Nasal mask positive pressure ventilation in paediatric patients with type II respiratory failure

We report our experience with nasal mask ventilation in children and adolescents with type II respiratory failure admitted to the paediatric intensive care unit (PICU) over an 18-month period. Seven patients were treated with nasal mask ventilation during part of their PICU stay. All showed significant improvement in arterial pH, Pa_CO2, and Pa_O2/FiO₂ from presentation to discharge, although at discharge Pa_CO2 and Pa_O2/FiO₂ fell outside of the normal range. Complications occurred in four patients. When compared to 11 patients with type II respiratory failure not treated with nasal mask ventilation, the nasal mask ventilation group had a similar PICU length of stay and incidence of complications. We conclude that nasal mask ventilation may be useful in maintaining near normal alveolar ventilation in selected children with type II respiratory failure and that a prospective study of this technique is indicated.     

The Involvement of General Practitioners in the Care of Patients with Human Immunodeficiency Virus Infection: Current practice and Future Implications

The objective was to determine the current use of their generalpractitioner (GP) by patients with human immunodeficiency virus(HIV) infection and whether such patients would be interestedin having ‘shared care’ between a specialist HIVclinic and their GP. A questionnaire was administered to 203HIV-positive men attending the HIV outpatient clinic of a centralLondon teaching hospital. The main outcome measures were patientcharacteristics, numbers of patients registered with a GP, numbersof patients with a GP aware of their diagnosis, contacts withthe GP in the last year and level of interest and shared care.Eighty-five per cent of patients were registered with a GP ofwhom 67% knew of the diagnosis. Those diagnosed for more than2 years were significantly more likely to have an informed GP.A total of 73% of those registered had visited their GP in theprevious year although only 27% had visited for an HIV-relatedproblem. Only 19% had a GP actively involved in their HIV care.In all 51% of the patients indicated an interest in having sharedcare between the clinic and their GP. A high proportion of HIVpatients are registered with and attend a GP although they rarelyconsult for HIV-related problems. A significant proportion ofpatients expressed interest in having shared care suggestingthat there is the potential for increased GP involvement inthe care of patients with HIV infection.     

Pelvic Dosimetry Comparison of Two Manual Afterloading Systems

Two different, manually afterloaded, gynaecological applicators for intracavitary therapy are compared in a study of the pelvic dose distribution in 114 patients. The applicators have a similar shape but the source geometry in the vaginal ovoids is significantly different. The change in the geometry accounts for a 17% reduction in the dose to the recto-vaginal septum. One of the applicators is constructed from stainless-steel, the other from polyvinyl chloride. On the average, the mid-line symmetry appeared better with the plastic applicators, but the variation between patients was greater.     

Assessing community support for harm reduction services: Comparing two measures

Introduction and Aims . Previous attitudinal research has found that the way survey questions are asked can influence respondents’ answers regarding their support for sensitive issues. This study aimed to explore whether findings regarding community support for harm reduction services could be manipulated through priming of language and information contained within survey items. Design and Method. A convenience sample of 260 university students from Sydney Australia were surveyed during late 2008 about their attitudes towards harm reduction services. Participants were randomly allocated to two groups: one received a questionnaire that provided factual information about harm reduction services (Survey 1), while a second group received a questionnaire that contained no information about harm reduction services and framed heroin use as problematic (Survey 2). Results. Participants who completed Survey 1 expressed significantly higher levels of support for harm reduction services overall than participants who completed Survey 2 (t₍₂₄₉₎ = ?5.8, P < 0.001). Regression analysis indicated that overall support for harm reduction services was associated with the survey version that participants received and participants’ political affiliations. These two factors accounted for 17.5% of the variance in the data. Discussion and Conclusions. Research findings regarding community support for harm reduction services are influenced by questionnaire design. This has implications for the development and expansion of harm reduction services and policy.[Hopwood M, Brener L, Frankland A, Treloar C. Assessing community support for harm reduction services: Comparing two measures. Drug Alcohol Rev 2010]     

The place of suxamethonium in pediatric anesthesia

Suxamethonium is a drug that promotes very strong views both for and against its use in the context of pediatric anesthesia. As such, the continuing debate is an excellent topic for a 'Pro–Con' debate. Despite ongoing efforts by drug companies, the popular view still remains that there is no single neuromuscular blocking drug that can match suxamethonium in terms of speed of onset of neuromuscular block and return of neuromuscular control. However, with this drug the balance of benefit vs risk and side effects are pivotal. Suxamethonium has significant adverse effects, some of which can be life threatening. This is particularly relevant for pediatric anesthesia because the spectrum of childhood diseases may expose susceptible individuals to an increased likelihood of adverse events compared with adults. Additionally, the concerns related to airway control in the infant may encourage the occasional pediatric anesthetist to use the drug in preference to slower onset/offset drugs. In the current environment of drug research, surveillance and licensing, it is debatable whether this drug would achieve the central place it still has in pediatric anesthesia. The arguments for and against its use are set out below by our two international experts, Marcin Rawicz from Poland and Barbara Brandom from USA. This will allow the reader an objective evaluation with which to make an informed choice about the use of suxamethonium in their practice.     

Emergence of fluoroquinolone‐resistant clonal group A: clonal analysis of Norwegian and Russian E. coli isolates

Strand L, Jenkins A, Grude N, Allum A‐G, Mykland H‐C, Nowrouzian FL, Kristiansen B‐E. Emergence of fluoroquinolone‐resistant clonal group A: clonal analysis of Norwegian and Russian E. coli isolates. APMIS 2010; 118: 571–77. We describe a study of urinary tract and intestinal isolates of Escherichia coli from Norway and Russia using automated ribotyping, single nucleotide polymorphism analysis for clonal group A (CgA) supplemented with phylogrouping, virulence gene profiling and resistance profiling. CgA comprised 19% of the Norwegian UTI isolates from 2001. Two highly multiresistant fluoroquinolone‐resistant CgA isolates were found. Ribotypes clustered into four major and six minor groups (ribogroups). Fluoroquinolone‐resistant isolates and phylogroups A and B1 were associated with ribogroup ^RA. Ribogroup ^RB predominated among Russian UTI isolates and was predominantly phylogroup A and depleted in P‐fimbriae. Ribogroup ^RC predominated among Norwegian UTI isolates and was rich in virulence factors (S‐fimbriae, haemagglutinin and haemolysin) and predominantly phylogroup B2 and D. Ribogroup ^RG was associated with CgA and predominantly phylogroup D. Ribogroups ^RD, ^RE and ^RF had too few members for statistical analysis. The correlation between ribotype and phylogenetic group was not as strong as reported in other studies.