Cost-effectiveness of gastrostomy placement for children with neurodevelopmental disability.

INTRODUCTION: Malnutrition and growth deficiency are common in neurologically impaired children. Gastrostomy placement has been shown to result in significant catch-up growth, improved health of the child and reduction in family stress; its cost-effectiveness has not been investigated. AIMS: Costs related to gastrostomy placement are estimated here from a prospective controlled study of children referred to a tertiary paediatric centre in the UK. METHODS: Costs of inpatient stay, medication, tests, general practitioner consultations, community healthcare, equipment, and parents' indirect costs were estimated at baseline and follow-up. Costs of the different types of gastrostomy surgery are given. RESULTS: Results for both time periods were available for 54 of the 76 children recruited to the study. Five-day food diaries were kept at baseline and follow-up. Costs of food increased slightly but not significantly post surgery from pound sterling 33 to pound sterling 40 (Euro 44 to Euro 54, US$65 to US$78) per week. Variation in cost between cases was considerable but the mean net cost difference of pound sterling 20.80 (CI - pound sterling 43.79 to pound sterling 85.35) (Euro 28 (CI Euro-59 to Euro 115), US$41 (CI US$-86 to US$167)) per week per child including for food and surgery, was also not significant. Community service costs were significantly lower post surgery. Few parents reported personal costs at either time point, although many had reduced or stopped paid work to care for the child. CONCLUSION: As gastrostomy placement for these children resulted in significant clinical benefit at no significant extra cost, it is concluded that the procedure is cost-effective.

Evaluating the impact of primary care consultations on teenage lifestyle: a pilot study.

This study piloted an evaluation of the effectiveness of inviting teenagers to UK general practice consultations with health behaviour advice and appropriate follow-up care. 132 teenagers aged 14/15 years were randomised: intervention teenagers were invited to attend a health consultation with a practice nurse, the control group received usual care. Teenagers in two practices were consulted by postal survey and in focus groups to ensure the intervention met their needs. 56% of the teenagers invited attended for a consultation. 55% of the intervention group and 45% of the controls reported some positive change in health related behaviour at one month.

Clindamycin versus metronidazole in the treatment of bacterial vaginosis.

One hundred forty-three women with complaints of vaginitis were assigned to receive either 500 mg of metronidazole twice daily for 7 days or clindamycin 300 mg twice daily for 7 days. There was no significant difference in the failure rate between patients treated with clindamycin (6.1%) and those treated with metronidazole (4%). Adverse reactions were infrequent and mild in both treatment groups. Three patients who received clindamycin developed non-bloody diarrhea, which was mild and did not necessitate discontinuing therapy. We conclude that clindamycin may be a safe and effective alternative to metronidazole for treating women with bacterial vaginosis.

Hepatic encephalopathy: a retrospective analysis.

A review of 34 patients was conducted to investigate the causes of hepatic encephalopathy. Hypokalemia, infection, and gastrointestinal tract bleeding were found to be the usual precipitating factors. Women are affected more commonly, and gastrointestinal tract hemorrhage is usually the terminal event.

Parathyroid adenoma and light chain myeloma.

An elderly patient with simultaneous hyperparathyroidism and light chain myeloma is described. The patient presented with hypercalcemia, bone pain, pathologic fractures, and cystic and lytic bone lesions. The problems of diagnosis and management are discussed. It is recommended that elderly patients with hypercalcemia and bone lesions should have not only diagnostic studies for hyperparathyroidism but also serum and urine immunoelectrophoresis to detect multiple myeloma or plasma cell neoplastic variants. Surgery is indicated for the hyperparathyroidism. Chemotherapy and localized radiotherapy usually control the myelomatous disease.

Ischaemic heart disease mortality risks for smokers and non-smokers.

Although many studies have shown that smoking is associated with an increased risk of death from ischaemic heart disease (IHD), and that the increase appears to vary with age and amount smoked, there has been little formal specification or estimation of the relationship. In this paper two alternative models are tested, using data for different ages and levels of smoking from four major studies in three countries. One model explains 80% of the variation in mortality in terms of a positive linear function of the number of cigerettes smoked, the parameters of which decrease with age. We estimate that every cigerette smoked per day increases the risk of dying from IHD by as much as 35% at ages 35 to 44, reducing to 2% at ages 65 to 74. The risk attributable to smoking may account for more than 80% of IHD deaths of men aged 35 to 44, and 27% of those of men aged 45 to 64. Although the relative risk is highest for younger age groups, the absolute risk of death from IHD that is attributable to smoking increases with age. The evidence suggests that both are increasing with time.

Blood chemistry abnormalities in bacterial endocarditis of narcotic addicts.

We recently treated two narcotic addicts with bacterial endocarditis who developed the syndrome of inappropriate antidiuretic hormone secretion (SIADH). This prompted a retrospective review of blood chemistry studies in all narcotic addicts admitted to our hospital over a 30-month period because of a clinical suspicion of bacterial endocarditis. Patients with culture-positive endocarditis (group 1) had significantly lower plasma osmolality, sodium, calcium and albumin values (P less than .02, .001, .005, and .005 respectively) than addicts without endocarditis (group 2). More than 90% of those in group 1 had hyponatremia, and 48% had plasma hypoosmolality. These findings may be of value in the initial evaluation of ill narcotic addicts for hospitalization.

Bacterial endocarditis in narcotic addicts: analysis of arterial blood gases.

We studied the arterial blood gas determinations done on the first hospital day in 14 narcotic addicts with bacterial endocarditis (group 1) and six addicts with other medical complications of narcotic addiction (group 2). The arterial oxygen tension (PaO2) was 67.3 +/- 3.3 mm Hg (SEM) in group 1, and 75.0 +/- 6.4 mm Hg in group 2, with no statistically significant difference (P less than .20) between the groups. The arterial CO2 tension (PaCO2), 27.8 +/- 1.7 mm Hg, in group 1 was significantly lower (P less than .005) than that of group 2, 40.1 +/- 3.7 mm Hg. The arterial blood pH, 7.47 +/- 0.01 units, in group 1 was significantly higher (P less than .025) than that of group 2, 7.36 +/- 0.06 pH units. Abnormal blood gas values were found in each of the patients in group 1 with a normal admission chest roentgenogram. Arterial blood gas determinations may be useful in the initial examination of ill narcotic addicts.