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Biomedical subjects

F Jarman

Publications and source records attributed to F Jarman.

7 recordsLinked to original sources
PubMed2000

Clinical markers of serious illness in young infants: a multicentre follow-up study.

OBJECTIVE: To perform a multicentre follow-up study to determine if previously identified markers of serious illness in early infancy were robust and statistically reliable. METHODS: Infants aged 1 week to 26 weeks presenting to the Emergency Departments of the Royal Children's Hospital and two Melbourne metropolitan hospitals were seen over a 12-month period. Eleven clinical markers as well as their temperature were documented by nursing staff and resident medical officers. Serious illness was defined if infants had a positive body fluid bacterial culture, a positive chest X-ray or if significant treatment was required in hospital. The predictive values, sensitivity and specificity for the individual and the best combination of clinical markers were determined. RESULTS: Assessments (3806) were performed with 312 infants being assessed as seriously ill (8.2%). The combination of either drowsiness on history or examination, pallor on history or examination, breathing difficulty (chest wall recession), temperature above 38 degrees C and a lump being present, identified 82.5% of all babies deemed subsequently to be seriously ill. The positive predictive value of an infant who was febrile, drowsy and pale on examination was 70.7% (previous study 74%). CONCLUSIONS: This study confirmed the high individual predictive value of arousal variables, pallor, and chest wall recession, especially when associated with fever, reaffirming their utility in the recognition of serious illness in infants under 6 months of age.

Biomarkers↗
PubMed1997

"Growing pains": clinical and behavioral correlates in a community sample.

Parents of 183 children identified them as having "pain in arms, legs, or joints during the previous 12 months." This group was compared with a group of children without pains selected randomly from the rest of a 1605-member community-based cohort in a study of chronic illness. The pains were most likely to be deep seated, to involve predominantly the lower limbs, and to be described in vague, nonspecific terms. These children were significantly more likely to have recurrent abdominal pain, a negative mood, and behavior problems, and to be aggressive, anxious, and hyperactive. There were no differences between the groups on any teacher ratings of behavior, temperament, social skills, or academic achievement. We conclude that children with "growing pains" are rated by their parents, but not their teachers, as having different temperamental and behavioral profiles than controls. These data suggest a psychosocial contribution to growing pains akin to that seen with other pain syndromes.

Adolescent↗
PubMed1997

Side effects of methylphenidate and dexamphetamine in children with attention deficit hyperactivity disorder: a double-blind, crossover trial.

OBJECTIVE: To compare the side effect profiles of methylphenidate (MPH) and dexamphetamine (DEX) in children with attention deficit hyperactivity disorder (ADHD), as well as to determine which symptoms are genuine adverse effects of stimulant medication, as opposed to aspects of the child's underlying behavioral phenotype. DESIGN: Double-blind, crossover study. SETTING: Pediatric teaching hospital ambulatory behavior clinic. SUBJECTS: A total of 125 children with ADHD with a mean age of 104.8 months. INTERVENTIONS: Subjects received DEX (0.15 mg/kg/dose) and MPH (0.3 mg/kg/dose) twice a day for 2 weeks each in a randomized order. OUTCOME MEASURES: The Barkley Side Effects Rating Scale (17 symptoms; 0 = absent, severity rated from 1 to 9) was completed by parents at baseline and at the completion of each trial fortnight. RESULTS: Subjects' parents reported a significantly greater mean number (8.19) and mean severity (4.08) of "side effects" before commencing the trial than during the MPH period (number 7.19; severity 3.24), but not the DEX period (number 7.64, severity 3.73). The mean severity (but not mean number) was greater on DEX than on MPH. DEX caused more severe insomnia and appetite suppression compared with the baseline rating. Appetite suppression was the only item rated more severe on MPH than at baseline. Six side effects were significantly more severe on DEX than MPH: insomnia, irritability, proneness to crying, anxiousness, sadness/unhappiness, and nightmares. None were more severe on MPH than DEX. Overall, both MPH and DEX were well tolerated by most subjects, with only four subjects discontinuing the trial period because of severe adverse effects (2 -1.6%- on each stimulant). CONCLUSIONS: Many symptoms commonly attributed to stimulant medication are actually preexisting characteristics of children with ADHD and improve with stimulant treatment. At the doses investigated, both DEX and MPH caused appetite suppression, and DEX caused insomnia. Negative emotional symptoms were more severe on DEX than MPH.

Adolescent↗
PubMed1997

Methylphenidate versus dexamphetamine in children with attention deficit hyperactivity disorder: A double-blind, crossover trial.

OBJECTIVE: To compare methylphenidate (MPH) and dexamphetamine (DEX) in a sample of children with attention deficit hyperactivity disorder (ADHD). METHOD: A total of 125 children with ADHD received both MPH (0.3 mg/kg twice daily) and DEX (0.15 mg/kg twice daily) for 2 weeks a double-blind, crossover study. Outcome measures were Conners' Parent Rating Scale-Revised, Conners' Teacher Rating Scale-Revised, a Parent Global Perceptions questionnaire, the Continuous Performance Test, and the Barkley Side Effects Rating Scale. RESULTS: There were significant group mean improvements from baseline score on all measures for both stimulants. On the Conners' Teacher Rating Scale-Revised, response was greater on MPH than DEX on the conduct problems and hyperactivity factors, as well as on the hyperactivity index. On the Conners' Parent Rating Scale-Revised, anxiety was the only factor to differ significantly, in favor of MPH. Parents rated 73% of subjects as globally improved on MPH and 69% improved on DEX, compared with baseline. Overall, 46% of parents chose MPH as the preferred drug, compared with 37% who chose DEX. On the Continuous Performance Test, there was no difference in the number of correct responses or errors between the two drugs. CONCLUSIONS: Most children with ADHD improve significantly on both MPH and DEX. There was a slight advantage to MPH on most measures.

Adolescent↗
PubMed1995

Late diagnosis of congenital sensorineural hearing impairment: why are detection methods failing?

This study was designed to look in detail at the paths to diagnosis for a group of 197 children with congenital sensorineural hearing impairment (SNHI), who were diagnosed between 1989 and 1991 in the state of Victoria, Australia. Despite the existence of universal infant screening at 7-9 months by distraction test or questionnaire, the median age at diagnosis for the study group was 18.0 months, with median age at aid fitting of 20.8 months, and median age at commencement of specialised intervention programmes of 22.3 months. Parent questionnaires completed for 143 (73%) of these children showed that 49% had known risk factors for hearing loss yet only 20% of them had been referred for audiological assessment before the 7-9 month screen. Only 63% of those eligible for the 7-9 month screen had received it. Of those children who were screened by distraction test 46% passed as did 57% of those screened by questionnaire. Twenty four parents (17%) described how they had initially 'denied' their own observations of their infants' abnormal hearing behaviour. When concerns were raised with professionals, 10% of parents were falsely reassured without audiological assessment. Detection methods are failing through a combination of poor screen test efficacy, incomplete population coverage, and parental and professional denial.

Age Factors↗
PubMedDate not supplied

Informed consent. Communication problems: a patient's view.

In this paper, the author gives a personal account of how healthcare professionals' communication skills can contribute to confusion and fear in patients undergoing major treatment. She discusses why it is important for nursing staff to act as patient advocates and provide consistent information that is easily understood and that the patient can share with a relative or carer.

Communication↗