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8.  Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines 
Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. A standardized approach for the detection, evaluation, and management of anaemia in this setting has been identified as an unmet medical need. A multidisciplinary panel of physicians was convened by the Network for Advancement of Transfusion Alternatives (NATA) with the aim of developing practice guidelines for the detection, evaluation, and management of preoperative anaemia in elective orthopaedic surgery. A systematic literature review and critical evaluation of the evidence was performed, and recommendations were formulated according to the method proposed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. We recommend that elective orthopaedic surgical patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible (Grade 1C). We suggest that the patient's target Hb before elective surgery be within the normal range, according to the World Health Organization criteria (Grade 2C). We recommend further laboratory testing to evaluate anaemia for nutritional deficiencies, chronic renal insufficiency, and/or chronic inflammatory disease (Grade 1C). We recommend that nutritional deficiencies be treated (Grade 1C). We suggest that erythropoiesis-stimulating agents be used for anaemic patients in whom nutritional deficiencies have been ruled out, corrected, or both (Grade 2A). Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value. Implementation of anaemia management in the elective orthopaedic surgery setting will improve patient outcomes.
PMCID: PMC3000629  PMID: 21148637
anaemia; blood transfusion; orthopaedic surgery; preoperative assessment; preoperative preparation
9.  Predictors of pulmonary exacerbations in patients with cystic fibrosis infected with multi‐resistant bacteria 
Thorax  2006;61(11):969-974.
This study examined characteristics of adult and adolescent patients with cystic fibrosis (CF) to determine factors associated with an increased risk of pulmonary exacerbations.
249 patients with CF infected with multidrug resistant bacteria were recruited and prospectively followed for up to 4.5 years until they experienced a pulmonary exacerbation severe enough to require intravenous antibiotics. Multivariable regression analyses were used to compare the characteristics of patients who experienced an exacerbation with those who did not.
124 of the 249 patients (50%) developed a pulmonary exacerbation during the first year and 154 (62%) experienced an exacerbation during the 4.5 year study period. Factors predictive of exacerbations in a multivariable survival model were younger age (OR 0.98, 95% CI 0.96 to 0.99), female sex (OR 1.45, 95% CI 1.07 to 1.95), lower forced expiratory volume in 1 second (FEV1) (OR 0.98, 95% CI 0.97 to 0.99), and a previous history of multiple pulmonary exacerbations (OR 3.16, 95% CI 1.93 to 5.17). Chronic use of inhaled corticosteroids was associated with an increased risk of exacerbation (OR 1.92, 95% CI 1.00 to 3.71) during the first study year.
Patients who experience pulmonary exacerbations are more likely to be younger, female, using inhaled steroids, have a lower FEV1, and a history of multiple previous exacerbations. It is hoped that knowledge of these risk factors will allow better identification and closer monitoring of patients who are at high risk of exacerbations.
PMCID: PMC2121166  PMID: 16844728
cystic fibrosis; pulmonary exacerbations; bacterial resistance; lung infections; risk factors
13.  Long term psychosocial outcomes after mild head injury in early childhood 
Objectives: The question of whether any adverse cognitive or psychosocial outcomes occur after mild head injury in early childhood has evoked considerable controversy. This study examined mild head injury before age 10 and potential differences in late childhood/early adolescence as a function of severity of mild injury and age at injury.
Methods: A fully prospective longitudinal design tracked a large birth cohort of children. Confirmed cases of mild head injury before age 10 were divided on the basis of outpatient medical attention (n=64–84) or inpatient observation (hospital overnight; n=26–28 ) and compared with the non-injured remainder of the cohort (reference group; n=613–807). A range of pre-injury and post-injury child and family characteristics were used to control for any potential confounds. Outcome after injury before and after age 5 was also assessed.
Results: After accounting for several demographic, family, and pre-injury characteristics, the inpatient but not the outpatient group displayed increased hyperactivity/inattention and conduct disorder between ages 10 to 13, as rated by both mothers and teachers. Psychosocial deficits were more prevalent in the inpatient subgroup injured before age 5. No clear effects were evident for various cognitive/academic measures, irrespective of severity of mild injury or age at injury.
Conclusions: Most cases of mild head injury in young children do not produce any adverse effects, but long term problems in psychosocial function are possible in more severe cases, perhaps especially when this event occurs during the preschool years. The view that all mild head injuries in children are benign events requires revision and more objective measures are required to identify cases at risk.
PMCID: PMC1738032  PMID: 12185159
14.  Autologous versus allogeneic transfusion: patients' perceptions and experiences 
BACKGROUND: Preoperative autologous donation is one way to decrease a patient's exposure to allogeneic blood transfusion. This study was designed to determine patients' perceptions about the autologous blood donation process and their experiences with transfusion. METHODS: To assess patient perception, a questionnaire was administered a few days before surgery to patients undergoing elective cardiac and orthopedic surgery in a Canadian teaching hospital. All patients attending the preoperative autologous donation clinic during a 10-month period were eligible. A convenience sample of patients undergoing the same types of surgery who had not predonated blood were selected from preadmission clinics. Patient charts were reviewed retrospectively to assess actual transfusion practice in all cases. RESULTS: A total of 80 patients underwent cardiac surgery (40 autologous donors, 40 nondonors) and 73 underwent orthopedic surgery (38 autologous donors, 35 nondonors). Of the autologous donors, 75 (96%) attended all scheduled donation appointments, 73 (93%) said that they were "very likely" or "likely" to predonate again, and 75 (96%) said that they would recommend autologous donation to others. There was little difference in preoperative symptoms between the autologous donors and the nondonors, although the former were more likely than the latter to report that their overall health had remained the same during the month before surgery (30 [75%] v. 21 [52%] for the cardiac surgery patients and 30 [79%] v. 18 [51%] for the orthopedic surgery patients). When the autologous donors were asked what they felt their chances would have been of receiving at least one allogeneic blood transfusion had they not predonated, the median response was 80%. When they were asked what their chances were after predonating their own blood, the median response was 0%. The autologous donors were significantly less likely to receive allogeneic blood transfusions (6 [15%] for cardiac surgery and 3 [8%] for orthopedic surgery) than were the nondonors (14 [35%] for cardiac surgery and 16 [46%] for orthopaedic surgery). They were, however, more likely to receive any transfusion (autologous or allogeneic) than were the nondonors (25 [63%] v. 14 [35%] for cardiac surgery and 31 [81%] v. 16 [46%] for orthopedic surgery). INTERPRETATION: Patients who underwent preoperative autologous blood donation were positive about the experience and did not report more symptoms than patients who did not donate blood preoperatively. Autologous donors overestimated their chances of receiving allogeneic blood transfusions had they not predonated and underestimated their chances after they had predonated. They were less likely to receive allogeneic transfusions, but more likely to receive any type of transfusion, than were patients who did not predonate.
PMCID: PMC1230233  PMID: 10207337
17.  Inhalation powder and oral salbutamol combination. 
Archives of Disease in Childhood  1986;61(11):1111-1113.
Fifty six children with chronic asthma were treated with the inhaled dry powder of salbutamol or the combination of inhaled and oral salbutamol. Over three months the combination provided a significantly greater sustained symptomatic relief from asthma. Side effects were minimal and did not result in any withdrawals from the study.
PMCID: PMC1778109  PMID: 3539032
18.  Social and family factors in childhood hospital admission. 
The relation between social, economic, and family life event measures and rates of hospital admission during the period from birth to 5 years was studied in a birth cohort of New Zealand children. Both family social background and family life events made a significant contribution to the variability in the risk of hospital admission. However, economic factors made no significant contribution to rates of admission when the correlated effects of family social background and life events were taken into account. In addition, the effects of family life events on risks of admission appeared to be far more marked than the effects of family social background. Possible explanations of the consistent association between life events and rates of morbidity during early childhood are discussed.
PMCID: PMC1052488  PMID: 3711769
19.  Theory and practice of decision making in coronary care in general practice. 
Decisions about coronary care made by 39 randomly selected general practitioners in New Zealand over one year were investigated. Demographic variables and variables relating to the patient's condition, history, and social circumstances were assessed for 113 patients, and practitioners' belief about the relevance of each variable to the decision was elicited. A comparison was made between the objective criteria found to be related to the decision, the criteria believed by the practitioners to be relevant to the decision, and a theoretical model of what should govern the decision to admit. The theoretical model was found to be built into the beliefs of the practitioners, but the objective model was far simpler. Further research is needed to determine whether the use of the more complex, theoretical models will confer any benefit, in terms of patient wellbeing, over the pragmatic model in use at present.
PMCID: PMC1417855  PMID: 3931836
20.  Early hospital admissions and subsequent behaviour problems in 6 year olds. 
Archives of Disease in Childhood  1984;59(9):815-819.
The relation between admission to hospital during the preschool years and teacher and maternal ratings of child behaviour problems at age 6 years was studied in a birth cohort of New Zealand children. There was a slight but consistent trend for reported behaviour problems to increase with increasing length of hospital stay, however, control for family and social factors suggested that this correlation was spurious. Children admitted to hospital tended to come from socially disadvantaged backgrounds and from families reporting large numbers of life events, and independently of this social background and life events were related to childhood behaviour problems. When the effects of family social background and life events were controlled for, there was no significant association between duration of hospital stay and reports of child behaviour problems. It is concluded that there is little evidence to suggest that in a modern paediatric setting, admission to hospital has any significant effect on the child's subsequent behavioural pattern.
PMCID: PMC1628705  PMID: 6486858
21.  Spread of rotavirus within families: a community based study. 
The spread of rotavirus infection was studied over four weeks in a sample of 28 families exposed to a child with rotavirus infection. The results showed a high incidence of intrafamilial infection, with 46% of members of these families developing rotavirus infections compared with none in another series of 18 families. Children in the families with an index case were more frequently affected than adults: 75% of the children developed rotavirus infection but only 33% of the adults. Children tended to suffer the infection in a more severe form. Intrafamily contact is clearly important in transmitting rotavirus infection, and preventive measures should aim at reducing the likelihood of such cross infection.
PMCID: PMC1549010  PMID: 6309316
22.  Acute asthma and antidiuretic hormone secretion. 
Thorax  1983;38(8):589-591.
Plasma antidiuretic hormone concentrations were measured in a group of children with acute asthma and in a control group. Very high levels of antidiuretic hormone were found in the asthmatic group. There were no changes in other biochemical indices. If overproduction of antidiuretic hormone is sustained then fluid administration to children with severe acute asthma is potentially dangerous.
PMCID: PMC459616  PMID: 6612649
23.  Combination of salbutamol inhalational powder and tablets in asthma. 
Archives of Disease in Childhood  1983;58(4):283-285.
A double-blind cross-over trial was conducted to assess the effects of salbutamol administered by inhalation of dry powder, by tablet, and combined tablet and inhalational powder in a sample of 18 severely asthmatic children. The combined treatment had a rapid onset of effect and sustained action. The onset of action of the tablet treatment was less rapid but sustained, whereas the inhalational powder treatment had rapid onset but fairly short action. The response characteristics of the combined treatment were shown to be an additive function of its tablet and inhaled components. Children on the combined or tablet treatment showed a significant, but slight, increase in pulse rate. Few other side effects were observed.
PMCID: PMC1627941  PMID: 6342544
24.  Asthma and infant diet. 
The relationship of milk diet and solid feeding practices during the first 4 months of life to rates of early childhood asthma was studied prospectively in a birth cohort of 1110 children. The results of the analysis showed no significant association between rates of asthma and breast feeding or solid feeding practices. This was true for children both of asthmatic and non-asthmatic parentage. It is concluded that there is no evidence to indicate that early breast feeding had any detectable effect on the risk of subsequent asthma in this birth cohort. However, the possibility still remains that breast feeding may have a prophylactic effect for children from highly atopic families.
PMCID: PMC1628157  PMID: 6830275
25.  Effects of oral theophylline and oral salbutamol in the treatment of asthma. 
Archives of Disease in Childhood  1982;57(9):674-676.
A double-blind randomised controlled trial was conducted to study the effects of oral theophylline alone compared with oral theophylline and salbutamol in a sample of asthmatic children. Each treatment was administered at maximum recommended dosage. Children treated with the theophylline and salbutamol combination had higher pulse rates, lower peak flow measurements, and depressed blood theophylline levels. These results suggest that when given at maximum oral dosage, theophylline and salbutamol in combination, tend to interact negatively producing tachycardia and reduced therapeutic function.
PMCID: PMC1627759  PMID: 6751238

Results 1-25 (32)