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PubMed1999

Practitioner review: communicating with hospitalised children: review and application of research pertaining to children's understanding of health and illness.

There is growing recognition amongst child health care practitioners of children's rights to be informed about their condition and treatment, and to be actively involved in decisions pertaining to their care. In order to facilitate such understanding, there is a need to explore the ways in which such concepts can best be communicated, in particular to younger children whose conceptual ability may be regarded as limited. Consideration of the literature on how children's conceptualisation of health and illness develops reveals diverse perspectives, with seminal work heavily influenced by the work of Piaget (1929), and a belief that the understanding of younger children may be minimal. However, more contemporary theorists refute such beliefs, suggesting that children may have far more potential to understand complex illness concepts than they have previously been given credit for. The work of Carey (1985) and Vygotsky (1962) offers alternative developmental theories congruent with this perspective, which might more appropriately underpin current practice. A variety of clinical situations are then explored in the light of this debate, including preparation of children for hospitalisation, their competence to consent, their views of pain and death, and approaches to child health promotion. Guidelines are offered to practitioners throughout, with the aim of enhancing children's understanding of their conditions, and their active participation in care, which in turn has the potential to optimise care delivery.

Adolescent↗
PubMed2000

[Facial artery. Embryological review, descriptive and functional anatomy based on a review of the literature].

After a summary of the embryology and anatomy of the arterial blood supply of the face, the authors present the descriptive anatomy of the facial artery and its eight most frequent branches. Variations of the origin, course and division of the artery are then described. The literature contains 3 to 5 different descriptions of the course of the artery. The authors considered 4 of these descriptions to be relevant: I (angular), II (nasal), III (superior labial), IV (hypoplastic). Seventeen different branches have been described, many of which are inconstant. The superficial and deep anastomotic network is described, with emphasis on the subdermal network and that of the transverse facial artery. The various vascular regions of the face, first described by Mitz and Whetzel, are described. Based on these observations, and on Lasjaunias'theory of the triple hemodynamic balance, the authors propose a functional analysis of the arterial blood supply of the face. According to this analysis, the anatomic variations observed are determined by regional hemodynamic balances. These observations influence the design and creation of certain local facial flaps, such as the submental, nasolabial and buccinator flap. They may also influence present concepts concerning the hemodynamics of arteriovenous malformations of the face.

Arteries↗
PubMed2001

Reviewing the reviewers: the quality of reporting in three secondary journals.

BACKGROUND: Secondary journals such as ACP Journal Club (ACP), Journal Watch (JW) and Internal Medicine Alert (IMA) have enormous potential to help clinicians remain up to date with medical knowledge. However, for clinicians to evaluate the validity and applicability of new findings, they need information on the study design, methodology and results. METHODS: Beginning with the first issue in March 1997, we selected 50 consecutive summaries of studies addressing therapy or prevention and internal medicine content from each of the ACP, JW and IMA. We evaluated the summaries for completeness of reporting key aspects of study design, methodology and results. RESULTS: All of the summaries in ACP reported study design, as compared with 72% of the summaries in JW and IMA (p < 0.001). In summaries of randomized controlled trials the 3 secondary journals were similar in reporting concealment of patient allocation (none reported this), blinding status of participants (ACP 62%, JW 70% and IMA 70% [p = 0.7]), blinding status of health care providers (ACP 12%, JW 4% and IMA 4% [p = 0.4]) and blinding status of judicial assessors of outcomes (ACP 4%, JW 4% and IMA 0% [p = 0.4]). ACP was the only one to report whether investigators conducted an intention-to-treat analysis (in 38% of summaries [p < 0.001]), and it was more likely than the other 2 journals to report the precision of the treatment effect (as a p value or 95% confidence interval) (ACP 100%, JW 0% and IMA 55% [p < 0.001]). INTERPRETATION: Although ACP provided more information on study design, methodology and results, all 3 secondary journals often omitted important information. More complete reporting is necessary for secondary journals to fulfill their potential to help clinicians evaluate the medical literature.

Chi-Square Distribution↗