Children with fever and cough at emergency care: diagnostic accuracy of a clinical model to identify children at low risk of pneumonia.

Objectives: To develop and validate a prediction model for the early identification of children with pneumonia in emergency care settings.

Methods: This was a diagnostic study with derivation and validation of multivariate logistic regression models. This study was carried out on children aged 1 month-16 years presenting with fever and cough visiting the pediatric emergency department of the Erasmus MC-Sophia, Rotterdam, the Netherlands (derivation population, n=504); Pediatric Assessment Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK (validation population 1, n=420); Accident & Emergency Department, Queen's Medical Centre, Nottingham, UK (validation population 2, n=366).

Which symptoms and clinical features correctly identify serious respiratory infection in children attending a paediatric assessment unit?

Objective: Parent-reported symptoms are frequently used to triage children, but little is known about which symptoms identify children with serious respiratory infections. The authors aimed to identify symptoms and triage findings predictive of serious respiratory infection, and to quantify agreement between parent and nurse assessment.

Design: Prospective diagnostic cohort study.

Views on personalized medicine: do the attitudes of African American and white prescription drug consumers differ?

Aims: Although recent advances in pharmacogenomics are making possible the use of genetic testing to determine the best medication for patients, little is known about how patients view such procedures. The aims for this study that were developed collaboratively as part of a community-academic partnership are: (1) What are the attitudes and perceptions of prescription drug consumers concerning personalized medicine and genetic testing for drug compatibility and how do they differ between African American and white patients? (2) What are the attitudes and perceptions of patients concerning race-based prescribing and how do they differ between African American and white patients?

Methods: We conducted 6 focus groups, 2 with white participants and 4 with African American participants. Focus groups were audio-recorded, transcribed, and analyzed to ascertain common themes.

How well do vital signs identify children with serious infections in paediatric emergency care?

Objectives: To determine whether vital signs identify children with serious infections, and to compare their diagnostic value with that of the Manchester triage score (MTS) and National Institute for Health and Clinical Excellence (NICE) traffic light system of clinical risk factors.

Design: Prospective cohort of children presenting with suspected acute infection. We recorded vital signs, level of consciousness, activity level, respiratory distress, hydration and MTS category.

Children and young people's preference of thematic design and colour for their hospital environment.

In this innovative project, the views of children and young people were explored regarding their preference of thematic design and colour for their hospital environment in a new children's unit. The novelty of the approach was that it was driven by the preferred choices of children and young people through the use of 'child-friendly' interviews and questionnaires. Informing the study was the development of a group of children and young people who underwent research training, and with support, developed all data collection tools and helped to verify data analysis.

Acute disseminated encephalomyelitis: a review of 18 cases in childhood.

Objective: Acute disseminated encephalomyelitis (ADEM) is a treatable inflammatory demyelinating disorder seen more commonly in children than in adults. It typically presents to general paediatricians, often, like encephalitis, with non-specific cerebrospinal fluid findings. The brain computerized tomography scan is usually normal, so is falsely reassuring and delays the diagnosis, which might result in considerable morbidity.

Analysis of ploidy and proliferative activity in childhood non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD).

We have performed DNA analysis by means of fluorescence-activated cell cytometry on paraffin-embedded tissue from the diagnostic biopsy specimens in 40 cases of non-Hodgkin's lymphoma (NHL) and 25 of Hodgkin's disease (HD) and from 50 normal tonsils as controls. For HD cases, aneuploidy was found in 7 of 25 (28%), a higher proportion than in two previous studies of mainly adult patients. Diploid tumors showed S-phase fractions (SPFs) similar to those of controls.

Immunophenotypic analysis of childhood Burkitt's lymphoma in the West Midlands 1957-1986.

Aims: To analyse the immunophenotype of a large number of non-endemic Burkitt's lymphomas to determine whether a B cell phenotype is consistently recognisable using formalin fixed, paraffin wax embedded archival material and a standard panel of commercially available antibodies.

Methods: Archival material was obtained from 30 cases of childhood Burkitt's lymphoma registered with the West Midlands Regional Children's Tumour Research Group. These were analysed by a standard avidin biotin complex immunoperoxidase method using antibodies to CD45, CD43, CD30, CD20, CD15, and immunoglobulin heavy and light chains.

Hodgkin's disease in children in the West Midlands, 1957-1986: a large population-based study.

One hundred forty-one children were diagnosed with Hodgkin's disease between 1957 and 1986 in the West Midlands Health Authority Region (1991 population, 1.1 million children). Eighty-seven were boys and 54 were girls, representing a significant male:female ratio of 1.

Parental imprinting of human chromosome region 11p15.3-pter involved in the Beckwith-Wiedemann syndrome and various human neoplasia.

Cytogenetic and DNA analyses of patients with the Beckwith-Wiedemann syndrome (BWS) enabled us to refine the localization of the syndrome at 11p15.3-pter to two distinct regions. One chromosome region (BWSCR1) is near the insulin (INS) and insulin-like growth factor 2 (IGF2) genes.

Epstein-Barr virus (EBV) and Hodgkin's disease in children: incidence of EBV latent membrane protein in malignant cells.

Previous studies have detected EBV DNA by Southern blotting or in situ hybridization in biopsy material from up to 30 per cent of adult cases of Hodgkin's disease. Here we have used monoclonal antibodies specific for the EBV latent membrane protein LMP1 to examine archival material from children with Hodgkin's disease. Material from 74 cases (54 males and 20 females) was examined and 37 (30 males and 7 females) were classified as LMP1-positive in the malignant cells.

Post-operative analgesia following femoral-neck surgery--a comparison between 3 in 1 femoral nerve block and lateral cutaneous nerve block.

A prospective controlled randomized trial on patients receiving surgery for fractured neck of femur was carried out, in which post-operative analgesic requirements in three separate groups were compared. Patients in Group 1 acted as controls, whilst those in Groups 2 and 3 received lateral cutaneous nerve blocks and 3 in 1 femoral nerve blocks, respectively. Patients in Group 3 needed significantly less analgesia than the other two groups, and the time to first administration of analgesia was significantly longer.

Changes in the postenteropathic form of the hemolytic uremic syndrome in children.

An analysis was made of clinical and laboratory findings in children with the diarrheal form of the hemolytic uremic syndrome (HUS) treated at The Children's Hospital, Birmingham between 1970 und 1987. From 1982 the rate of referral increased, the prodromal illness more often consisted of bloody diarrhea, and the mean age at presentation doubled from 2 to 4 years. For patients with a good outcome there was an excess of males in the period 1970-81, and females in the period 1982-87.

Guillain-Barré syndrome mimicking brainstem death.

There must be a defined, predisposing condition to fulfil the criteria of brainstem death in the UK. A patient presented recently in coma and with absent brainstem reflexes, but no diagnosis was initially obvious. A subsequent diagnosis of Guillain-Barré syndrome was made, and the patient made a full recovery.

The clinical significance of the glomerular location of segmental lesions in focal segmental glomerulosclerosis.

Serial sections of renal biopsies obtained from 44 nephrotic children with focal segmental glomerulosclerosis (FSGS) were reviewed in order to determine the glomerular location of segmental lesions and relate the findings to the outcome of illness. There were 23 boys and 21 girls aged 0.9-14.

The M1 air crash. The demands placed on anaesthetic and intensive care services of two hospitals.

The M1 air crash provided an enormous challenge to the anaesthetic and intensive care services of the hospitals which admitted the survivors, many of whom had serious injuries. This account describes some of the problems which were encountered in two of the hospitals, details the workload imposed on the anaesthetists and the staff of the Intensive Therapy Units and identifies factors which, if improved, might advance the management of multiple casualties admitted from the scene of a major disaster.

Caudal anaesthesia for postoperative pain relief in children: a comparative trial of different regimens using plain bupivacaine.

A comparative trial between three different dosage regimens of bupivacaine administered by the caudal route, used for the prevention of postoperative pain in children undergoing elective inguinal herniotomy or ligation of patient processus vaginalis was undertaken. The regimens compared were bupivacaine 0.25% (1 ml/kg), bupivacaine 0.

Molecular nature of genetic changes resulting in loss of heterozygosity of chromosome 11 in Wilms' tumours.

In this paper we describe the analysis of genetic changes in chromosome 11 in Wilms' tumours. Using a range of probes for regions 11p15, 11p13 and 11q we have screened DNA from 14 Wilms' tumours together with control DNA obtained from the patients' lymphocytes and their parents. We have been able to demonstrate loss of heterozygosity in 5 of the 14 different Wilms' tumours.

Evaluation of blood loss during suction termination of pregnancy: ketamine compared with methohexitone.

Blood loss during suction termination of pregnancy was estimated in patients anaesthetised with intravenous ketamine (n = 25) and compared with those anaesthetised with intravenous methohexitone (n = 25). Both groups received midazolam 0.15 mg/kg intravenously 3 min prior to induction of anaesthesia.