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This article investigates the perspectives of University of Liverpool graduate foundation doctors and their consultants on their preparedness for professional practice. [ABSTRACT FROM AUTHOR]

The article focuses on the findings of a study related to the practice of consultants as well as their experiences in the health care industry in Great Britain. It explores the experiences of newly appointed consultants and investigates the transition from medical student to doctor. Researchers found that new consultants are highly skilled and experienced professionals but may still need a prescriptive support system.

Aim: To assess the factors determining patient choice of GH device, and whether offering free patient choice improves compliance with GH therapy. Methods: A prospective cross-sectional study performed on patients offered free choice of GH device in a regional growth clinic. In a subgroup having home delivery, GH compliance was assessed using ampoule counts. Results: 125 patients (74 (59%) male), median (range) 9.30 (1.0–18.3) years were commenced on GH from January 2001 to March 2004, and offered free choice of device. 68 (54%) chose a needled device, and 57 (46%) needle-free. There was no statistical difference in age, sex or diagnostic category between the two groups. Light blue devices were more likely to be chosen by males (p = 0.056). Questionnaires giving reasons for choosing a device were available in 40, and a further 50 gave reasons for both choosing a specific device and not choosing others. Other than choice of needled/needle-free device, the factor most likely to determine choice was ‘ease of use’. Only 6 (4.8%) subsequently changed device, and compliance remained high but unchanged at ∼90%. Conclusions: There are no specific features which determine what GH device a patient will choose. For those units offering free patient choice, a wide range of different devices should be made available. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Unlabelled: As survival improves in beta-thalassaemia, osteoporosis is emerging as a significant problem. This study examines bone mineral density (BMD) of thalassaemic patients of Asian origin (age range 9.5-24 y) to evaluate the extent of problems in this group and identify potential risk factors. Eleven patients were scanned using dual-energy X-ray absorptiometry. BMD z-scores and the bone mineral apparent density (BMAD) z-scores were calculated, to correct for short stature. All but three patients had lumbar spine BMD and BMAD z-scores below the mean. Three patients had BMAD z-scores more than 2.5 standard deviations below the mean. A negative correlation between age and BMAD was seen, as was an association between endocrine disorders and decreased bone density.Conclusion: The data confirm significant reductions in BMD in the Asian thalassaemic population, even after correcting for body size. Further research is needed to identify risk factors and means of prevention. [ABSTRACT FROM AUTHOR]

Captopril was used in 20 infants aged less than 1 year with heart failure secondary to defects with predominantly a left to right shunt that was poorly controlled with digoxin and diuretics. Total daily dose of captopril ranged from 0.88 to 2.5 mg/kg (mean 1.3 mg/kg) in three divided doses. Improvement in the control of heart failure was seen mainly as an increase in the rate of weight gain from a mean of 48 g/week before treatment to 102 g/week on treatment and a decrease in the mean respiratory rate from 68 breaths/minute to 60 breaths/minute. Side effects were seen in four patients--two with asymptomatic mild hypotension, one with renal insufficiency which improved with a reduction in dose, and one with severe oliguria progressing to renal failure. Significant changes in plasma electrolyte concentration did not occur except in the infant who developed acute renal failure. [ABSTRACT FROM AUTHOR]

The preterm infant is deficient in vitamin A (retinol) and this has been implicated in the pathogenesis of chronic lung disease of prematurity. Conjunctival impression cytology (CIC) has been used in adults to assess retinol status. We aimed to assess the feasibility of performing CIC in the preterm infant and to determine the significance of abnormal CIC findings. CIC samples were collected during routine retinopathy screening, and classified as inadequate, normal, borderline normal or abnormal. Ninety preterm infants were studied. Seventy-four (82%) CIC specimens produced a positive yield, whereas 16 (18%) were inadequate. Of the 74 adequate samples, 61 (82%) were normal or borderline normal and 13 (18%) abnormal. Seventy-three CIC specimens were assessed by a second histopathologist with complete agreement on 64 (88%) samples and disagreement on 9 (12%) samples. Ten sets of conjunctival impressions, taken from both eyes, gave identical results in all adequate samples. Birth weight was significantly lower in this abnormal group. Four infants (32%) in the abnormal group required treatment for retinopathy compared to two (3%) in the normal/borderline normal group. (P < 0.01)Conclusion Conjunctival impression cytology is simple and reproducible technique which maybe easily applied to the preterm infant. Abnormal CIC is associated with retinopathy of prematurity requiring treatment. [ABSTRACT FROM AUTHOR]

Background The most serious complication of subcutaneous fat necrosis (SCFN), a rare condition of the newborn characterized by indurated purple nodules, is hypercalcaemia. However, the mechanism for this hypercalcaemia remains unclear. Objectives To determine whether the hypercalcaemia associated with SCFN involves expression of the vitamin D-activating enzyme 25-hydroxyvitamin D3-1α-hydroxylase (1α-hydroxylase) in affected tissue. Methods Skin biopsies from two male patients with SCFN and hypercalcaemia were taken. The histological specimens were assessed using a polyclonal antibody against 1α-hydroxylase. Results Histology in both cases showed strong expression of 1α-hydroxylase protein (brown staining) within the inflammatory infiltrate associated with SCFN. This was consistent with similar experiments in other granulomatous conditions. Conclusions Hypercalcaemia in SCFN appears to be due to abundant levels of 1α-hydroxylase in immune infiltrates associated with tissue lesions. This is consistent with previous observations of extrarenal 1α-hydroxylase in skin from other granulomatous conditions such as sarcoidosis and slack skin disease. [ABSTRACT FROM AUTHOR]

Background/Aims: Although childhood obesity is a major problem, routine assessment methods do not reflect fat mass. Body mass index, which is most commonly used, gives an indication of weight for height and not a degree of adiposity. Methods: Bioelectrical impedance and dual-energy X-ray absorptiometry (DEXA) were used in a group of obese children to assess body fat. Results: Comparison between DEXA and commercial bioelectrical impedance scales in 46 children showed a highly significant correlation (R = 0.944, p < 0.001) in fat mass. Fat mass measured using bioelectrical impedance was 2.4 kg lower compared to measurement using DEXA. Conclusion: These bioelectrical scales may prove useful in the management of childhood obesity as they are able to provide important clinical information regarding fat mass and adiposity. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Vitamin D has steroid hormonal effects which can produce clinical symptoms and signs unrelated to calcium homoeostasis. Its deficiency has been implicated as a risk factor for diabetes, ischaemic heart disease, and tuberculosis in Asians. In this review, the incidence, aetiology, prevention, and treatment of symptomatic vitamin D deficiency in childhood are considered. A renewed public health campaign is required in the UK to address the continuing problem of vitamin D deficiency in Asian families. [ABSTRACT FROM AUTHOR]

Aims--To assess survival and neurodevelopmental outcome following prolonged ventilation beyond 27 or 49 days of postnatal life in neonates treated with antenatal steroids and surfactant. Methods--The medical records of 84 babies born in 1994-1996 requiring ventilation after 27 postnatal days at Liverpool Women's Hospital were reviewed to determine the duration of mechanical ventilation, survival, and neurodevelopmental outcome at 3 years of age. Results--Fifty six babies were mechanically ventilated after 27 postnatal days but for less than 50 days; 48 (86%) survived to 3 years. Twenty six (54%) of the survivors had normal neurodevelopment at 3 years and seven (15%) had only mild disability. Twenty eight babies were ventilated after 49 postnatal days; 14 survived to 3 years. Five of these survivors were neurodevelopmentally normal at 3 years and two had mild disability. Conclusions--Survival decreases with more prolonged ventilation. When antenatal steroids and postnatal surfactant are used, there appears to be improved survival and neurodevelopmental outcome in preterm babies who require prolonged ventilation. [ABSTRACT FROM AUTHOR]

Aims: To investigate the use of the aminobisphosphonate, disodium pamidronate, in children with vertebral osteoporosis.Methods: Five children (aged 10-15 years) with vertebral osteoporosis who developed compression fractures in the thoracic and/or lumbar spine as a consequence of five different conditions, received treatment with intravenous disodium pamidronate in doses ranging from 0.5 to 12 mg/kg/y.Results: Each child had rapid pain relief following the first treatment, followed by large increments in lumbar spine bone density over one year; the change in bone density standard deviation score ranged from 0.5 to 2.5 with percentage increments of 26% to 54%.Conclusion: Intravenous pamidronate appears to be a useful therapeutic option in childhood osteoporosis, but its use in children must still be regarded as experimental and therefore closely monitored. [ABSTRACT FROM AUTHOR]

On reassessment of 179 children who had previously been diagnosed as having cystic fibrosis seven (4%) were found not to have the disease. The importance of an accurate sweat test is emphasised as is the necessity to prove malabsorption or pancreatic abnormality to support the diagnosis of cystic fibrosis. [ABSTRACT FROM AUTHOR]

Two hundred and twenty nine children aged 6 to 15 years attending the asthma clinic at the Royal Hospital for Sick Children, Edinburgh, had throat swabs taken to determine the incidence of candida colonisation of the oropharynx. One hundred children (group A), who were not receiving steroids, were compared with 91 children (group B) receiving less than 500 micrograms of inhaled beclomethasone a day and 38 children (group C) receiving 500 micrograms or more of inhaled beclomethasone a day. Sore throat and hoarse voice were not related to the presence of candida or to treatment with inhaled steroids. The incidence of candida was greater in the groups given treatment with steroids but did not increase at a higher dosage, nor was it related to the type of inhaler used. There was only one case of clinical thrush in all the children studied. [ABSTRACT FROM AUTHOR]

The relation between the superior orientation of the QRS axis and the anatomical site of the defect in the ventricular septum in patients with a ventricular septal defect was studied. Of 1031 patients with a ventricular septal defect, 64 (6.2%) had a superior axis on their electrocardiogram. In 59% of these patients the defect was in the inlet portion of the ventricular septum or affected this area. None of the cases was classified as an isolated ventricular septal defect of the persistent atrioventricular canal type. While there is an association between a superior axis and perimembranous inlet ventricular septal defect, a superior QRS axis does not characterise a ventricular septal defect as being of the atrioventricular canal type. [ABSTRACT FROM PUBLISHER]

Sublingual nifedipine was used for the treatment of acute severe hypertension in 12 children with renal disease. An average dose of 0.24 mg/kg was safe and proved effective on most occasions within 30 minutes with a median duration of action of three hours. There were no major adverse effects. [ABSTRACT FROM AUTHOR]

The article offers information on outcomes of "pre-ST4," a two-day neonatal simulation course for Level 2 and 3 physicians developed by Royal Colleges, Deaneries and Hospital Trusts in Merseyside, England in January 2012. It highlights that the course includes a clinical skills workshops, airway management and umbilical catheterisation. It further presents a table depicting the precourse score and postcourse ability score for trainee skills.

A letter to the editor is presented in response to the article on the appropriate level of training for items of equipment used by different staff groups.

A survey of West Midlands paediatricians in 2001 identified 24 cases of symptomatic vitamin D deficiency in children less than 5 years of age. The overall incidence was 7.5 per 100 000 children per year with notable differences in incidence per ethnic group. [ABSTRACT FROM AUTHOR]

Over the 10 year period 1987-1996, 328 children with type 1 diabetes mellitus presented in the city of Birmingham, England, of whom 27% had diabetic ketoacidosis. Asian children under the age of 5 had an eightfold increased risk of presenting in diabetic ketoacidosis compared with non-Asian children of the same age. [ABSTRACT FROM AUTHOR]