Vocalization assessed by electrolaryngography is unaffected by topical lidocaine anesthesia: a prospective, crossover, randomized, double-blind placebo-controlled study.

BACKGROUND: Topical anesthesia of the upper airway is often recommended when difficulty in airway management is anticipated. There are published reports, however, of administration of topical anesthesia resulting in complete loss of airway control. Adverse effects are mostly attributed to interference with involuntary protective airway reflexes, while gross motor function itself generally is thought to be preserved. We hypothesized that if motor control is affected, measurable quantitative changes in vocalization should follow the use of topical anesthesia. METHODS: A prospective, crossover, randomized, double-blind study was conducted, in which 24 healthy volunteers each performed 2 vocal exercises, while having their glottic appearance recorded digitally via fiberoptic nasendoscopy. Subjects gargled with 3 test solutions on separate occasions (placebo, 2% lidocaine, and 4% lidocaine) and repeated the vocal exercises and nasendoscopy. The angle between the vocal cords was measured using MB-Ruler®, and the Laryngograph Speech Studio® software was used for vocal parameter analysis. RESULTS: The only significant changes in voice quality occurred between the control and test groups (P = 0.014). No difference could be found between the placebo and lidocaine groups. CONCLUSIONS: Although gargling with local anesthetic affected vocalization, no pharmacological effect attributable to local anesthetic was observed.

Impact of community-acquired paediatric rotavirus gastroenteritis on family life: data from the REVEAL study.

BACKGROUND: Rotavirus is the leading cause of acute gastroenteritis (AGE) and the most frequent cause of severe diarrhoea in children aged less than 5 years. Although the epidemiology of rotavirus gastroenteritis (RVGE) is well documented, there are few data on the impact of RVGE on the families of affected children. METHODS: Data associated with the burden of RVGE, including number of working days lost, levels of parental stress, the need for alternative childcare arrangements and additional nappies used, were extracted from questionnaires completed by parents of children participating in a prospective, multicentre, observational study (Rotavirus gastroenteritis Epidemiology and Viral types in Europe Accounting for Losses in public health and society, REVEAL), conducted during 2004-2005 in selected areas of Belgium, France, Germany, Italy, Spain, Sweden, and the United Kingdom to estimate the incidence of RVGE in children aged less than 5 years seeking medical care as a result of AGE. RESULTS: 1102 children with RVGE were included in the present analysis. The proportion of RVGE cases that required at least one parent or other person to be absent from work was 39%-91% in the hospital setting, 44%-64% in the emergency department, and 20%-64% in primary care. Self-reported levels of parental stress were generally high (mean stress levels, > or = 5 on a 10-point visual analogue scale). Additional childcare arrangements were required in up to 21% of RVGE episodes. The mean number of nappies used per day during RVGE episodes was approximately double that used when the child was not ill. CONCLUSIONS: Paediatric RVGE cases cause disruption to families and parental stress. The burden of RVGE on children and their families could be substantially reduced by routine rotavirus vaccination of infants.

Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland.

OBJECTIVES: To determine the incidence of severe hyperbilirubinaemia in the newborn, and to identify associated clinical and demographic variables, and short-term outcomes. DESIGN: Prospective, population-based study. SETTING: UK and Republic of Ireland, between 1 May 2003 and 31 May 2005. PARTICIPANTS: Infants in the first month of life with severe hyperbilirubinaemia (maximum unconjugated serum bilirubin >/=510 micromol/l). RESULTS: 108 infants met the case definition, 106 from the UK and 2 from the Republic of Ireland. The UK incidence of severe hyperbilirubinaemia was 7.1/100 000 live births (95% CI 5.8 to 8.6). Only 20 cases presented in hospital; 88 were admitted with severe jaundice. 64 (60.4%) cases were male, and 56 (51.8%) were of ethnic minority origin. 87 (80.5%) cases were exclusively breast fed. Co-morbidity included haemolysis, dehydration, infection and bruising. 14 infants showed evidence of bilirubin encephalopathy, of whom 3 died. The UK incidence of bilirubin encephalopathy was 0.9/100 000 live births (95% CI 0.46 to 1.5). CONCLUSIONS: This is the first large, prospective, population-based study of the incidence of severe hyperbilirubinaemia in the newborn. The clinical and demographic associations, and short-term outcomes identified, are the same as those reported recently in North America and Europe.

Paediatric cervical spine injury but NEXUS negative.

Cervical spine injuries in paediatric patients following trauma are extremely rare. The National Emergency X-Radiography Utilization Study (NEXUS) guidelines are a set of clinical criteria used to guide physicians in identifying trauma patients requiring cervical spine imaging. It is validated for use in children. A case of a child who did not fulfil the NEXUS criteria for imaging but was found to have a cervical spine fracture is reported.

Distribution of rotavirus genotypes in Europe, 2004-2005: the REVEAL Study.

BACKGROUND: Rotavirus gastroenteritis (RVGE) constitutes a significant burden of pediatric disease. Knowledge of currently cocirculating rotavirus genotypes is required to help guide immunization strategies. METHODS: During the 2004-2005 RVGE season, a prospective, multicenter, observational study of RVGE was conducted in children <5 years of age seeking health care in primary care, emergency department, and hospital settings in selected areas of Belgium, France, Germany, Italy, Spain, Sweden, and the United Kingdom. Rotavirus was identified by enzyme-linked immunosorbent assay (ELISA), and genotypes were determined by reverse-transcription polymerase chain reaction (RT-PCR) analysis of stool samples for which ELISA results were positive. RESULTS: ELISA results were available for 2712 of the 2846 children with acute gastroenteritis who were recruited for the study; of these 2712 children, 1102 (40.6%) were rotavirus positive. RT-PCR results were available for 1031 children with ELISA-positive samples. G1-G4 and G9 were the most prevalent genotypes identified: G1 was identified in Spain, Sweden, and the United Kingdom; G9 in Italy, France, and Belgium; and G4 in Germany. Only the G4 and G9 genotypes were identified in all study areas. Rotavirus infections showed seasonal variation, with different patterns noted among the genotypes. CONCLUSIONS: Rotavirus genotypes G1-G4 and G9 are associated with the majority of RVGE infections in the areas studied, with geographic and seasonal variation in the distributions of rotavirus strains. Rotavirus vaccines should, therefore, provide protection against all major genotypes to decrease effectively the RVGE disease burden in Europe.

Clinical consequences of rotavirus acute gastroenteritis in Europe, 2004-2005: the REVEAL study.

BACKGROUND: The availability of comprehensive, up-to-date epidemiologic data would improve the understanding of the disease burden and clinical consequences of rotavirus gastroenteritis (RVGE) in Europe. METHODS: During the 2004-2005 season, a prospective, multicenter, observational study was conducted in children <5 years of age in primary care, emergency department, and hospital settings in selected areas of Belgium, France, Germany, Italy, Spain, Sweden, and the United Kingdom. The clinical consequences of acute gastroenteritis (AGE) and RVGE were estimated. RESULTS: The estimated percentage of children with rotavirus-positive AGE admitted to a hospital was 10.4%-36.0%, compared with 2.1%-23.5% of children with rotavirus-negative AGE. In France, Germany, Italy, Spain, and the United Kingdom, the relative risk of hospitalization was statistically significantly higher for children with rotavirus-positive AGE than for those with rotavirus-negative AGE. Children with rotavirus-positive AGE were more likely to have lethargy, fever, vomiting, and dehydration, and, therefore, more severe disease than were children with rotavirus-negative AGE. Dehydration was up to 5.5 times more likely in children with rotavirus-positive AGE than in those with rotavirus-negative AGE. CONCLUSIONS: Rotavirus-positive AGE is more severe, causes more dehydration, and results in more emergency department consultations and hospitalizations than does rotavirus-negative AGE. Variations in the management of RVGE seen across study areas could be explained by differences in health care systems. Routine rotavirus vaccination of infants could significantly reduce the substantial burden of RVGE and would have major benefits for potential patients, their families, and health care providers.

Multicenter prospective study of the burden of rotavirus acute gastroenteritis in Europe, 2004-2005: the REVEAL study.

BACKGROUND: Rotavirus is recognized as a significant cause of pediatric gastroenteritis worldwide. Comprehensive data on the burden of rotavirus disease in Europe were lacking. METHODS: A prospective, multicenter, observational study was conducted during the 2004-2005 season in selected areas of Belgium, France, Germany, Italy, Spain, Sweden, and the United Kingdom, to estimate the incidence of acute gastroenteritis (AGE) and rotavirus gastroenteritis (RVGE) in children <5 years of age who require medical care in primary care, emergency department, and hospital settings. RESULTS: A total of 2846 children with AGE were included in the study, and, of the 2712 children for whom ELISA results were available, 1102 (40.6%) were found to be rotavirus positive. The estimated annual incidence of RVGE was 2.07-4.97 cases/100 children <5 years of age, and it was highest among children 6-23 months of age, with 56.7%-74.2% of all RVGE cases occurring in children in this age group. Overall, RVGE was estimated to account for 27.8%-52.0% of AGE cases, and it was responsible for up to two-thirds of hospitalizations and emergency department consultations, as well as one-third of primary care consultations for AGE. CONCLUSIONS: Rotavirus infections account for a significant proportion of AGE cases in children <5 years of age in Europe, many of whom require frequent primary care consultations or care in emergency department and/or hospital settings. The results of the present study suggest that routine rotavirus vaccination for infants <6 months of age could significantly reduce the substantial burden of this potentially serious childhood disease.

Experience of wrong site surgery and surgical marking practices among clinicians in the UK.

BACKGROUND: Little is known about the incidence of "wrong site surgery", but the consequences of this type of medical error can be severe. Guidance from both the USA and more recently the UK has highlighted the importance of preventing error by marking patients before surgery. OBJECTIVE: To investigate the experiences of wrong site surgery and current marking practices among clinicians in the UK before the release of a national Correct Site Surgery Alert. METHODS: 38 telephone or face-to-face interviews were conducted with consultant surgeons in ophthalmology, orthopaedics and urology in 14 National Health Service hospitals in the UK. The interviews were coded and analysed thematically using the software package QSR Nud*ist 6. RESULTS: Most surgeons had experience of wrong site surgery, but there was no clear pattern of underlying causes. Marking practices varied considerably. Surgeons were divided on the value of marking and varied in their practices. Orthopaedic surgeons reported that they marked before surgery; however, some urologists and ophthalmologists reported that they did not. There seemed to be no formal hospital policies in place specifically relating to wrong site surgery, and there were problems associated with implementing a system of marking in some cases. The methods used to mark patients also varied. Some surgeons believed that marking was a limited method of preventing wrong site surgery and may even increase the risk of wrong site surgery. CONCLUSION: Marking practices are variable and marking is not always used. Introducing standard guidance on marking may reduce the overall risk of wrong site surgery, especially as clinicians work at different hospital sites. However, the more specific needs of people and specialties must also be considered.