child's birth had high scores on a psychological screening test, and were more likely to be single parents. Mothers who had lost a child were more likely to smoke during the next pregnancy. No significant differences between cases and control subjects were detected on other health, behavioural, or developmental outcomes. Stillbirth or death of a child appears to have little measurable effect on siblings assessed at 5 years of age. This study does not exclude important longer term psychological effects from sibling death.

Bereavement↗
PubMed1982

Doves in false garb.

Explore the source record for details and available documents.

International Cooperation↗
PubMed1982

Effects of dietary fibre and exercise on mid-morning diabetic control--a controlled trial.

Twenty-one insulin-dependent diabetic children completed a trial of 4 different breakfasts, given in random order. Three diets differed in fibre content. The fourth diet contained soya beans as part (38%) of the dietary fibre source. Children collected capillary blood samples on to filter paper strips which were analysed for blood glucose content. Each morning the children were asked to exercise vigorously for an hour and to rest for an hour, resulting in comparable rest and exercise periods for each child. Mean initial blood glucose levels on the 4 diets were not significantly different. The low-fibre diet resulted in the highest blood glucose concentrations after breakfast. Blood glucose levels on the high-fibre diet did not differ from those on the medium-fibre diet. The bean diet produced the lowest mean blood glucose level and the smallest reduction in blood glucose level in the hour before lunch. All the children found the bean diet unacceptable but liked the high- and medium-fibre diets, which were as popular as the low-fibre diet. The level of prescribed exercise had no effect on the level of blood glucose. It appears that the potentially major benefits from beans are limited by their unpalatability. The more acceptable cereal fibre produces a smaller but important benefit on morning hyperglycaemia after breakfast.

Adolescent↗
PubMed1982

Impact of home blood glucose monitoring on childhood diabetes.

Ninety diabetic children each provided at least one 24-hour blood glucose profile at home using an impregnated filter paper strip. The mean 24-hour blood glucose level correlated significantly with urine control, height velocity, and Hb A1. The correlation coefficient for individual blood glucose values (r = 0.61) and for mean 24-hour blood glucose values (r = 0.73) repeated within 14 days showed an acceptable degree of reproducibility for the blood glucose profiles. Mean 24-hour blood glucose values fell significantly overall (11.4 to 9.8 mmol/l; 205 to 176 mg/100 ml) in 47 children who had repeated profiles more than 2 weeks apart. Unrecognised nocturnal hypoglycaemia (less than 3.0 mmol/l; 54 mg/100 ml) was found in 19% of children on twice-daily Semitard insulin. The study shows that children over age 7 years manage home blood glucose monitoring without difficulty. It shows that the results are reproducible and correlate with other indices of control, and that it provides a practical basis for the improvement of diabetic control.

Blood Glucose↗
PubMed1981

Many parents think their child is dying when having a first febrile convulsion.

Fifty parents of 36 consecutive children admitted to hospital with their first febrile convulsion were interviewed shortly after the event. Very few parents voluntarily said that they had thought their child was dying, but when asked specifically the majority said they had thought the child was dying or likely to die. This common fear should be kept in mind when discussing febrile convulsions with parents, who are unlikely to volunteer the information.

Adult↗
PubMed1979

Marrow relapse on maintenance chemotherapy in childhood acute lymphoblastic leukaemia.

A retrospective study on 190 children with acute lymphoblastic leukaemia and marrow relapse on therapy demonstrated a universally poor prognosis with a high risk of extramedullary leukaemia. 49.1% of children achieved a second remission, the median duration of haematological remission being 97 days. The median duration of survival was 157 days, with no survivors beyond 2 years 3 months from relapse. Children with high white blood counts at diagnosis, those relapsing early and older children had a particularly poor prognosis. Children who achieved a first remission with difficulty and those receiving regular vincristine and prednisolone in their remission were less likely to achieve a second remission. Those who failed to go back into remission with the more commonly used drugs were not usually responsive to other drugs.

Adolescent↗