Children's over‐the‐counter medicines pharmacoepidemiological (COPE) study

Objective To quantify the extent and types of minor ailments in children that were presented at community pharmacies and the types of over‐the‐counter (OTC) medicines purchased in response to these ailments. Method Data on all requests and sales of OTC medicines for children (aged 16 years and under) and consultations for minor ailments in children were recorded in eight community pharmacies for one week every month over a 12‐month period. Participants were members of the public who consulted the pharmacists or other pharmacy staff in the community pharmacies. Key findings A total of 976 consultations was recorded with 61.5% requesting an OTC medicine by name and 38.5% by symptom presentation. An average of 10.2 consultations was made per pharmacy per week. Requests for treatment were usually made within five days of symptom occurrence (86%). Most of the consultations were made by mothers (75%), although 17% were by fathers. The most commonly purchased OTC medicine was paracetamol. There were five requests for aspirin and one was for a 2‐year old child. A total of 62 cases (6%) was referred back to the child's primary care physician (general practitioner). Conclusions Symptoms related to cough and cold were the most common problems in children presenting to community pharmacies for treatment. Paracetamol was the most widely used OTC medicine in children. Pharmacy staff do question the request for OTC medicines such as aspirin, to ensure its safe use. Community pharmacies play an important role as the first port of call for advice on minor ailments in children and have an opportunity to provide health promotion to carers of children.     

Cisapride in the treatment of post-operative ileus

The effect of cisapride on duration of post-operative ileus after surgery was investigated in a randomized, double-blind, placebo-controlled study. Patients undergoing elective upper gastrointestinal (n = 47) or colonic (n = 22) surgery were pre-operatively randomly allocated to treatment with either cisapride 30 mg t.d.s., by rectal administration, or placebo. Treatment started exactly 48 h after surgery if the patient at this time had not passed stool. Time to passage of first stool after surgery was estimated. Mean time to passage of stool was 85 (32) h (s.d.) for cisapride-treated and 91 (43) h for placebo-treated patients. No difference between the treatment groups was noted. Treatment with cisapride did not shorten the duration of postoperative ileus after either upper gastrointestinal or colonic surgery.     

Rhinoplasty analysis

Accurate analysis is the foundation for successful rhinoplasty. A general outline for systematic analysis is presented. The importance of accurate recordkeeping and self-analysis is stressed. Examples illustrate the high points of the article.     

Effect of helium and heliox on glutamate decarboxylase activity

The activity of glutamate decarboxylase (GAD) in pure helium at 6.8 MPa was significantly enhanced when compared to GAD activity in air at 0.1 MPa (906 vs. 602 nmol.h-1.mg-1 protein, respectively). No significant difference was found between GAD activities in heliox at 6.8 MPa (0.87% O2 at 6.8 MPa) and in air at 0.1 MPa. On the other hand, the activities in heliox at 0.1 MPa (0.87% O2 at 0.1 MPa) and air at 0.1 MPa were significantly different (655 and 446 nmol.h-1.mg-1 protein, respectively). These data indicate that pressures up to 6.8 MPa do not affect the GAD-catalyzed synthesis of gamma-aminobutyric acid, but that the enzyme, as previously reported, is sensitive to low levels of oxygen.     

A two-period crossover design for the comparison of two active treatments and placebo

This paper discusses a two-period crossover design for the comparison of two active treatments (A and B) and placebo (P) for relief of recurrent symptoms of a chronic health disorder. It is based on blocks of ten patients for which the treatment sequences A:B and B:A are each assigned to three patients and the sequences A:P, P:A, B:P, and P:B are each assigned to one patient; thus, treatment periods have a 2:2:1 allocation for A, B, and P. The principal model for analysis of this design involves additive subject effects, period effects, and treatment effects. Analysis of within-patient differences provides an estimate of the comparison between active treatments with variance (2vw/7r) and an estimate of the comparison between an active treatment and placebo with variance (4vw/7r); here vw is the within-patient variance and r is the number of blocks of ten patients. Analyses which address carryover effects and treatment effects adjusted for carryover effects are also described. An example using simulated data on relief of recurrent gastrointestinal pain illustrates the methodology.     

Severely displaced supracondylar fractures of the humerus in children: a simple method of treatment

A simple form of overhead olecranon traction has been used to treat 27 children with severely displaced supracondylar fractures, in whom a satisfactory reduction could not be obtained by closed means. All the children were assessed clinically and radiologically at an average of 54 weeks after injury. Twenty-two children (81%) had an excellent result, with preservation of the normal carrying angle and no significant loss of movement; the other five children had a good result. Only two children (7%) were left with a minimal cubitus varus deformity. The method is technically easy to perform and has not been associated with significant complications.     

Gastric ulcer disease in infants: US findings

Among 600 infants examined with ultrasound for vomiting, seven (mean age, 3 months) had distinctive features that can be considered diagnostic of gastric ulcer. The findings are thickening of the mucosa (greater than 4 mm) in the antropyloric region, elongation of the antropyloric canal, persistent spasm, and delayed gastric emptying. Two of the infants had slight thickening of the pyloric muscle. Gastrointestinal series or endoscopy demonstrated thickened gastric mucosa and a deformed gastric antrum in all infants, as well as actual ulceration in five.     

Scaphoid fractures in children

Fracture of the carpal scaphoid before skeletal maturity represents 0.34% of all fractures in children and 0.45% of children's upper limb fractures. Seventy-seven children, with a mean age of 11 years (range 8-14 years), suffered a scaphoid fracture in Nottingham, England, between 1977 and 1984 inclusive. Sixty-four of them have been personally reviewed. The mechanism of injury was usually a fall onto the outstretched hand and in the majority was an undisplaced fracture of the distal third of the bone. Immobilization in a scaphoid type of forearm-hand cast led to union in virtually all instances. Nonunion is very rare in treated cases of fresh fracture of the carpal scaphoid.