Talking to the parents of a baby who is likely to develop permanent neurological impairment following a brain insult in the perinatal period.
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Birth Injuries↗
Biomedical subjects
S Ryan
Publications and source records attributed to S Ryan.
Telling parents their child has severe congenital anomalies.
A large number of potential malformations exist, but the key skills in communicating with the parents of a malformed baby are the same. Dissatisfaction is common in this situation and has prompted a national initiative in improving standards of disclosure of disability and malformation--the Right from the start strategy (see appendix). Key skills include keeping the family together, ie, not removing the baby unnecessarily, knowing how parents like to be informed, listening, checking that parents have understood, being nonderogatory and, most importantly, emphasizing the positive side of their newborn child.
Communication↗
A quantitative approach to quality improvement and resource allocation.
This report illustrates ways in which routinely collected hospital morbidity data can be used to inform and improve decisions about resource allocation, priorities for services and opportunities for improvement. All hospitals, public and private, Australia-wide collect these data at enormous expense. The resources allocated to processing, analysing and utilizing the data are minimal by comparison. Used appropriately these data can provide valuable information to managers and clinicians alike.
Australia↗
Posttraumatic stress disorder in a clinical sample of adults sexually abused as children.
Forty-seven help-seeking, adult survivors of childhood sexual abuse (CSA) were assessed to examine the relationship between the level of CSA exposure and the subsequent development of posttraumatic stress disorder. CSA exposure was operationalized to include the overall level of exposure, frequency and duration of the abuse, age of onset, use of force, perceived life threat, and the occurrence of penetration. Participants were administered standardized measures of PTSD, including the Structured Clinical Interview of DSM-III-R (SCID). On the SCID, 69% of the survivors met full DSM-III-R criteria for PTSD. Significant correlations were found between several overall exposure measures and PTSD diagnostic status and the intensity of PTSD symptomatology. Similar relationships were identified with the duration and frequency of the abuse, the age of onset, and the use of force. This study is important in that it utilized standardized measures of PTSD and found a significant incidence of PTSD among adult CSA survivors.
Adolescent↗
Systemic embolism in thyrotoxicosis without cardiac arrhythmia.
A 39-year-old woman presented with an acute left hemisphere stroke and was found to have severe hyperthyroidism. She developed an acute right brachial artery occlusion while under continuous cardiac monitoring, and at no time exhibited atrial fibrillation. This case, and a review of the literature, suggests that thromboembolism occurs in thyrotoxicosis without atrial fibrillation.
Adult↗
Functional maturation of the medial efferent olivocochlear system in human neonates.
The effect of contralateral acoustic stimulation on transient evoked otoacoustic emissions (TEOAE) was used to investigate the functional maturity of the medial efferent olivocochlear system in full term neonates and a 6-week-old baby. The technique used was to record the TEOAE alternately with and without contralateral noise. The result was a reduction in TEOAE amplitude and latency. This was best illustrated with a difference waveform obtained from the subtraction of the TEOAE waveform recorded with contralateral noise, from the waveform recorded without contralateral noise. All the full term neonates and also the 6-week-old baby showed significant effects indicating functional maturity of the medial olivocochlear system.
Acoustic Stimulation↗
Pancreatic enzyme elevations after blunt trauma.
BACKGROUND: Elevations in levels of the pancreatic enzymes amylase and lipase occur frequently after trauma. The purpose of this prospective study was to examine the incidence of these enzyme elevations in patients suffering blunt trauma, their natural history, and their relationship to posttraumatic pancreatitis. METHODS: One hundred consecutive trauma patients were studied on admission to the surgical intensive care unit with daily serum amylase and lipase measurements, which were blinded to the clinical service. If the enzyme levels were elevated after 3 days, the patient was enrolled in the study and observed and examined daily, and enzyme levels were measured every other day. These patients were fed enterally by the clinical service if no symptoms of clinical pancreatitis were present. RESULTS: In 17% of patients persistent pancreatic enzyme elevations developed. These patients more frequently had had hypotension, higher Injury Severity Scores, and were more likely to have had severe head injuries than those whose enzyme levels remained normal. Five percent of those studied displayed evidence of clinical pancreatitis, and none of these patients had only isolated head injuries. Lumbar spine injuries and retroperitoneal hematomas were present more frequently in the group in whom symptomatic pancreatitis developed. CONCLUSIONS: After blunt trauma 17% of patients displayed persistent pancreatic enzyme elevations, but the majority remained asymptomatic despite enteral feeding. Retroperitoneal injury may identify patients at risk for pancreatitis. Patients with isolated head injuries should be fed enterally.
Adolescent↗
Steroids for babies.
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Adrenal Cortex Hormones↗
Health after childbirth: a comparison of normal and assisted vaginal delivery.
413 women were included in the study: 100 who had had a normal delivery and 313 who had participated in a randomised controlled comparison of forceps or ventouse delivery. The study comprised a questionnaire and assessment at 24-48 hours after delivery and a questionnaire in the second year after delivery. There was significantly more morbidity in the women in the instrumental delivery group compared to women in the normal delivery group at both the early assessment and long-term follow-up.
Adult↗
Adolescent health status measurement: development of the Child Health and Illness Profile.
This report describes the early stages in the development and testing of an instrument, known as the CHIP (Child Health and Illness Profile), for assessing the health of individuals aged 11 through 17. The purpose of the instrument is to assess health in epidemiologic surveys, to determine the existence of systematic differences in health in subpopulations (including the socioeconomically disadvantaged), and to provide a basis for assessing the impact of changes in health services or health policies. An instrument consisting of six domains with 25 subdomains was developed based on the literature, the involvement of focus groups and expert panels, and pretesting in four groups of teenagers known to differ in their health. The results of work with panels of experts suggest that the instrument has content validity. Most domains and subdomains had acceptable reliability as measured by alpha coefficients. Differences in the scores of individuals in the four groups were in the predicted directions, suggesting that the instrument also has construct validity. Additional research is under way to establish other aspects of validity as well as reliability in school populations of adolescents as well as specific clinical settings.
Activities of Daily Living↗
Scombroid poisoning--an outbreak in two Ontario communities.
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Adult↗
The dynamics of MS-222 anaesthesia in a marine teleost (Pagrus auratus: Sparidae).
1. MS-222 anaesthesia of the marine teleost Pagrus auratus caused a dose-dependent elevation in haematocrit. 2. At 60 mg/l MS-222 the elevated haematocrit was fully accounted for by erythrocyte swelling, but at 100 mg/l red cell count also increased. 3. Uptake of anaesthetic in all tissues was rapid and the rate of onset of anaesthesia was dose-dependent. 4. Stage III level of anaesthesia (loss of equilibrium) was correlated with critical levels of MS-222 in the blood and brain. 5. The presence of acetylated derivatives of MS-222 in the blood demonstrated degradation of the anaesthetic, and high levels in the liver and kidney suggested that these organs were the sites of drug metabolism.
Aminobenzoates↗
Bone mineralization and growth.
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Bone Diseases, Metabolic↗
Lipid and apolipoprotein levels in an Australian community.
Serum levels of total and high density lipoprotein (HDL) cholesterol and apolipoproteins A1 and B were measured in over 600 men and women aged 30-69 years who were selected at random from an Australian community. Total cholesterol and apolipoprotein A1 and B levels increased with age, with this effect being most pronounced for total cholesterol and apolipoprotein B in women. Body mass index and waist-to-hip ratio were positively correlated with apolipoprotein B and total cholesterol levels, and negatively correlated with apolipoprotein A1 and HDL cholesterol levels. All lipid and apolipoprotein A1 levels increased with the quantity of alcohol consumed. After adjusting for age, body mass index and smoking, the association with alcohol was strongest for apolipoprotein A1 and HDL cholesterol levels in men (P = 0.0001), and for apolipoprotein A1 levels in women (P = 0.01). Levels of apolipoprotein A1 and HDL cholesterol were lower, and of apolipoprotein B and total cholesterol were higher, in current cigarette smokers than non-smokers, with significant associations for apolipoprotein B (P = 0.004) and HDL cholesterol levels (P = 0.04) in men. In general, the associations between apolipoprotein A1 levels and the other variables were weaker than those for HDL cholesterol levels, whereas the associations with apolipoprotein B levels were stronger than those for total cholesterol levels (except for alcohol consumption). Thus, obesity, alcohol consumption and cigarette smoking should be considered when interpreting apolipoprotein levels.
Adult↗
Relationship between arthroscopic evidence of cartilage damage and radiographic evidence of joint space narrowing in early osteoarthritis of the knee.
We examined the relationship between articular cartilage degeneration, as visualized arthroscopically, and joint space narrowing (JSN) in standing anteroposterior knee radiographs of 161 patients with chronic knee pain. The majority of these patients had radiographic findings of mild osteoarthritis. Twenty-five (33%) of the 76 patients in the series whose radiographs showed tibiofemoral JSN had grossly normal articular cartilage in both tibiofemoral compartments at arthroscopy (false-positive). The specificity of medial JSN for the presence of medial compartment articular cartilage degeneration was 0.61, i.e., only 61% of patients with normal (grade 0) medial compartment cartilage had a normal medial joint space. Of 22 patients with greater than 50% medial JSN, 9 (41%) had normal articular cartilage in the medial compartment at arthroscopy. Of 6 patients with greater than 50% lateral JSN, 3 (50%) had normal lateral compartment articular cartilage at arthroscopy. Among 36 patients with greater than 25% JSN who had neither medial nor lateral compartment articular cartilage degeneration, JSN was associated with articular cartilage degeneration in the patellofemoral compartment in 8 (22%), with meniscus degeneration in 18 (50%), and with both in 8 (22%). Thus, in these patients with chronic knee pain, radiographic evidence of JSN in the tibiofemoral compartment did not permit confident prediction of the status of the articular cartilage.
Adolescent↗
Solid phase extraction of oxcarbazepine and its metabolites from plasma for analysis by high performance liquid chromatography.
A rapid, sensitive and simple-to-operate high performance liquid chromatographic method for the simulataneous determination of oxcarbazepine, 10-hydroxycarbazepine and 10,11-dihydro-10,11-trans-dihydroxy-carbamazepine in plasma is described. The drug and its metabolites were extracted from plasma using commercially available reversed phase octadecylsilane bonded-silica columns (Bond Elut C18, 1 mL capacity). Chromatographic separation of oxcarbazepine and its metabolites was achieved using a mobile phase consisting of acetonitrile/methanol/water (13:25:62 by volume) at a flow rate of 1.2 mL/min in conjunction with a Waters Associates Nova-Pak C18 column. The analytical column, in Radial-Pak cartridge form, was used in combination with a LiChrospher 5 microns C18 guard column. By measuring the UV absorbance at 214 nm, plasma levels in the region of 50-100 ng/mL for the drug and its metabolites can be detected with only 100 microL of plasma. The method has been applied to pharmacokinetic studies of oxcarbazepine and its metabolites in children with epilepsy; preliminary pharmacokinetic findings in two patients at steady-state are presented.
Anticonvulsants↗
Otoacoustic emission tests in neonatal screening programmes.
Otoacoustic emission (OAE) testing has many characteristics which suit it for use as an objective neonatal auditory screener. The most important of these is the speed with which it can be performed. This feature alone opens up the possibility of much more general neonatal screening programmes. We here review the important considerations in applying otoacoustic testing to neonatal screening applications, and discuss the future role of OAE testing. Practical considerations in applying the technique are illustrated by examples and experiences drawn from a pilot whole-population neonatal screening project. Unselected screening takes us into unexplored territory. Test failure rate will inevitably far exceed the real incidence of hearing impairment. The concept of rapid whole-population neonatal OAE screening techniques as an additional risk factor detector rather than a definitive hearing test seems more appropriate to the low incidence of hearing impairment in the population and to the ethical problems surrounding early and erroneous diagnosis of hearing impairment.
Cochlea↗
The influence of contralateral acoustic stimulation on click-evoked otoacoustic emissions in humans.
Contralateral acoustic stimulation has the effect of reducing the amplitude and shifting the phase of click-evoked OAEs. This effect is thought to be mediated via the medial efferent system and, therefore, the presence of this effect could be used to test the integrity of the neural pathway from one cochlea to the other. With a clinical application in mind, a technique for demonstrating the influence of contralateral acoustic stimulation on click-evoked OAEs was designed to overcome fluctuations in patient and environmental noise. The results of this test on three normal subjects and a patient with a posterior fossa lesion are described.
Acoustic Stimulation↗