The effect of gastroesophageal reflux on the pediatric airway.

The child with airway signs and symptoms that may be associated with GER presents diagnostic challenges. A high index of suspicion may be needed to make the diagnosis of GER, because no one test gives consistently definitive results. Specialists from multiple disciplines, including otolaryngology, gastroenterology, pulmonology, pediatrics, critical care, anesthesiology, and pediatric surgery may ultimately need to work together to arrive at the correct diagnosis and implement appropriate therapy.     

Measurement of diet in a large national survey: comparison of computerized and manual coding of records in household measures

A diary method using household measures was employed to obtain dietary records in a large national prospective survey and a computer program, DIDO (Diet In Data Out), was designed for direct entry of the diaries. The accuracy of this computerized coding system was examined alongside that of the manual coding used for a similar diary in a previous wave, 7 years earlier, of the same survey. Accuracy was assessed by analysis of the errors in the coded and checked records by stringent re-checking of nominal 2% random subsamples of the diet diaries coded by each method. The mean time to code and check each of the 2086 7-day records in the whole survey using DIDO was 58 minutes (SD 30) compared with reported results of 1–4 hours for manual methods. The mean error rate of computerized coding and checking with DIDO was 2.3% (SD 2.1; range 0–8.9) per diary in the subsample. Correcting these mistakes made insignificant changes to the calculated mean energy and nutrient intakes for the subsample. The percentage of individuals changing to an adjacent third of nutrient distribution after correcting unambiguous errors ranged from none (for alcohol) to 11% (for carbohydrate and calcium intake). The mean error rate on a similar subsample of diaries from the earlier survey which had been coded manually was significantly higher at 5.9% (SD 4.1; range 0–17) per diary. Emphasis is laid on the importance, in coding, of dealing with ambiguities in the subjects' records, since this can affect the accuracy and the precision of the nutrient results obtained. We conclude that the DIDO coding method has the advantages of greater accuracy, speed, consistency and efficient data handling, and affords greater data accessibility for checking, compared with manual systems.     

Immunology

A selection of interesting papers that were published in the two months before our press date in major journals most likely to report significant results in immunology.     

Prodromal frontal/executive dysfunction predicts incident dementia in Parkinson's disease.

To identify the cognitive characteristics predictive of incident dementia in Parkinson's disease (PD), we examined the baseline neuropsychological profiles of 18 initially non-demented patients with PD who met diagnostic criteria for dementia (PDD) at one-year follow-up. PDD participants' baseline neuropsychological test scores were compared to the baseline performance of 18 patients with PD who did not meet criteria for dementia at one-year follow-up (PDND) and 18 normal controls (NC). The three groups were matched on baseline demographic and disease variables. Relative to the PDND group, the incident PDD participants demonstrated significantly poorer performance on digits backward (Wechsler Memory Scale-Revised), word list learning and recognition (California Verbal Learning Test), and perseverative errors on the Wisconsin Card Sorting Test. Each of these baseline neuropsychological variables exhibited adequate diagnostic classification accuracy in predicting PDD and PDND group membership at follow-up. These results suggest that subtle frontal/executive dysfunction is evident during the immediate PDD prodrome and may be of prognostic value in identifying PD patients at risk for dementia. Accordingly, neuropsychological evaluation may facilitate early identification of PDD and thereby inform appropriate dispositional planning.