A preliminary investigation into the effectiveness of a group-delivered sleep management intervention for parents of children with intellectual disabilities.

Sleep problems are more prevalent and severe among children with intellectual disabilities and autism compared to typically developing children. Training parents in behavioural approaches to manage sleep problems is advocated. However, delivering such interventions via groups is novel. This article reports the findings from a preliminary evaluation of a group-delivered intervention routinely delivered by a Child and Adolescent Mental Health Service Learning Disability team in England. For this purpose, parents (n = 23) of children with intellectual disabilities were recruited. The Children's Sleep Habits Questionnaire, Parents' Sense of Competence Scale and parent-set goals captured outcomes at pre-intervention, post-intervention and 3- and 6-month follow-up. Intervention delivery costs were collected. Take-up was high (86%), and no parent dropped out. Statistically significant improvements in night wakings, parent-set goals and parents' sense of efficacy were observed. The estimated mean cost of delivering each intervention was British (GBP) £1570. Findings suggest the intervention is a low-cost, acceptable service warranting further evaluation.

Superior survival after replacing oral with intravenous busulfan in autologous stem cell transplantation for non-Hodgkin lymphoma with busulfan, cyclophosphamide and etoposide.

Autologous stem cell transplantation (ASCT) with cyclophosphamide, etoposide and oral busulfan (BuCyVP) is an effective therapy for relapsed or refractory non-Hodgkin lymphoma (NHL). Substituting intravenous for oral busulfan reduces variability in drug exposure, potentially improving the safety and efficacy of the BuCyVP regimen. We retrospectively compared the outcomes of 604 consecutively treated patients who underwent ASCT for NHL with BuCyVP using oral (n = 468) or IV (n = 136) busulfan, without measurement of busulfan levels for pharmacokinetic (PK) analysis. Patients who received oral busulfan experienced more severe oral mucositis and a higher incidence of nonrelapse mortality. Median overall survival (OS) after ASCT was 72 months with oral busulfan but was not reached for the IV busulfan group. IV busulfan was associated with a lower rate of relapse, and superior relapse-free survival (RFS) and OS. In multivariate models, the route of busulfan administration was an independent prognostic factor for relapse (P = 0.01), RFS (P = 0.002) and OS (P = 0.001). IV busulfan appears to provide better efficacy and lower toxicity than oral busulfan in ASCT with BuCyVP for NHL. Whether PK-based busulfan dosing can achieve further improvements in this setting is worthy of study.

Microscopic hematuria in pregnancy: relevance to pregnancy outcome.

BACKGROUND: The significance of dipstick or microscopic hematuria in pregnancy is uncertain, with some studies suggesting this is associated with a greater risk for preeclampsia. We sought to determine the prevalence and clinical significance of microscopic hematuria during pregnancy. METHODS: This was a prospective case-control study in the antenatal Clinic of St George Hospital, Kogarah, Australia, a teaching hospital without tertiary referral antenatal care, with approximately 2,600 deliveries per year. One thousand pregnant women attending for routine antenatal care were invited to have a routine urinalysis performed and be referred to a nephrology clinic for further investigation if dipstick microscopic hematuria was detected on more than 1 occasion before 32 weeks' gestation. Main outcome measures were the prevalence of dipstick hematuria, prevalence of hematuria confirmed by urine microscopy, and the development of preeclampsia or gestational hypertension or delivery of a small-for-gestational-age baby. RESULTS: One hundred seventy-eight of 902 women (20%) who entered the study had dipstick hematuria on at least 2 occasions in pregnancy; 66 of 126 women (53%) who had hematuria before 32 weeks attended the nephrology clinic, where microscopic hematuria was confirmed in 40 women (61%). Renal imaging results were normal in all except 1 woman, and all women had a serum creatinine level of 0.90 mg/dL or less (< or =80 micromol/L). The development of preeclampsia or gestational hypertension or delivery of a small-for-gestational-age baby were similar in women with and without dipstick hematuria. Microscopic hematuria persisted in half (15 women) of those who attended for follow-up after 3 months postpartum. CONCLUSION: Dipstick hematuria is very common during pregnancy, but rarely signifies a disorder likely to impact on the pregnancy outcome. Postpartum follow-up is recommended to detect women who have persistent hematuria and presumed underlying mild glomerulonephritis.

Lecithin decreases human milk fat loss during enteral pumping.

BACKGROUND: The fat content of human milk provides the majority of calories for infants. However, large fat losses in human milk have been observed using enteral pump systems, causing poor growth in infants. The fat may adhere in the pump system. Lecithin, a phospholipid, has been used in the food industry as a lipophilic emulsifier of fats. OBJECTIVE: The purpose of this study was to evaluate the effects of lecithin on the delivery of human milk fat from an enteral pump. It is hypothesized that the addition of lecithin would decrease the fat loss during human milk delivery. METHODS: Six mothers at a mature stage of lactation (>4 weeks of lactation) donated human milk. The human milk samples were stored separately at -20 degrees C before analysis and evaluated individually. The fat content of the milk samples was estimated by the creamatocrit method, in which the samples were centrifuged in a standard hematocrit tube and the fat layer read with vernier calipers and expressed as a percentage of the length of the milk column to the nearest 0.5%. The accuracy of this method is 92%. The Kangaroo 324 Feeding Pump (Sherwood Medical, St. Louis, MO) was used as the continuous pump system. The human milk samples were divided into either control samples without lecithin or with lecithin (1 or 0.5 g soy lecithin dissolved in 50 mL milk). All samples were pumped at 10 to 50 mL/h for at least 4 hours. The pumped milk was collected in an iced container, and creamatocrits were determined in duplicate. RESULTS: There was significant fat loss in the control milk samples compared with the milk samples with added lecithin. The average fat loss was 58% +/- 13% for control samples and 55% +/- 26% for the milk with 0.5 g soy lecithin. Milk with 1 g soy lecithin averaged 2% +/- 2% fat loss. The pumping rate had no effect on fat loss. The greatest fat loss (70% +/- 6%)occurred during the first 4 hours of pumping. CONCLUSIONS: The addition of 1 g soy lecithin per 50 mL milk decreased the human milk fat loss during intermittent pumping and may help infants receive more calories from human milk administered by pump.

The clinical utility of routine urinalysis in pregnancy: a prospective study.

OBJECTIVES: To determine whether routine urinalysis in the antenatal period facilitates diagnosis of pre-eclampsia. Can routine urinalysis during pregnancy be discontinued in women with normal results of dipstick urinalysis and microscopy at the first antenatal visit? DESIGN: Prospective observational study. SETTING: A metropolitan public hospital and a private hospital in Sydney (NSW). PARTICIPANTS: One thousand women were enrolled at their first antenatal visit (March to November 1999), and 913 completed the study. OUTCOME MEASURES: The primary outcome was a diagnosis of de novo hypertension (gestational hypertension, pre-eclampsia, or pre-eclampsia superimposed on chronic hypertension). RESULTS: Thirty-five women had dipstick proteinuria at their first antenatal visit. In 25 (71%) of these women, further dipstick proteinuria was detected during pregnancy, and two (6%) were diagnosed with pre-eclampsia. Of the 867 without dipstick proteinuria at the first visit, 338 (39%) had dipstick proteinuria (> 1+) at some time during pregnancy. There were no statistically significant differences in the proportion of women with and without dipstick proteinuria at their first visit who developed hypertension during pregnancy. Only six women developed proteinuria before the onset of hypertension. Women who had an abnormal result of a midstream urine test at their first visit, compared with women with a normal result, were more likely to have a urinary tract infection diagnosed during pregnancy; however, the numbers were small. CONCLUSION: In the absence of hypertension, routine urinalysis during pregnancy is a poor predictor of pre-eclampsia. Therefore, after an initial screening urinalysis, routine urinalysis could be eliminated from antenatal care without adverse outcomes for women.