The role for 'reminders' in dental traumatology: 2. The effectiveness of a reminder stamp compared with the current clinical practice for documenting the diagnostic working length

Abstract –  The aim of this study was to establish if a predesigned prompt in the form of a reminder stamp placed in a patient's dental records is more effective for recording the essential details of a diagnostic working length compared to the current practice without any specific prompts. Following a pilot study of current practice, a stamp was introduced. Twelve months following the introduction of the stamp, 198 patient records were examined, where endodontic treatment had been carried out mainly for traumatic injuries. The following parameters were specifically investigated whether a radiograph had been taken to establish working length and was it available for examination, whether the working length was recorded in the notes and whether a reference point for the measurements was given. The working length was conventionally recorded by 127 notes, whereas 71 used the stamp. A working length radiograph was taken and a working length recorded for 95% of the cases where no stamp had been used, compared to 100% of the stamp group. Where no stamp had been used only 83% of working length radiographs were available compared to 100% of the stamp group. Interestingly, a reference point from where the working length had been measured was only recorded in 5% of the cases where the stamp had not been used compared to 94% using the predesigned stamp. This result was statistically significant using a chi-squared test ( P  < 0.001). The stamp was generally more effective than the conventional method of recording the working length for endodontics.     

Copper distribution among serum proteins in paediatric liver disorders and malignancies

Fractionation of normal serum on Sephadex G-150, followed by determination of copper, caeruloplasmin and albumin concentrations, indicated that only approximately 71% of total serum copper was associated with caeruloplasmin; less than previously reported values. Seven per cent was associated with a high molecular weight protein, designated 'transcuprein', 19% with albumin and 2% with amino acids. Compared with adult serum the concentrations of caeruloplasmin and of copper associated with caeruloplasmin were low both in serum from neonates and in serum from patients with symptomatic Wilson's disease. However, in contrast to the neonate, Wilson's disease patients exhibited a raised total serum copper and raised non-caeruloplasmin-copper. In Indian Childhood Cirrhosis serum caeruloplasmin and caeruloplasmin-copper levels were normal, whilst the non-caeruloplasmin-copper was raised. Elevated non-caeruloplasmin-copper in Wilson's disease and Indian Childhood Cirrhosis may therefore represent an overspill into the serum from a copper-laden liver. Children with malignancy showed increased serum concentrations of copper and caeruloplasmin. Both caeruloplasmin-bound and non-caeruloplasmin-bound copper concentrations were elevated. It remains to be determined whether increased 'transcuprein'- and albumin-bound copper result from a sequestering of copper released from peripherally utilized caeruloplasmin, or are associated with increased rates of caeruloplasmin synthesis.     

Childhood Asthma. Part II: Recent Developments in Psychological Treatment (Behavioural Therapy)

The behavioural management of childhood asthma has been critically reviewed with the focus on relaxation training, systematic desensitisation, assertive training, biofeedback and the use of deconditioning with exercise induced asthma. The authors conclude that there is a questionable level of relief from these behavioural intervention strategies and suggest that behavioural techniques may be better used in the management of asthma-related problems, such as the use of drugs and equipment, academic and social problems. The first part of this paper appears in the Australian Occupational Therapy Journal 1981, 28(2), 49–54.     

Prescription of non-steroidal anti-inflammatory drugs for children: A survey of Quebec physicians

An essential step in the assessment of the relative benefits and risks of a drug's use is the monitoring of its actual utilization in specific populations. However, few studies have documented the extent to which non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed for children. We surveyed a sample of 1448 Quebec physicians by mailed questionnaire to estimate approximately how often and for which indications NSAIDs, excluding ASA and acetaminophen, had been prescribed over the past year for children under 16 years of age. The sample included all pediatricians and rheumatologists in the province, and a stratified random sample of general practitioners. A response rate of 81.5 per cent was achieved. The proportion of physicians prescribing NSAIDs varied with speciality and clinical condition. The highest proportions were recorded for dysmenorrhea and juvenile rheumatoid arthritis, followed by tendinitis/bursitis, musculoskeletal trauma and recurrent headaches. Patterns of use were also explored for conditions such as osteochondroses, chronic or recurrent limb and back pain, tooth abscess, and patent ductus arteriosus. These data indicate that NSAIDs are prescribed for conditions for which they are not currently recommended in the pediatric population. Further research is thus required regarding the implications of their use for a wider range of conditions.     

Fluconazole and itraconazole susceptibilities of Candida spp. isolated from oropharyngeal specimens and blood cultures of paediatric haematology/oncology patients

This study examined the in vitro susceptibilities to fluconazole and itraconazole of isolates of Candida spp. from surveillance oropharyngeal specimens and blood cultures from paediatric patients with malignancy. The species distribution of 100 isolates from oropharyngeal specimens was C. albicans 86%, C. glabrata 7%, C. lusitaniae 4%, C. parapsilosis 2% and C. tropicalis 1%. From a total of nine isolates from blood cultures the species distribution was C. albicans 33.3%, C. parapsilosis 33.3 % and C. guilliermondii 33.3%. Only three of the oropharyngeal isolates were resistant to fluconazole (MIC > or = 64 mg l(-1)) and only two were resistant to itraconazole (MIC > or = 1 mg l(-1)). None of the blood culture isolates was resistant to either agent. At this centre, C. albicans is the predominant species from oropharyngeal specimens, but non-albicans Candida species predominate in blood cultures. Although resistance to fluconazole and itraconazole is rare at present, continued surveillance is warranted to monitor trends in species distribution and antifungal susceptibility.     

Use of the measure of process of care for families (MPOC-56) and service providers (MPOC-SP) to evaluate family-centred services in a paediatric disability setting

BACKGROUND: The value of family-centred principles in paediatric professional caregiving services is widely acknowledged. However, the degree to which such services adhere to these principles is not well documented. AIM: To examine the perceptions of both families and service providers of the extent to which family-centred services were being implemented by a paediatric disability service provider and to pinpoint areas for improvement. METHOD: A sample of 158 families receiving services from the Cerebral Palsy Association of Western Australia completed the Measure of Processes of Care for families (MPOC-56) and 43 clinicians (most of them physiotherapists, speech pathologists and occupational therapists) completed the Measure of Processes of Care for service providers (MPOC-SP). RESULTS: As in previous studies, the families rated 'respectful and supportive care' highest and 'providing general information' lowest. Clinicians rated 'showing interpersonal sensitivity' highest and 'providing general information' lowest. Analysis of individual items revealed that the following areas of family-centred services were in need of improvement: provision of general written information to families on a range of issues, continuity of care, greater involvement of the family in therapy and provision of more detailed information about therapy issues and provision of more general support to whole families. CONCLUSIONS: The MPOC tools have been found useful in enabling disability service providers to identify areas for improvement and move towards providing services that are more family centred.     

The medicines for children agenda in the UK

Children can expect the medicines prescribed for them to have at least as good an evidence base as in adult practice. Current licensing arrangements in the UK ensure a rigorous assessment of most drugs used for adults, whereas prescribing outside the licence is relatively common for children. Until the evidence base is increased, consensus guidelines or formularies, such as the new British National Formulary for Children, provide some protection for children and prescribers. For the future, there is optimism that the dearth of research on which to base children's prescribing will be addressed by new initiatives, such as the UK Medicines for Children Research Network and draft EU legislation providing incentives to industry.     

循证医学对儿科临床教学的意义

循证医学的核心是在医疗决策中将临床证据、个人经验与患者的实际情况和意愿三者相结合,它给临床教育发展提供极有价值的启示,是现代临床医学教育发展的必然趋势,对儿科临床教学有重要意义和影响。     

Absence of cross-reactive antibodies to influenza A (H1N1) 2009 before and after vaccination with 2009 Southern Hemisphere seasonal trivalent influenza vaccine in children aged 6 months-9 years: a prospective study

Please cite this paper as: McVernon et al. (2010) Absence of cross‐reactive antibodies to influenza A (H1N1) 2009 before and after vaccination with 2009 Southern Hemisphere seasonal trivalent influenza vaccine in children aged 6 months–9 years: a prospective study. Influenza and Other Respiratory Viruses 5(1), 7–11. Background Early outbreaks of the pandemic influenza A (H1N1) 2009 virus predominantly involved young children, who fuelled transmission through spread in homes and schools. Seroprevalence studies conducted on stored serum collections indicated low levels of antibody to the novel strain in this age group, leading many to recommend priority immunisation of paediatric populations. Objectives In a prospective study, we sought evidence of cross‐reactive antibodies to the pandemic virus in children who were naïve to seasonal influenza vaccines, at baseline and following two doses of the 2009 Southern Hemisphere trivalent influenza vaccine (TIV). Patients/Methods Twenty children were recruited, with a median age of 4 years (interquartile range 3–5 years); all received two age appropriate doses of TIV. Paired sera were collected pre‐ and post‐vaccination for the assessment of vaccine immunogenicity, using haemagglutination inhibition and microneutralisation assays against vaccine‐related viruses and influenza A (H1N1) 2009. Results Robust responses to H3N2 were observed regardless of age or pre‐vaccination titre, with 100% seroconversion. Fewer seroconverted to the seasonal H1N1 component. Only two children were weakly seropositive (HI titre 40) to the pandemic H1N1 strain at study entry, and none showed evidence of seroconversion by HI assay following TIV administration. Conclusions Administration of 2009 Southern Hemisphere TIV did little to elicit cross‐reactive antibodies to the pandemic H1N1 virus in children, in keeping with assay results on stored sera from studies of previous seasonal vaccines. Our findings support the recommendations for influenza A (H1N1) 2009 vaccination of children in preparation for the 2010 winter season.