Assessment of gross motor skills of at-risk infants: predictive validity of the Alberta Infant Motor Scale

The Alberta Infant Motor Scale (AIMS) is a norm-referenced measure of infant gross motor development. The objectives of this study were: (1) to establish the best cut-off scores on the AIMS for predictive purposes, and (2) to compare the predictive abilities of the AIMS with those of the Movement Assessment of Infants (MAI) and the Peabody Developmental'Gross Motor Scale (PDGMS). One hundred and sixty-four infants were assessed at 4 and 8 months adjusted ages on the three measures. A pediatrician assessed each infant's gross motor development at 18 months as normal, suspicious, or abnormal. For the AIMS, two different cut-off points were identified: the 10th centile at 4 months and the 5th centile at 8 months. The MAI provided the best specificity rates at 4 months while the AIMS was superior in specificity at 8 months. Sensitivity rates were comparable between the two tests. The PDGMS in general demonstrated poor predictive abilities.     

The effects of aging on layer 1 in area 46 of prefrontal cortex in the rhesus monkey

The effect of age on layer 1 of area 46 of prefrontal cortex was determined in the cerebral cortices of 15 rhesus monkeys, 13 of which had been behaviorally tested. Five of the monkeys were young (5-7 years of age), three were middle-aged (9-12 years) and seven were old (24-32 years). It was found that with age, layer 1 becomes significantly thinner and the glial limiting membrane becomes thicker. Counts of synapses in layer 1 of seven of these monkeys using the physical disector method on thin sections revealed that compared to young monkeys, there is a 30-60% reduction in the density of synapses per unit volume in old monkeys. This loss of synapses is accompanied by a reduction in the frequency of profiles of postsynaptic dendrites and their spines from the neuropil of layer 1, indicating that some spiny dendrites that belong to the apical dendritic tufts of pyramidal cells are degenerating and being lost with age. Correlation of these morphological changes with the behavioral data shows that there is a significant correlation between the thickness of layer 1 and memory function, as measured by the 2 min delay condition of the delayed non- matching to sample task. Also, there is significant correlation between the numerical density of synapses in layer 1 and three of the behavioral measures used, as well as the Cognitive Impairment Index. Thus, the changes that occur with age in layer 1 provide one possible basis for the age-related cognitive impairment evidenced in monkeys and humans alike.      

Prevalence Study of Domestic Violence Victims in an Emergency Department

Study objective: In 1992, a study of the prevalence and predictors of domestic violence victims among individuals who presented to a major public hospital emergency department was conducted to replicate a study conducted by the authors in the same setting 12 months previously. The second study aimed to investigate more accurately the presentation of current victims of domestic violence to the ED. Methods: In a retrospective, cross-sectional study, a screening questionnaire was administered to participants to establish the prevalence of a history and current presentation of domestic violence problems among patients who presented to the ED of a major public hospital. The study group comprised a representative sample of 670 male and 553 female adults (older than 16 years) who presented to all sections of a public hospital ED during 53 randomly selected 8-hour nursing shifts over an 8-week period in 1992. Results: The results of the second prevalence study confirmed those of the first study. Of the 1,223 respondents in the study, 15.5% disclosed a history of adult domestic violence (8.5% of men, 23.9% of women). Women were at greater risk than men for abuse as adults (raw relative risk [RR], 3.27; 95% confidence interval [CI], 2.23 to 4.79; RR adjusted for age, history of child abuse, and country of birth, 4.13; CI, 2.86 to 5.95). Women were at greater risk than men for being doubly abused (as a child and as an adult) (raw RR, 2.17; CI, 1.33 to 3.53). The second prevalence study confirmed what had been indicated in the first study: that 2.0% of women who presented to the ED (11.6% of all women with a history of adult domestic violence) were current victims of domestic violence and that these women presented mainly between the hours of 5 pm and 8 am, when no social work services were available for referral of victims. Conclusion: These Australian studies support the findings of prevalence studies of domestic violence victims in ED in the United States. The prevalence and risk factors indicate the need for training of physicians and nurses in the ED about domestic violence and for provision of appropriate backup referral services such as after-hours social work services. [Roberts GL, O'Toole BI, Raphael B, Lawrence JM, Ashby R: Prevalence study of domestic violence victims in an emergency department. Ann Emerg Med June 1996;27:747-753.]     

Changes in Esophageal Function after Vertical Banded Gastroplasty as Demonstrated by Esophageal Scintigraphy

Background: The effects of surgery for morbid obesity on the function of the upper gastrointestinal (GI) tract are of interest to bariatric surgeons. This study was undertaken to determine any changes in esophageal function, following vertical banded gastroplasty (VBG) in morbidly obese patients, as detected by esophageal scintigraphy. Methods: Ten consecutive morbidly obese patients (six female and four male) underwent preoperative esophageal scintigraphy and upper GI endoscopy. These investigations were repeated 12 months after VBG to coincide with expected appreciable weight reduction. The results were tabulated together with body mass indices, crude weights and percentage excess weight lost. Results: Before VBG one patient gave a history of mild heartburn, one had mild dyspepsia and the remaining eight patients had no GI symptoms. No patient had a hiatus hernia or endoscopic evidence of reflux esophagitis. Preoperatively all patients had abnormal scintiscans. The abnormalities were esophageal retention (all) and intraesophageal reflux (five out of 10 patients). Gastroesophageal reflux was not identified in any patient. Postoperatively scintiscans were normal or improved in six out of 10 patients and unchanged in four out of 10 patients. In three patients the scans were normal and three showed overall improvement in esophageal function, although in one of these latter patients gastroesophageal reflux was observed. Conclusions: In this series of morbidly obese patients, esophageal function as assessed by scintigraphy was abnormal. Following VBG it improved in six out of 10 patients and was unchanged in four out of 10. However, in one patient, who had shown an overall improvement in esophageal function, gastroesophageal reflux was demonstrated when it had not been seen preoperatively. This was asymptomatic. Thus, adverse changes in esophageal function after VBG were uncommon.     

Evaluation of photoscreener instruments in a childhood population: 1. Otago photoscreener and Dortmans videophotorefractor

Objective: To evaluate two photoscreeners in a childhood population.
Study design: Double-masked study.
Subjects and method: One hundred and thirteen children aged between 11 and 44 months with either normal vision or known visual disorders were photoscreened without cycloplegia by the Otago and Dortmans (prototype) photoscreeners. Each child had a full ophthalmological examination either on the day of screening or in the preceeding six months. Photoscreen images were reviewed by an independent observer for indicators of amblyopiogenic risk factors, and compared to the full ophthalmological examination to determine sensitivity and specificity for each instrument.
Results: The Otago photoscreener returned a sensitivity of 70% and specificity of 82% for the detection of amblyopiogenic risk factors. The Dortmans photoscreener returned a sensitivity of 70% and specificity of 90%. Both photoscreeners were portable and easily operated. Conclusion: Children can be screened successfully for amblyopiogenic risk factors with these photoscreening systems. Further evaluation is required to determine specificity in a normal population. This would also provide information on the potential usefulness of photoscreeners in a cost effective childhood vision screening program.     

Recovery from anaesthesia in children

There are no published comprehensive surveys of paediatric recovery room experience and the incidence of complications. A prospective survey was made of 16,700 consecutive admissions to the recovery room at the Royal Manchester Children's Hospital during the years 1985-1988. The incidence of respiratory complications was low, with laryngospasm 0.85%. The incidence of hypotension was higher than that in adult studies; over 50% of children recorded a decrease in blood pressure in the recovery room of more than 20%, compared to values before operation. The incidence of vomiting in the recovery room was also lower than in comparable adult studies. Certain aspects of recovery room practice changed during the 4 years of the study; these included routine oxygen administration, parents in the recovery room, and our approach to postoperative analgesia. The implications of these changes are discussed.     

Premedication for children with oral trimeprazine and droperidol

In 60 children aged 1-9 years, weighing under 33 kg, oral trimeprazine and oral trimeprazine plus droperidol were compared as premedicants in a controlled, double-blind clinical trial. The addition of droperidol to the trimeprazine syrup produces greater uniformity in pre-operative sedation, a low incidence of postoperative vomiting, and a reduced requirement for postoperative analgesia.     

ARE INTRAVENOUS CANNULAE STILL BEING MISUSED?

SUMMARY We have surveyed the use of intravenous cannulae (IVC) in a district general hospital. Of 354 patients interviewed on various wards, 125 (35.3%) had IVC in situ. The wrist was the commonest location for the cannulae (41.6%). An indication for cannula insertion was present in the majority (93.7%) of patients. Cannulae were left in situ even after their use had ceased, most commonly on wards for the elderly, and on these wards complications were more common. Other wards had specific IVC documentation, which resulted in fewer complications. Cannulae should be used for specific indications and should be reviewed daily for the development of complications and the need for their continued presence.