'Did not attends' in children 0-10: a scoping review.

Patients who do not attend ('DNA') health appointments have been identified as a service problem incurring significant costs to the NHS. In order to explore the causes, effects and costs of child DNAs, we carried out a scoping study to map the literature and identify gaps in the research. Given the breadth of issues underpinning DNAs, a scoping study, including research studies, audits, policy documents and conference abstracts, was the most useful way to map the field. To foster public and patient participation, we sought advice from parents participating in the National Children's Bureau's Family Research Advisory Group. From a pool of 1997 items, we found few UK studies with non-attendance of 0-10 year olds as a primary focus, though many more incidentally reported DNA rates. Overall, four topics predominated: the conceptualization of DNAs; the correlates of non-attendance; initiatives to reduce non-attendance; and the relationship between non-attendance and safeguarding. The Family Research Advisory Group identified broadly similar issues, but with a stronger emphasis on communication and practical matters. While there may be circumstances where failing to attend appointments makes little or no difference to a child (or even benefits them) it is likely that there are children whose health or well-being are compromised as a result of failing to attend appointments. Both 'over' and 'under'-attendance can be a source of anxiety to health professionals. Areas where further work is needed include robust evaluation of the effectiveness, cost-effectiveness and maintenance of measures to reduce DNAs and a better understanding of the relationship of safeguarding to non-attendance.

A systematic review of lay views about infant size and growth.

OBJECTIVES: To understand lay views on infant size and growth and their implications for a British population. METHODS: A systematic review of parental and other lay views about the meanings and importance of infant size and growth using Medline, PsycInfo, CINAHL, Sociological Abstracts, IBSS, ASSIA, British Nursing Index ChildData, Caredata, SIGLE, Dissertation Abstracts (US), Index to Theses. 19 studies, most of which reported the views of mothers, from the US, Canada, the UK and Finland were reviewed. RESULTS: Notions of healthy size and growth were dominated by the concept of normality. Participants created norms by assessing and comparing size and growth against several reference points. When size or growth differed from these norms, explanations were sought for factors that would account for this difference. When no plausible explanation could be found, growth or size became a worry for parents. CONCLUSIONS: Parents consider the importance of contextual factors when judging what is appropriate or healthy growth. For public health advice to be effective, lay, as well as scientific, findings and values need to be considered.

It might work in Oklahoma but will it work in Oakhampton? Context and implementation in the effectiveness literature on domestic smoke detectors.

OBJECTIVE: To explore data on factors affecting implementation processes in papers contributing to a Cochrane systematic review (SR) of smoke alarm interventions, supplemented by further papers not included in the review. DESIGN: Screening for data on implementation on the basis of: (1) primary studies included in a Cochrane SR, (2) further papers relating to these and similar studies, and (3) approaches to authors of these and other relevant studies and reports. RESULTS: Relatively few data were found to help people seeking to implement smoke alarm promotion interventions. CONCLUSIONS: For practitioners and policymakers to be able to build on research evidence, researchers and journal editors need to ensure that sufficient data are published, or are otherwise available to interested parties to move from understanding the evidence to using it.

An alternate method for calibrating the thromboelastograph.

OBJECTIVE: This study evaluated various substances that could be used to calibrate the Thrombelastograph. DESIGN: Prospective, controlled comparison. SETTING: Operating room laboratory at a tertiary care university hospital. PARTICIPANTS: None. INTERVENTIONS: Six substances commonly available in the operating room setting (ointments, creams, and gels) were analyzed by thromboelastography for 3 minutes. Sixty measurements were made for each substance. MEASUREMENTS AND MAIN RESULTS: Thromboelastographic analysis of the ointments and cream preparations had an amplitude variability that exceeded 10 mm within the 3-minute recording period. The conductive gel had the most reproducible thromboelastography tracing with a mean amplitude of 62.5 +/- 1.1 mm (analysis of variance, p < 0.0005). There was a significant correlation between the reported viscosity of the three gels and the deflection amplitude (linear regression, R2 = 0.97; p < 0.0001). CONCLUSION: Conductive gel is a useful substance for quickly checking the functional status of the Thrombelastograph at an operational stage. Calibration of the Thrombelastograph using a gel of known viscosity is clinically relevant and may be more practical than testing with thromboelastographic-defined normal and abnormal blood analogs.

The use of ondansetron to treat pruritus associated with intrathecal morphine in two paediatric patients.

Intrathecal morphine is an effective technique for providing postoperative analgesia after major surgical procedures in children. Pruritus is a common side effect associated with intrathecal morphine. We report two patients who experienced significant pruritus associated with intrathecal morphine administration and were successfully treated with ondansetron. Ondansetron appears to be a beneficial and safe method of relieving pruritus associated with intrathecal morphine.