Biomedical subjects

C V E Powell

Publications and source records attributed to C V E Powell.

6 recordsLinked to original sources

PubMed2005

Comparison of complementary and alternative medicine use: reasons and motivations between two tertiary children's hospitals.

AIMS: To compare prevalence, reasons, motivations, initiation, perceived helpfulness, and communication of complementary and alternative medicine (CAM) use between two tertiary children's hospitals. METHODOLOGY: A study, using a face-to-face questionnaire, of 500 children attending the University Hospital of Wales, Cardiff, UK was compared to an identical study of 503 children attending the Royal Children's Hospital, Melbourne, Australia. RESULTS: One year CAM use in Cardiff was lower than Melbourne (41% v 51%; OR = 0.67, 95% CI 0.52-0.85), reflected in non-medicinal use (OR = 0.41, 95% CI 0.29-0.58) and general paediatric outpatients (OR = 0.38, 95% CI 0.21-0.67). Compared to Melbourne, factors associated with lower CAM use in Cardiff included families born locally (father: OR = 0.58, 95% CI 0.44-0.77) or non-tertiary educated parents (mother: OR = 0.54, 95% CI 0.38-0.77). Cardiff participants used less vitamin C (OR = 0.31, 95% CI 0.18-0.51) and herbs (OR = 0.49, 95% CI 0.34-0.71), attended less chiropractors (OR = 0.25, 95% CI 0.06-0.37) and naturopaths (OR = 0.08, 95% CI 0.02-0.33), but saw more reflexologists (OR = 3.33, 95% CI 1.08-10.29). In Cardiff, CAM was more popular for relaxation (OR = 1.92, 95% CI 1.03-3.57) but less for colds/coughs (OR = 0.4, 95% CI 0.27-0.73). Most CAM was self-initiated (by parent) in Cardiff and Melbourne (74% v 70%), but Cardiff CAM users perceived it less helpful (OR = 0.46, 95% CI 0.31-0.68). Non-disclosure of CAM use was high in Cardiff and Melbourne (66% v 63%); likewise few doctors/nurses documented recent medicinal CAM use in inpatient notes (0/21 v 2/22). CONCLUSIONS: The differences in CAM use may reflect variation in sociocultural factors influencing reasons, motivations, attitudes, and availability. The regional variation in use and poor communication highlights the importance of local policy development.

Adolescent↗

PubMed2004

Asthma in emergency departments: combined adult and paediatric versus paediatric only centres.

OBJECTIVE: To compare the management of paediatric patients with mild or moderate asthma in paediatric-only emergency departments (POEDs) to treatment in a mixed adult-child emergency departments (mixed EDs). METHODS: Prospective, observational study conducted in 36 Australian emergency departments (EDs) for 2 weeks in 2001. Children aged 1-15 years with acute asthma classified as mild or moderate severity. Details of demography, severity assessment, and type of treatment facility, treatment and disposition were collected. Analysis used descriptive statistics, comparison of proportions by chi2, and multiple logistic regression. RESULTS: Two-hundred and nine children were treated at POEDs and 257 at mixed EDs. The groups had similar severity. Spacers to deliver beta-agonists were used more frequently in POEDs (67.5% vs 24.2%; P < 0.01). Children treated at POEDs with a mild attack were more likely to be admitted (20.6% vs 9.5%; P < 0.02) and given salbutamol (82.8% vs 71.9%; P = 0.03). For children with moderate asthma, oral steroid prescription on hospital discharge was more common for those treated in a mixed ED (81.0% vs 95.7%; P = 0.01). Ipratropium bromide (IB) was widely used at both types of ED but more commonly used in mixed EDs (41.7% vs 54.9%; P < 0.01). There were no differences in length-of-stay, representation rate within one month and oral steroid use for attack. Less than 2/3 of children with mild asthma attacks received steroid treatment in the ED. CONCLUSION: Treatment was similar between the two types of ED. IB was overused in mild asthma and oral steroids were underused in moderate asthma, by both ED types. Spacers were under-utilized in mixed EDs.

Adolescent↗

PubMed2002

Asthma in children: gaps between current management and best practice.

OBJECTIVES: To determine the extent to which steps three to six of the Australian six-step asthma management plan are being implemented in the community and to identify barriers to the adoption of best practice asthma management. METHODS: A cross-sectional descriptive study was conducted at the Royal Children's Hospital and Sunshine Hospital, Melbourne. Two hundred and thirty-one 2-5-year old children who visited the emergency department for asthma were enrolled in the study. Main outcome measures were frequency of asthma management practices and barriers, as measured by parent-completed questionnaire. RESULTS: Gaps: 51% of parents do not feel they have enough information about asthma triggers, more than 60% of children with persistent or frequent episodic asthma are not using regular preventive medication, 48% do not have a written action plan, 39% have not had their asthma reviewed in the last 6 months, and 38% of parents do not feel that they have enough information about their child's asthma. Areas where current practice was close to best practice: 83% of doctors had talked to parents about what causes or 'triggers' their child's asthma, less than 1% of children are using puffers without a spacer, 83% of parents who had an action plan used it for the current visit to the emergency department. CONCLUSIONS: Large gaps still exist between current management and best practice in this group of emergency department attenders. Improvements in asthma management could be achieved if the child's asthma doctor requested review visits for asthma, provided an action plan and followed best practice in relation to asthma medications.

Asthma↗

PubMed2002

A parent completed questionnaire to describe the patterns of wheezing and other respiratory symptoms in infants and preschool children.

AIM: To develop a standardised and validated respiratory symptom questionnaire for use in epidemiological or follow up studies in infants and preschool children. METHODOLOGY: After initial design and development, the questionnaire was administered to two cohorts of subjects, one recruited from a respiratory clinic and the other from a postnatal ward. The two cohorts then repeated the questionnaire, two weeks apart. The qualities of the questionnaire were assessed. RESULTS: Response rate to the initial questionnaire was 100% for the clinic based cohort and 64% for postnatally recruited families (total number of subjects 114). Questions showed good to moderate short term reliability (weighted kappa scores 0.47-0.7; average correct classification rates 0.74-0.91). Four domain concept scores showed excellent internal consistency (Cronbach alpha scores 0.87-0.95). Using principal component factor analysis, four new domains were devised showing acceptable construct validity and internal consistency. Criterion validity was assessed using a respiratory physician based diagnosis of asthma (RPBDA) as the gold standard for comparison. All eight scales in the questionnaire could significantly distinguish between infants with RPBDA and well or mildly symptomatic subjects. CONCLUSION: We have developed a practical, acceptable questionnaire with eight concept domains for use in infants and preschool children. The questionnaire has strong construct validity and internal consistency with good short term reliability of questions. More detailed study of criterion validity and the responsiveness of the questionnaire is required using a larger population and including children with the different phenotypes of wheezy illness.

Child, Preschool↗

PubMed2002

AHR in asthma.

Explore the source record for details and available documents.

Asthma↗

PubMedDate not supplied

Cephalosporin resistant urinary tract infections in young children.

OBJECTIVE: To describe the antibiotic resistance pattern of bacteria causing urinary tract infection (UTI) in a cohort of Australian children under 6 years of age. METHODS: Data were collected over a 12-month period from children under 6 years of age with a provisional diagnosis of UTI made in the Emergency Department of Sunshine Hospital, Victoria. RESULTS: During the study period 100 culture-proven UTI were identified in 97 children. Three children had two episodes. Out of the 100 episodes, 39% were male, 56% were under 12 months of age at presentation and 61% were managed as outpatients. Clinical features were non-specific in the majority of cases. Hydronephrosis and vesicoureteric reflux was detected in 5.5% and 28.6%, respectively, of children with their first investigated UTI. A single bacterial isolate was cultured from 97 urines and two from three samples. Escherichia coli (n = 90) and Proteus mirabilis (n = 5) were the most common isolates. In vitro resistance to ampicillin/amoxycillin was found in 52% of isolates, to trimethoprim in 14% and to cephalothin/cephalexin in 24%. This resistance rate to first generation cephalosporins is the highest reported to date in adult or paediatric UTI in Australia. CONCLUSIONS: Ampicillin/amoxycillin or cephalothin/cephalexin may not be the optimal choice of antibiotic for the empiric treatment of UTI in this and possibly other paediatric populations.

Cephalosporin Resistance↗