Performance of the AST-to-platelet ratio index as a noninvasive marker of fibrosis in pediatric patients with chronic viral hepatitis.

We investigated the performance of aspartate aminotransferase to platelet ratio index (APRI) as a noninvasive marker of fibrosis and cirrhosis in children with chronic viral hepatitis. All of the patients 0 to 20 years old with chronic hepatitis B or C presenting at a tertiary medical center from 1992 to 2008 were identified. Thirty-six patients were evaluated with 48 biopsy results.

Tetralogy of fallot with persistent fifth aortic arch: echocardiographic diagnosis.

Although persistent, fifth aortic arch (P5A) is an uncommon anomaly. Its incidence is unknown due largely to failure of recognition. Fundamental to its diagnosis is an adequate understanding of the various settings in which P5A may manifest.

Nurse staffing and adverse events in hospitalized children.

This study determined whether the number of hours of care provided by RNs was related to mortality and complications in hospitalized children. Administrative data (1996-2001) were used to examine discharges of 3.65 million pediatric patients in 286 general and children's hospitals in California.

Prevalence of factor V G1691A (Leiden), prothrombin G20210A, and methylene tetrahydrofolate reductase C677T thrombophilic mutations in children with inflammatory bowel disease.

Background: Patients with inflammatory bowel disease (IBD) have an increased incidence of thromboembolic events. This risk may be caused by an increased frequency of thrombophilic mutations such as factor V Leiden G1691A (FVL), prothrombin G20210A (PT), or methylene tetrahydrofolate reductase C667T (MTHFR). Prevalence rates of heterozygous mutations in FVL, PT, and MTHFR are reported for whites (1.

Women referred for on-site domestic violence services in a managed care organization.

Background: Limited data about victims of domestic violence in health care settings hinder development of appropriate services. A comprehensive program was established in a managed care organization to increase identification and referral of domestically abused female patients.

Methods: Female victims of domestic abuse were referred to a trained social worker for further assessment.

Beyond screening for domestic violence: a systems model approach in a managed care setting.

Background: Implementation of screening guidelines for domestic violence has been challenging. The multifaceted "systems model" may provide an effective means to improve domestic violence screening, identification, and intervention in the healthcare setting.

Methods: We developed: (1) a systems model approach using tools for effective referral, evaluation, and reporting of domestic violence; (2) materials for distribution to female patients; (3) training for social service and mental health clinicians to provide domestic violence evaluation; and (4) strong links to the community.

Transcatheter occlusion of large pulmonary arteriovenous fistula.

We describe the compound transcatheter occlusion of a large and symptomatic pulmonary arteriovenous malformation in a 58-yr-old man. Pre- and postintervention clinical and laboratory data support the impression of an excellent outcome.

Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care.

Background: Primary care treatment of depression needs improvement.

Objective: To evaluate the efficacy of 2 augmentations to antidepressant drug treatment.

Design: Randomized trial comparing usual care, telehealth care, and telehealth care plus peer support; assessments were conducted at baseline, 6 weeks, and 6 months.

Significant pulmonary valve incompetence following oversize balloon pulmonary valveplasty in small infants: A long-term follow-up study.

Oversized dilatation balloons are recommended for relief of valvar pulmonic stenosis in infants and children during cardiac catheterization. Little information exists about the long-term outcome of this practice. Six of 107 consecutive patients undergoing balloon pulmonary valveplasty developed increasing pulmonary valve incompetence during follow-up periods of 0.

Vessel-sparing technique for coil occlusion of the very small patent ductus arteriosus.

A technique is described for coil occlusion of the small patent ductus arteriosus through a 4 French arterial catheter. The need for a 5 French sheath and catheter to stabilize the 3 French size delivery catheter system is obviated. The method is proposed as a way to minimize arterial vascular injury in the small patient undergoing transcatheter occlusion of the small ductus.

The contribution of attachment to burden in adult children of institutionalized parents with dementia.

The impact of adult attachment to parents, perceived disease severity, and caregiving behaviors, moderated by perceived caregiving adequacy, were investigated in 108 adult children of patients with dementia. Multiple regression analyses indicated that attachment style, the trait aspect of attachment, predicted both aspects of caregiver burden: caregiving difficulty and psychological symptomatology. Attachment preoccupation, the state aspect of attachment, predicted psychological symptomatology.

Five scales in search of a construct: exploring continued attachment to parents in college students.

The multitude of measures and differences across self-report indices of continued parental attachment raise questions regarding the validity and meaning of these scales. The purpose of this study was to examine the convergent and construct validity of 5 measures of continued parental attachment. Five attachment scales and 6 personality scales were administered to 216 undergraduate students.

Changing the nasal tip: part VI (of VI parts).

Like others in my field, I wasn't happy with sharp edges of tip cartilage or a wider narial base postoperatively. Necessity is the mother of invention, and the techniques described for eliminating those pitfalls are safe and effective. I hope that you have found these segments on nasal tip surgery provocative.