Tamil Nadu nutritional survey comparing children aged 0–3 years with the NCHS/CDC reference population

A cross-sectional nutritional survey of children belonging to Tamil Nadu State of India, aged 0–3 years was conducted on a representative sample of 2039 children. The collected data was analysed using the recommended indices of height-for-age and weight-for-height based on standard deviation (SD scores) and cross-classified using the SD scores. The nutritional status of these children was compared with the NCHS standard. Prevalence of stunting (27.6%), wasting (9.9%) and simultaneous wasting and stunting (10.7%) was high among the children studied:     

Kann man die Progression der chronischen Niereninsuffizienz verzögern?

Chronic renal failure does not only involve the risk for the patient of becoming dependent on hemodialysis, but also increases the risk of premature death due to cardiovascular events. In most renal diseases, progressive chronic loss of renal function develops once a critical extent of renal damage has occurred, independent of the course of the underlying renal disease. The key factors driving the progressive loss of renal function are, apart from the underlying nephrological disease, arterial hypertension and diabetes mellitus. The loss of renal function is also promoted by other factors, such as increased intake of dietary proteins, chronic inflammation, smoking, and anemia. With the help of a multimodal therapeutic concept, the progression of chronic renal failure can be delayed effectively. This approach comprises strict blood pressure control with a target blood pressure of 130/80 mmHg in patients with micro-albuminuria and of 120/75 mmHg in patients with proteinuria of >1 g/d. The preferred drugs for the treatment of hypertension are ACE inhibitors and angiotensin receptor blockers. In diabetics with renal insufficiency, target Hb_A1c levels below 7% are to be aimed for. Dietary protein intake should be restricted to 0.8–1 g/kg body weight/d. Additional therapeutic targets include nicotine abstinence, early treatment of renal anemia, weight reduction, and, if indicated, lipid-lowering therapy.     

Levobupivacain in der Geburtshilfe

Levobupivacaine, the S-enantiomer of racemic bupivacaine, will be available in Germany in mid-2004. Pharmacological studies demonstrated that, compared to bupivacaine, levobupivacaine has equal local anaesthetic potency with reduced potential for cardiac and CNS toxicity. This review introduces the new long-acting amide local anaesthetic levobupivacaine to the reader and evaluates its place in obstetric analgesia and anaesthesia compared to bupivacaine and ropivacaine.     

Klinik und Therapie rheumatischer Erkrankungen und Vaskulitiden im Kindesalter

Rheumatic diseases are the second most common autoimmune disease in childhood after diabetes mellitus. Because cutaneous findings are so common, a dermatologist is often the first physician these children and their parents see. The most common rheumatic disease is juvenile idiopathic arthritis. Except for the systemic form and psoriatic arthritis JIA usually does not show cutaneous symptoms. However, there are many rheumatic diseases that start with skin manifestations such as Henoch-Schönlein purpura, systemic lupus erythematosus and Kawasaki syndrome. Knowledge of these diseases and their symptoms is therefore of importance for the dermatologist.     

überrollverletzungen

Background

The rate of long-term disability following run-over injuries has not been investigated so far. Therefore the aim of this study was to evaluate the long-term outcome following run-over injuries.

Material and methods

A total of 71 patients were enrolled in the study. Data were collected regarding the injury pattern, surgical treatment and clinical outcome. The quality of life was measured with the POLO chart

Results

The median ISS was 15. Eight patients died. The injuries were predominantly located at the lower extremities (39%) with severe soft tissue injuries in 68% of the cases. Patients were operated on a median of four times. In the follow-up evaluation with the SF36 7?years post-trauma, 57% of the patients had reduced physical functioning and 46% reduced psychological health.

Conclusions

The long-term disability following run-over injuries is severe and requires a multidisciplinary approach. Treatment should therefore be conducted in appropriate trauma centres.     

Expression of blood group antigens in urinary tract tumours: prospective fluorescence study using cryostat sections of fresh frozen tissues.

Cryostat sections of fresh frozen tissues were used in a prospective study of blood group H and A antigen fluorescence in 73 transitional cell carcinomas of the bladder. The aim was to evaluate antigen expression without subjecting the tumour tissues to organic solvents that extract blood group active glycolipids. Deletion of the genetically predicted antigen was twice as common in tumours of pT1 or greater stage than those of pTa stage and also twice as common in poorly differentiated than in moderately well differentiated tumours. The considerable heterogeneity and overlap, however, in patterns of reactivity in tumours of various histopathological stages and grades and the effect of secretor status on antigenicity meant that there was no obvious antigenic feature that correlated precisely with invasive stage or differentiation grade. It remains to be determined whether the antigen positive and antigen negative tumours represent different disease entities with differing clinical courses. Our results indicate, however, that studies of the blood group antigens in urinary tract tumours are more likely to be of value in research into biochemical disorders in the neoplastic process than in routine clinical assessment as a guide to treatment.     

Relationship Between Clinical Quality and Patient Experience: Analysis of Data From the English Quality and Outcomes Framework and the National GP Patient Survey

PURPOSE

Clinical quality and patient experience are both widely used to evaluate the quality of health care, but the relationship between these 2 domains remains uncertain. The aim of this study was to examine this relationship using data from 2 established measures of quality in primary care in England.

METHODS

Practice-level analyses (N = 7,759 practices in England) were conducted on measures of patient experience from the national General Practice Patient Survey (GPPS), and measures of clinical quality from the national pay-for-performance scheme (Quality and Outcomes Framework). Spearman’s rank correlation and multiple linear regression were used on practice-level estimates.

RESULTS

Although all the correlations between clinical quality summary scores and patient survey scores are positive, and most are statistically significant, the strength of the associations was weak, with the highest correlation coefficient reaching 0.18, and more than one-half were 0.11 or less. Correlations with clinical quality were highest for patient-reported access scores (telephone access 0.16, availability of urgent appointments 0.15, ability to book ahead 0.18, ability to see preferred doctor 0.17) and overall satisfaction (0.15).

CONCLUSION

Although there are associations between clinical quality and measures of patient experience, the 2 domains of care quality remain predominantly distinct. The strongest correlations are observed between practice clinical quality and practice access, with very low correlations between clinical quality and interpersonal aspects of care. The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.