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Background: Clinical vital signs in children (temperature, heart rate, respiration rate, and blood pressure) are an integral part of clinical assessment of degree of illness or normality. Despite this, only blood pressure and temperature have a reliable evidence base. The accepted ranges of heart and respiration rate vary widely. Methods: This study examined 1109 children aged 4–16 years in their own schools. Age, sex, height, weight, and resting respiration rate and heart rate were recorded. The data were used to produce age related reference ranges for everyday clinical use. Results: Reference intervals are presented for the range of heart rate and respiration rate of healthy resting children aged 4–16 years. The recorded values are at variance with standard quoted ranges in currently available texts.

This study examined the relative anti-Parkinson's disease (PD) tremor potencies of pergolide and pramipexole in people with PD, using a 3-month double-blind cross-over design. Patients were randomly assigned to receive either pergolide and then pramipexole (n = 9) or vice versa (n = 8). The dose of the respective dopamine agonist was increased according to a titration schedule up to a maximum 1.5 mg t.d.s., with cross-over at 10 weeks. Assessments were performed at baseline, 4, 8 and 12 weeks. The primary outcome measures were the differences in the clinical (rest and postural) tremor scores on pergolide versus pramipexole. Seventeen PD patients (11 females and six males) with a mean age 68.4 years (range: 55-84 years) and a mean disease duration of 3.9 years (range: 2 months to 13 years) participated in the study. Twelve of the patients were taking other anti-parkinsonian medications. Two patients dropped out of the study whilst on pergolide. Fifteen of 16 patients were able to cross-over from one dopamine agonist to the other, without major retitration. There were no significant differences between the effects of the two drugs on the primary outcome measures, suggesting that the anti-PD tremor efficacies of dopaminergic medications are not dependent on differential affinities for dopamine receptor types.

Background: Clinical databases are being used increasingly to assess outcomes in healthcare services to provide evidence of clinical effectiveness in routine clinical practice. Objectives: To explore the benefits of a database for routine collection of clinical outcomes within an inpatient neurorehabilitation setting; determine the effectiveness of inpatient neurorehabilitation in a range of neurological conditions; and determine variables influencing change in functional outcome. Methods: Over a nine year period, demographic and diagnostic characteristics were collected for the 1458 patients admitted consecutively to a neurorehabilitation unit. The level of function was measured on admission and discharge using the Barthel Index (BI) and Functional Independence Measure (FIM). Patient perception of rehabilitation benefit was evaluated using visual analogue scales (VAS). Results: Of the 1413 patients (mean (SD) age 48 (14.8), range 16 to 87) whose length of stay was more than 10 days (mean 34 (24) range 10 to 184), 282 had stroke, 614 multiple sclerosis, 248 spinal cord injuries, 93 a neuromuscular condition, and 176 other brain pathology. Patients improved in functional ability as measured by both BI and the FIM motor subscale (effect sizes 0.93 to 1.44 and 1.01 to 1.48, respectively). VAS ratings demonstrated high levels of patient perceived benefit. Diagnosis, functional activity score on admission, and length of stay were significant predictors of functional gain, explaining 44% of the variability in the change scores. Conclusions: Systematic collection, analysis, and interpretation of standardised clinical outcomes data are feasible within routine clinical practice, and provide evidence that inpatient rehabilitation is effective in improving functional level in neurologically impaired patients. These data complement those of clinical trials and are useful in informing and developing clinical and research practice.

Clostridium difficile is the main infectious cause of colitis in hospital inpatients. The incidence is increasing, and it is associated with significant mortality, morbidity, and increased length of stay. The main risk factor is use of broad-spectrum antibiotics, and antibiotic restriction is the most effective control measure. We carried out a retrospective case-control study to investigate whether use of proton pump inhibitors (PPI) was an additional risk factor. PPI use within the preceding eight weeks was associated with an increased risk of C. difficile diarrhoea (odds ratio 2.5, 95% CI 1.5-4.2). Reduction of unnecessary PPI use may be an additional strategy to reduce the incidence of this infection.