Maltreatment and Developmental Disabilities in Children

The purpose of this review is to explore the interactive influences of maltreatment and disabilities on children's development, and to provide practical suggestions about what may be done to optimize developmental outcomes. The review briefly describes maltreatment in the general population, noting incidence, proportions of children experiencing different types of maltreatment, and special risk for very young children. The disproportionate vulnerability of children with developmental disabilities is discussed, with emphasis on risk factors for maltreatment. The high incidence of developmental disabilities in maltreated children and reasons for it are described. Studies documenting the developmental consequences of abuse and neglect are reviewed. Specific recommendations, based on review of maltreatment and disability literature, include recognizing subtle forms of maltreatment; routinely screening for developmental problems; referring children for comprehensive multidisciplinary evaluation; identifying caregiver competency; gaining familiarity with intervention resources; and monitoring children's progress with directive guidance.     

Gefitinib therapy for advanced non-small-cell lung cancer

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical efficacy, and toxicity of gefitinib in non-small-cell lung cancer (NSCLC). DATA SOURCES: Primary literature search through MEDLINE and CANCERLIT, and abstract presentations (1966-May 2003). STUDY SELECTION AND DATA EXTRACTION: All published trials and abstracts citing gefitinib were evaluated, and all information deemed relevant was included in this article. DATA SYNTHESIS: NSCLC is known to overexpress epidermal growth factor receptor (EGFR). Gefitinib is a selective EGFR tyrosine kinase inhibitor. Based on the Phase I/II trial results, the optimal dose is 250 mg/d orally. It is well tolerated, with minimal and reversible toxicity. Skin rash and diarrhea are the most common adverse effects. Recent trials have shown that gefitinib provided a 10% tumor response rate and improved disease-related symptoms in patients with refractory, advanced NSCLC. CONCLUSIONS: Gefitinib, with a unique mechanism of action and favorable toxicity profile, has demonstrated clinical activity in NSCLC patients with chemotherapy-refractory disease. It provides a valuable addition to the treatment options as monotherapy in patients with advanced NSCLC after failure of both platinum-based and docetaxel chemotherapies. Further research is required to evaluate the use of gefitinib in different clinical settings.     

DIFFERENTIAL IMMUNOFLUORESCENCE OF FERTILIZED MOUSE EGGS WITH H-2 AND NON H-2 ANTIBODY

Mouse embryos at the two-cell and blastocyst stages, as well as unfertilized eggs, have been studied by indirect immunofluorescence for the expression of H-2 and non-H-2 histocompatibility antigens on surface membranes. Serologically-specific reactivity to non-H-2 antibody (H-3 and H-6) was observed as diffuse, patchy staining over the entire surface of the blastomeres at the two-cell stage. In contrast, no reactivity of two-cell or unfertilized egg embryos of four inbred strains was observed when antisera containing only multispecific H-2 cytolytic antibody were used. Antisera containing H-2 along with non-H-2 antibody of unknown specificity showed varying degrees of reactivity, which could be shown by absorption studies to be due to the non-H-2 content of the serum. The results suggest that the initial expression of histocompatibility genes varies and support the hypothesis that the appearance of these cell components may relate to specific stages of differentiation.     

Reducing the risk of unplanned perioperative hypothermia

Maintaining normothermia is important for patient safety, positive surgical outcomes, and increased patient satisfaction. Causes of unplanned hypothermia in the OR include cold room temperatures, the effects of anesthesia, cold IV and irrigation fluids, skin and wound exposure, and patient risk factors. Nurses at Riddle Memorial Hospital in Media, Pennsylvania, performed a quality improvement project to evaluate the effectiveness of using warm blankets, warm irrigation fluids, or forced-air warming on perioperative patients to maintain their core temperature during the perioperative experience. Results of the project showed that 75% of patients who received forced-air warming perioperatively had temperatures that reached or were maintained at 36° C (96.8° F) or higher within 15 minutes after leaving the OR.     

A model for examining predictors of outcomes of telephone nursing advice

Although telephone advice nursing is the fastest-growing nursing specialty, useful information to guide managers' decisions about how best to structure and support advice services to achieve desired outcomes is unavailable. We identified issues and variables relevant to outcomes of telephone advice from the perspectives of callers, nurses, and the system. Subsequently, we derived a model for studying factors affecting nursing advice outcomes that will help managers identify modifiable factors to improve outcomes of care.     

Consent in practice: a case review

Children under 16 years of age can give their own consent to treatment if deemed 'Fraser' competent. Parents of a 14-year-old boy had refused consent for him to receive BCG immunisation but he wished to be immunised. Although he met the criteria for 'Fraser' competence, the nurse did not immunise him. This case is discussed in the context of legal precedent and ethical guidance on consent by children and young people in healthcare situations. Nurses need a sound knowledge of the legal frameworks applicable to their area of work and must understand the developmental tasks of adolescence to enable them to assess if their clients are Fraser competent.     

Defining normal neonatal abdominal wall musculature with ultrasonography

Introduction

The development of new surgical approaches for the management of congenital abdominal wall defects may be facilitated by using an animal model. However, because the anatomy of the neonatal abdominal wall has not been described, a suitable model is yet to be identified. We aimed to evaluate and define the neonatal abdominal wall musculature using ultrasound, to be used as a reference to identify an appropriate animal model for the neonatal abdominal wall in the future.

Variation in training and use of the focused assessment with sonography in trauma (FAST)

Background

Training in ultrasound is variable among residents and practicing traumatologists. Focused Assessment with Sonography in Trauma (FAST) may be underused in non-urbanized areas, possibly due to lack of training.