Feasibility of Dual Energy X-Ray Absorptiometry Based Images for Measurement of Height, Sitting Height, and Leg Length in Children.

BACKGROUND: Interpretation of pediatric bone mineral density by dual energy absorptiometry (DXA) requires adjustment for height (Ht). This is often not easily obtainable in nonambulant subjects. AIMS: To investigate the feasibility of using DXA images to evaluate measurements of Ht, sitting height (SH), and leg length (LL). METHODOLOGY: A total of 2 observers performed measurements of Ht, SH, and LL on 3 separate occasion using DXA digital images in 125 children. Intraclass correlation and relative technical error of measurement (rTEM) were performed to assess reliability of repeated measurements. In 25 children, Ht and SH were measured in clinic on the same day and Bland-Altman analysis was performed to compare DXA measured Ht, SH, LL with clinic measurements for these 25 children. RESULTS: Intraclass correlation for DXA based Ht, SH, and LL measurements ranged from 0.996 to 0.998 (p < 0.0001). rTEM of Ht, SH, and LL for observer 1 was 0.0016%, 0.002%, and 0.0034%, respectively. rTEM of Ht, SH, and LL between observer 1 and 2 was 0.0047%, 0.0049%, and 0.0087%, respectively. Mean difference between clinic and DXA measurements from Bland-Altman plots were +0.57 cm (95% confidence interval [CI] -0.54 to +1.68) for Ht, +1.33cm (-1.60 to +4.24) for SH, and -0.76cm (-3.88 to +2.37) for LL. CONCLUSIONS: Our study demonstrated for the first time that Ht, SH, and LL in children can be measured very precisely using DXA images. Ht can be measured accurately. We believe this may be a convenient method to obtain Ht measurements to allow size adjustment of DXA bone mineral density in immobile children with chronic conditions.

A Catholic perspective on organ sales.

In this article, I address the issue of the sale of human organs and the moral implications of a market in human organs under the aegis of Christian Bioethics. I argue that moral issues of this kind cannot be adequately be addressed from the point of view of moral frameworks, which point exclusively to procedural norms. Rather, a moral perspective must embody some substantive norms derived from a particular content-full moral or theological perspective. This substantive norms to which I appeal in this article are those of Roman Catholicism. The most important sources cited include the works of Pius XIi (1956) and the works of John Paul II (1985 and 1991). The conclusion reached is that not only is it morally permissible for Catholics to participate in a market in organ sales but it may also be prudent public policy.

The initial hospital management of childhood febrile convulsions: an audit.

The records of 100 children admitted to hospital with a febrile convulsion during the years 1988-91 were studied. There were 295 investigations performed overall and all but one child had paracetamol prescribed during the hospital stay. Twenty-three per cent of the group received an antibiotic and 43% were discharged still receiving an antipyretic. Anticonvulsants were not widely used. The need for antipyretic use, the number of investigations performed and the need for children to be admitted overnight in the first instance is questioned.

The chest X-ray and childhood acute asthma.

Data from the medical records of 100 children who had a chest X-ray versus 100 children who did not during an attack of acute asthma were compared. No evidence could be found to suggest that the two groups varied in terms of age, sex, severity of the presenting illness, or in the clinical measures of pulse rate, respiratory rate, wheeze and accessory muscle use. It appeared that the X-ray request was an action not based on sound clinical judgement. Cost savings and a reduction in radiation exposure can be made by eliminating unnecessary chest X-ray requests.

Acute laryngo-tracheo-bronchitis (croup): an audit of hospital practice.

The objective of this study was to audit the management of acute laryngo-tracheo-bronchitis in a paediatric unit. This was achieved by retrospective case note audit and a review of the investigations and management of all admitted patients in light of the current literature. There was inappropriate use of radiography and outmoded therapies. There has been an increasing use of adrenaline and steroids in the past 4 years. Prescribing of adrenaline was lax and was associated with potential danger to the patient. For a common condition such as croup, an agreed protocol taking into account current published recommendations is warranted and has been introduced into this unit following this audit.

The lateral radiograph of neck in laryngo-tracheo-bronchitis (croup).

The films of 61 children who had a lateral radiograph of neck performed in the management of acute laryngo-tracheo-bronchitis were reviewed by a paediatric radiologist. He was unaware of the clinical history and the outcome of the children's illnesses. The clinical records of the same children were reviewed independently and information sought about the clinical relevance of the film results. Sixty per cent of the films were felt to be in keeping with a diagnosis of acute laryngo-tracheo-bronchitis. As judged by the information in the medical records these results did not influence the management of the children other than in one instance where a child underwent laryngoscopy. This decision was strongly influenced by the original film report. No child developed acute airway obstruction while in the Radiology Department. The findings of this study support the concept that a request for a lateral X-ray of neck in croup is an inefficient use of diagnostic facilities.

The paediatric hospital medical record: a quality assessment.

The objective of this study was to assess the quality of the medical contribution to patient records in a children's department. It was carried out in a tertiary level teaching hospital. A structured audit of 100 randomly selected case records, with independent observers using a grading system for 3 of the measures, was performed. The outcome provides a comparison with the hospital's guidelines for case histories and notes. The results of this study show inadequate documentation of basic information. Communication was hindered by poor hand writing and the use of abbreviations. Overall comprehension of the course of the patients' illnesses was regarded as only fair to average. Recording of diagnosis and initial plans of management were present in over 70% of records. While discharge information was well recorded, the recommendation for the duration of drug therapy was inadequate. Mediocre handwriting and poor documentation are still prevalent in medical records. Strict supervision of this important area of medical practice is mandatory.