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Biomedical subjects

E Molyneux

Publications and source records attributed to E Molyneux.

At least 19 recordsLinked to original sources
PubMed2006

An experience of emergency ultrasonography in children in a sub-Saharan setting.

Emergency ultrasonography is an appealing imaging modality in paediatric emergencies, given its non-invasive nature and potential as an adjunct to physical examination in a setting where rapid decisions need to be made. This review of a case series describes the applications, versatility, and limitations of emergency physician led ultrasonography in a paediatric resuscitation room in a sub-Saharan African setting.

Africa South of the Sahara↗
PubMed2004

Overcoming ethical barriers to childhood tuberculosis research in developing countries.

In 2002, an international Workshop on Tuberculosis in Children was held to determine priority areas for basic, clinical and programmatic research to improve paediatric TB practice. During the workshop, issues related to the ethical treatment of children as research subjects, particularly in resource-poor settings, were identified as major constraints to the goal of expanding paediatric TB research. Based on participation in the workshop discussions, this article proposes concrete activities that can begin to address the ethical barriers. The time and costs associated with creating collaborative scientific and ethical research projects between high and low-income countries should be supported in grants for paediatric TB research studies in developing countries. Paediatric TB researchers in developing countries should be given opportunities to participate in international programmes that develop bioethics expertise. Relevant case studies of paediatric research in developing countries can assist ethical review committees in industrialised countries in understanding the special issues related to paediatric research in resource-limited settings. Paediatricians in developing countries need to be included in childhood TB research studies and ethical review committees.

Age Factors↗
PubMed1999

Children's weights: guess or measure by tape?

Children's doses of drugs are prescribed according to bodyweight but in resource-poor countries weighing scales may be unavailable, inaccurate, or broken. We designed a length/weight tape for use in our community and found it reasonably accurate for weights of 4-16 kg and better than a clinician's guess.

Body Height↗
PubMed1999

Apparent life-threatening events presenting to a pediatric emergency department.

OBJECTIVE: To review the etiology, clinical decision-making process, and outcomes of apparent life-threatening events (ALTEs) presenting to a children's hospital emergency department (ED). DESIGN: Retrospective patient record review. SUBJECTS: One hundred thirty infants under the age of 1 year fulfilling the diagnostic definition of an apparent life-threatening event. RESULTS: In a calendar year, 130 infants presented to a large children's hospital ED. The total number of ALTEs studied was 196. The median age was 2 months, and 50% of infants had a normal clinical examination. Eighty-three percent of ALTEs resulted in admission to the hospital. The approach to investigation and management of an ALTE during admission appeared unstructured. Discharge diagnoses, both from the ED and the inpatient service, were numerous, the most common being convulsion, febrile convulsion, GOR, and lower respiratory tract infection. The diagnosis frequently changed in those attending more than once. Eighteen months after cessation of data collection, no infants had died. Follow-up information revealed a higher-than-expected prevalence of asthma and seizures. CONCLUSIONS: This is a diverse group of infants, many of whom appear normal following the ALTE. There are many possible diagnoses, but diagnosis correlates poorly with presenting symptoms. It also appears that many commonly performed investigations conducted in this group of infants may not be those that are most helpful for diagnosis, and doctors may be making diagnoses with little supportive evidence. Until research on this group of "first-presentation" infants provides management guidelines for family and emergency doctors, it may be prudent to advise that all such infants presenting with an ALTE should be admitted for a period of observation and further investigation. This would help ensure more accurate diagnosis, as well as provide reassurance for the family.

Apnea↗
PubMed1999

Development and technical basis of simplified guidelines for emergency triage assessment and treatment in developing countries. WHO Integrated Management of Childhood Illness (IMCI) Referral Care Project.

Simplified guidelines for the emergency care of children have been developed to improve the triage and rapid initiation of appropriate emergency treatments for children presenting to hospitals in developing countries. The guidelines are part of the effort to improve referral level paediatric care within the World Health Organisation/Unicef strategy integrated management of childhood illness (IMCI), based on evidence of significant deficiencies in triage and emergency care. Existing emergency guidelines have been modified according to resource limitations and significant differences in the epidemiology of severe paediatric illness and preventable death in developing countries with raised infant and child mortality rates. In these settings, it is important to address the emergency management of diarrhoea with severe dehydration, severe malaria, severe malnutrition, and severe bacterial pneumonia, and to focus attention on sick infants younger than 2 months of age. The triage assessment relies on a few clinical signs, which can be readily taught so that it can be used by health workers with limited clinical background. The assessment has been designed so that it can be carried out quickly if negative, making it functional for triaging children in queues.

Case Management↗
PubMed1998

Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi in 1996-97.

To design appropriate interventions, we collected clinical and demographic data prospectively on all children aged one day to 14 years admitted with a diagnosis of bacterial meningitis (BM) from April 1st 1996 to March 31st 1997 to the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. During the study period 267 children (2.7% of all paediatric admissions) were found to have BM; 83% were under 5 years of age, 61% under one year and 23% under one month. The most common causative organisms in the post neonatal period (n=206) were Streptococcus pneumoniae (27%), Haemophilus influenzae type b (Hib) 21%, and Salmonella typhimurium (6%). In the neonatal group (< 1 month, n=61) the most common causes were Streptococcus agalactiae (23%), S. typhimurium (15%), S. pneumoniae (11.5%) and other Gram negative rods (11.5%). Nineteen of 21 salmonella infections were in children under one year of age and all S. agalactiae were in infants under three months. There was delay on presentation: the average length of fever was 4.6 days, 39.5% had convulsed prior to arrival and 57% had an altered level of consciousness. An initial diagnosis of malaria had probably contributed to the delay in 22.5% (42 of 186 tested). 48% were < 80% weight for age, with 18% < 60%) weight for age. The overall mortality was 40%. The outcome was worst in salmonella infections, particularly neonatal salmonella BM with a case fatality rate (CFR) of 89% (8 of 9 cases). Coma on presentation worsened prognosis (mortality 64% if Blantyre Coma Score < 3, 26% if > 3). 15% of survivors had sequelae on discharge. 20% of Hib isolates were resistant to chloramphenicol, but all salmonellae were sensitive. 5% of S. pneumoniae were resistant to penicillin and 8% to chloramphenicol. Earlier access to adequate health care and awareness of BM in a malaria-endemic area would reduce mortality and morbidity. Vaccination against Hib infection would have reduced death by 18 (17%) and prevented sequelae in 7 cases.

Acute Disease↗
PubMed1998

Forms of better care.

The introduction of forms called critical care pathways into the paediatric unit of a hospital in Malawi has strengthened teamwork and helped to increase the efficiency with which resources are employed. They serve the dual function of indicating good management and providing an opportunity to note actions and potential progress.

Child↗
PubMed1995

Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus.

Lorazepam was compared with diazepam for the treatment of acute convulsions and status epilepticus in 102 children in a prospective, open, 'odd and even dates' trial. Convulsions were controlled in 76 per cent of patients treated with a single dose of lorazepam and 51 per cent of patients treated with a single dose of diazepam. Significantly fewer patients treated with lorazepam required additional anticonvulsants to terminate the seizure. Respiratory depression occurred in 3 per cent of lorazepam-treated patients and 15 per cent of diazepam-treated patients. No patient who received lorazepam required admission to the intensive care unit for either respiratory depression or persisting status epilepticus. Rectally administered lorazepam appeared to be particularly valuable (100 per cent efficacy) when venous access was not possible.

Administration, Rectal↗
PubMed1994

Audit of telephone advice in a paediatric accident and emergency department.

This paper audits the telephone requests for advice to a paediatric accident and emergency (A&E) Department over a 4-week period. All calls were answered by senior nurses. Most calls were received in the early evenings when the A&E department was busy. Parents were the most frequent callers and the majority of calls were for children under 5 years of age. The problems presented were wide ranging but advice over the telephone meant that many unnecessary visits to hospital were prevented. The public use the A&E department as a primary source for health advice and very few of the calls resulted in admissions. This telephone advice service is effective and helpful to the public but time consuming for A&E nursing staff at peak workload periods in their own department.

Child↗