RESUMO
Objective To assess type and adequacy of information provided by transfer forms (TFs) at two units of Lady Ridgeway Hospital for Children (LRHC), Colombo. Design Prospective observational study. Setting Wards 8 and 9 of LRHC. Subjects All children transferred from other medical institutions. Method Study was carried out over 3 months from 15th March, 2002 on all patients transferred to wards 8 and 9 from another hospital. Type of information provided in TFs was assessed and details taken into a pre-tested questionnaire. The information was analysed using Epi Info Version 6.04b. Results A total of 172 TFs, accounting for 3% admissions, were analysed. 74% transfers were under 5 years of age. Full name was not provided in 60%. Race and religion were not given in 35% and 43% respectively. Incomplete addresses were given in 10% and no addresses in 27%. Most transfers were from teaching, provincial and base hospitals. In 54% consultants had not signed TF and in 26% designation of transferring officer was not provided. Results of investigations were provided only in 57%. In 74% there was neither a diagnosis card nor a referral letter. Main complaints and clinical signs were given in 74% but details of patient's condition at time of transfer were given in only 42%. Date of admission to transferring institution was provided in only 18%. Treatment was instituted at transferring station in 74% but only 15% mentioned the date of starting treatment. In 30% duration of treatment was provided and in only 13% was date and time of last dose of drugs documented. Conclusions There were significant inadequacies in information provided in many TFs. A revised format of printed TF should be adopted to minimize these deficiencies.
RESUMO
OBJECTIVE: To establish efficacy and safety of deferiprone. DESIGN: Prospective study. SETTING: The Lady Ridgeway Hospital for Children, Colombo. PATIENTS: Transfusion-dependent children in the age group 1 to 15 years. INTERVENTION: Patients were given 75 mg/kg/day of deferiprone orally in divided doses. MEASUREMENTS: Efficacy of deferiprone therapy was assessed by 4 to 6 monthly serum ferritin (SF) assays. Safety of therapy was assessed by 4-weekly white cell counts and serum alanine aminotransferase (ALT) levels. The Z-score was used to assess the significance of the difference between the mean initial and final SF level. RESULTS: 82 patients received deferiprone therapy for a mean duration of 30 +/- 14 months. Initial SF levels ranged from 1115 to 12,165 micrograms/l with a mean of 5156 +/- 2631 micrograms/l. Final SF levels ranged from 312 to 15,285 micrograms/l with a mean of 2809 +/- 2380 micrograms/l (Z score 5.99; p < 0.001). Two (2.4%) children developed agranulocytosis which reverted to normal on discontinuation of treatment. 41 (50%) developed arthropathy and in 17 this was severe enough to require discontinuation of therapy. Serum ALT levels were raised in 35 (43%) patients but reverted to pretreatment values or lower despite continuation of deferiprone therapy. There was one death in a 9-year old child who developed diabetes mellitus and heart failure despite deferiprone therapy for 3 years. CONCLUSIONS: A final SF level < 2500 micrograms/l was achieved in 52% children. Severe arthropathy and agranulocytosis may necessitate permanent discontinuation of therapy.