http://hdl.handle.net/2139/9925 BioMed Central Wed, 22 May 2013 13:23:49 GMT 2013-05-22T13:23:49Z http://hdl.handle.net/2139/13733 Is the Advanced Pediatric Life Support formula used to calculate weight-for-age applicable to a Trinidadian population? Ali, Khalid; Sammy, Ian; Nunes, Paula Abstract Background In paediatric emergency medicine, estimation of weight in ill children can be performed in a variety of ways. Calculation using the ‘APLS’ formula (weight = [age + 4] × 2) is one very common method. Studies on its validity in developed countries suggest that it tends to under-estimate the weight of children, potentially leading to errors in drug and fluid administration. The formula is not validated in Trinidad and Tobago, where it is routinely used to calculate weight in paediatric resuscitation. Methods Over a six-week period in January 2009, all children one to five years old presenting to the Emergency Department were weighed. Their measured weights were compared to their estimated weights as calculated using the APLS formula, the Luscombe and Owens formula and a “best fit” formula derived (then simplified) from linear regression analysis of the measured weights. Results The APLS formula underestimated weight in all age groups with a mean difference of −1.4 kg (95% limits of agreement 5.0 to −7.8). The Luscombe and Owens formula was more accurate in predicting weight than the APLS formula, with a mean difference of −0.4 kg (95% limits of agreement 6.9 to −6.1%). Using linear regression analysis, and simplifying the derived equation, the best formula to describe weight and age was (weight = [2.5 x age] + 8). The percentage of children whose actual weight fell within 10% of the calculated weights using any of the three formulae was not significantly different. Conclusions The APLS formula slightly underestimates the weights of children in Trinidad, although this is less than in similar studies in developed countries. Both the Luscombe and Owens formula and the formula derived from the results of this study give a better estimate of the measured weight of children in Trinidad. However, the accuracy and precision of all three formulae were not significantly different from each other. It is recommended that the APLS formula should continue to be used to estimate the weight of children in resuscitation situations in Trinidad, as it is well known, easy to calculate and widely taught in this setting. Thu, 02 Aug 2012 00:00:00 GMT http://hdl.handle.net/2139/13733 2012-08-02T00:00:00Z http://hdl.handle.net/2139/13697 Cognitive behavioural therapy (CBT) for anxiety in people with dementia: study protocol for a randomised controlled trial Spector, Aimee; Orrell, Martin; Lattimer, Miles; Hoe, Juanita; King, Michael; Harwood, Kate; Qazi, Afifa; Charlesworth, Georgina Abstract Background Many people with dementia experience anxiety, which can lead to decreased independence, relationship difficulties and increased admittance to care homes. Anxiety is often treated with antipsychotic medication, which has limited efficacy and serious side effects. Cognitive behavioural therapy (CBT) is widely used to treat anxiety in a range of populations, yet no RCTs on CBT for anxiety in dementia exist. This study aims to develop a CBT for anxiety in dementia manual and to determine its feasibility in a pilot RCT. Methods/design Phase I involves the development of a CBT for anxiety in dementia manual, through a process of (1) focus groups, (2) comprehensive literature reviews, (3) expert consultation, (4) a consensus conference and (5) field testing. Phase II involves the evaluation of the manual with 50 participants with mild to moderate dementia and anxiety (and their carers) in a pilot, two-armed RCT. Participants will receive either ten sessions of CBT or treatment as usual. Primary outcome measures are anxiety and costs. Secondary outcome measures are participant quality of life, behavioural disturbance, cognition, depression, mood and perceived relationship with the carer, and carer mood and perceived relationship with the person with dementia. Measures will be administered at baseline, 15 weeks and 6 months. Approximately 12 qualitative interviews will be used to gather service-users' perspectives on the intervention. Discussion This study aims to determine the feasibility of CBT for people with anxiety and dementia and provide data on the effect size of the intervention in order to conduct a power analysis for a definitive RCT. The manual will be revised according to qualitative and quantitative findings. Its publication will enable its availability throughout the NHS and beyond. Trial registration ISRCTN64806852 Tue, 23 Oct 2012 00:00:00 GMT http://hdl.handle.net/2139/13697 2012-10-23T00:00:00Z http://hdl.handle.net/2139/13141 Identification of a novel cytosolic aldehyde dehydrogenase allele, ALDHIAI*4 Moore, Shelley M; Liang, Tiebing; Graves, Tamara J; McCall, Kevin M; Carr, Lucinda G; Ehlers, Cindy L Abstract This paper reports the identification of a novel cytosolic aldehyde dehydrogenase 1 (ALDHIAI) allele. One hundred and sixty-two Indo-Trinidadian and 85 Afro-Trinidadian individuals were genotyped. A novel ALDHIAI allele, ALDHIAI*4, was identified in an Indo-Trinidadian alcoholic with an A inserted at position -554 relative to the translational start site, +1. It was concluded that a wider cross-section of individuals needs to be evaluated in order to determine the representative frequency of the allele, and to see if it is associated with risk of alcoholism. Wed, 01 Jul 2009 00:00:00 GMT http://hdl.handle.net/2139/13141 2009-07-01T00:00:00Z http://hdl.handle.net/2139/12898 Does insulin resistance co-exist with glucocorticoid resistance in the Metabolic Syndrome? Studies comparing skin sensitivity to glucocorticoids in individuals with and without acanthosis nigricans Teelucksingh, Surujpal; Jaimungal, Sarada; Pinto Pereira, Lexley; Seemungal, Terence; Nayak, Shivananda Abstract Background The metabolic syndrome is associated with increased risk for both diabetes and coronary artery disease, which insulin resistance alone does not satisfactorily explain. We propose an additional and complementary underlying mechanism of glucocorticoid resistance. Results Using acanthosis nigricans (AN) and skin vasoconstrictor (SVC) response to topically applied beclomethasone dipropionate as markers of insulin and glucocorticoid resistance, respectively, we compared anthropometric, biochemical, pro-inflammatory markers and the SVC response in subjects with AN in two studies: STUDY 1 was used to compare subjects with AN (Grade 4, n = 32), with those without AN (n = 68) while STUDY 2 compared these responses among a cross-section of diabetic patients (n = 109) with varying grades of AN (grade 0, n = 30; grade 1, n = 24; grade 2, n = 18; grade 3, n = 25; grade 4, n = 12). Findings In both studies there was an inverse relationship between AN Grade 4 and the SVC response, (P < 0.001). In STUDY 1, AN Grade 4 was associated with age, waist circumference, BMI, fasting blood glucose, plasma lipids and hs-CRP (P < 0.05). SVC was an independent predictor of CRP and those with combined AN and a negative SVC response, CRP levels were highest. In Study 2 when the SVC response in subjects with type 2 diabetes mellitus with varying degrees of AN was studied, it showed that for any degree of AN, the SVC response is more likely to be negative and was independent of gender and ethnicity. Conclusion An absent SVC response represents a new biomarker for the metabolic syndrome and the exaggerated inflammatory response, which characterizes the metabolic syndrome, may be an outcome of deficient glucocorticoid action in vascular tissue. Fri, 30 Mar 2012 00:00:00 GMT http://hdl.handle.net/2139/12898 2012-03-30T00:00:00Z