Publications
238 results found
Raynor P, Rudolf MCJ, Cooper K, et al., 1999, A randomised controlled trial of specialist health visitor intervention for failure to thrive, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 80, Pages: 500-505, ISSN: 0003-9888
- Author Web Link
- Cite
- Citations: 30
Polnay J, Blair M, 1999, A Model Programme for Busy Learners, Child Abuse Review, Vol: 8, Pages: 284-288
Hampshire AJ, Blair ME, Crown NS, et al., 1999, Is pre-school child health surveillance an effective means of detecting key physical abnormalities?, British Journal of General Practice, Vol: 49, Pages: 630-633, ISSN: 0960-1643
Blair M, 1999, A randomised controlled trial of specialist health visitor intervention for failure to thrive - Commentary, Archives of Disease in Childhood, Vol: 80, ISSN: 0003-9888
Hampshire AJ, Blair ME, Crown NS, et al., 1999, Are child health surveillance reviews just routine examinations of normal children, British Journal of General Practice, Vol: 49, Pages: 981-985, ISSN: 0960-1643
BACKGROUND: The provision and content of child health surveillance (CHS) has changed greatly since 1990. However, its value continues to be questioned. The introduction of the personal child health record (PCHR) has provided a new means of collecting data about CHS. AIM: To identify what problems are recorded at CHS reviews in the PCHR during the first year of life, and what follow-up/referrals result directly from these reviews. METHOD: A total of 28 practices were recruited from one health authority. All babies born to mothers registered with study practices during one year were followed up. Health visitors returned copies of CHS reviews recorded in children’s PCHRs. Written comments on returned reviews were analysed. RESULTS: In all, 2308 babies were entered into the study and 2001 (87%) were followed up for one year. A total of 7848 (78%) CHS reviews were returned. Physical problems were recorded in 58% of children at the 10-14 day, 35% at the six to eight week, and 39% at the six to nine month review. Of physical problems recorded at CHS reviews, 30% required follow-up in primary care and 7% required referral to hospital. Other problems were recorded less frequently and health promotion was recorded at only 7.5% of CHS reviews. CONCLUSION: Child health surveillance provides important opportunities to discuss problems that may cause parental concern and to identify children requiring treatment or follow-up. The design and use of the PCHR needs to change to reflect increasing emphasis on health promotion.
Raynor P, Rudolf MC, Cooper K, et al., 1999, A randomised controlled trial of specialist health visitor intervention for failure to thrive., Archives of disease in childhood, Vol: 80, Pages: 500-506, ISSN: 0003-9888
AIMS: To determine whether home intervention by a specialist health visitor affects the outcome of children with failure to thrive. METHODS: Children referred for failure to thrive were randomised to receive conventional care, or conventional care and additional specialist home visiting for 12 months. Outcomes measured were growth, diet, use of health care resources, and Bayley, HAD (hospital anxiety and depression), and behavioural scales. RESULTS: Eighty three children, aged 4-30 months, were enrolled, 42 received specialist health visitor intervention. Children in both groups showed good weight gain (mean (SD) increase in weight SD score for the specialist health visitor intervention group 0.59 (0.63) v 0.42 (0.62) for the control group). Children < 12 months in the intervention group showed a higher mean (SD) increase in weight SD score than the control group (0.82 (0.86) v 0.42 (0.79)). Both groups improved in developmental score and energy intake. No significant differences were found for the primary outcome measures, but controls had significantly more dietary referrals, social service involvement, and hospital admissions, and were less compliant with appointments. CONCLUSIONS: The study failed to show that specialist health visitor intervention conferred additional benefits for the child. However, the specialist health visitor did provide a more coordinated approach, with significant savings in terms of health service use. Problems inherent to health service research are discussed.
Hampshire A, Blair M, Crown N, et al., 1999, Action research: A useful method of promoting change in primary care?, Family Practice, Vol: 16, Pages: 305-311, ISSN: 0263-2136
BACKGROUND: Action research has been used successfully to promote change in disciplines other than medicine, but there are few examples of its use in primary care. OBJECTIVE: We aimed to discuss the benefits and difficulties of using action research in primary care using the example of child health surveillance provision in general practice. METHODS: Twenty-eight general practices were randomly allocated into two groups. Action research was used to promote change in 14 practices by facilitating practice meetings and by providing written feedback. The other 14 practices received written feedback alone. The two groups of practices were compared using the following: (i) semi-structured interviews with one health visitor and GP from each practice; (ii) observation of baby clinics; (iii) questionnaires to parents; and (iv) return rates of child health surveillance reviews from the personal child health record. RESULTS: All 14 practices in the action research arm of the study met as individual practice teams and decided to make changes to their provision of child health surveillance. Ten practices audited their child health surveillance as a result. More health visitors in the action research practices than in the comparison practices reported changes to child health surveillance, audit, communication and use of the personal child health record. The majority of health visitors and GPs thought involvement in the action research process was beneficial. However, we were unable to show a statistically significant difference between the two groups of practices in baby clinic provision, parent satisfaction or the return rate of child health surveillance reviews. CONCLUSION: Our study suggests that action research is a successful method of promoting change in primary care. However, measuring the impact of change is difficult.
Blair M, Walker DA, 1998, Development and use of a weighted checklist for assessing clinical skills in medical undergraduates studying paediatrics and child health, Ambulatory Child Health, Vol: 4, Pages: 407-413, ISSN: 1355-5626
Aims. To develop and evaluate a weighted checklist for the assessment of paediatric undergraduates' ability to take an accurate and relevant clinical history and perform a physical exam, as part of the assessment within the undergraduate training in paediatrics and child health at the University of Nottingham, UK. Method. A weighted checklist was developed as a criteria based, formative training and assessment tool for clinical skills in paediatric undergraduates. One hundred and forty-eight undergraduate long case presentations were assessed using the checklist in parallel with the existing system. Seventy-four candidates were assessed before and 74 were assessed after being introduced to the list as part of formal training in history taking and examination techniques. The impact of introducing the checklist to the students was assessed by comparing 'final scores', arrived at by the established method with scores it generated, before and after its introduction to the students. Results. The weighted checklist was found to be acceptable to examiners, valuable for formative and summative assessment, and useful for student feedback. There was a significantly increased median checklist score in the group who had been introduced to the system when compared to those who had not (pre-median, 50; range, 23-78; post-median, 58; range, 22-80, p = 0.022); and a failed student was better predicted after its introduction, than previously. Conclusion. Introduction of the weighted checklist to the course has resulted in improved examination performance in history taking and physical examination technique. It provided a method for individual student feedback and helped influence course development, and could easily be adapted to meet the needs of training and assessment in other areas of undergraduate and postgraduate medical training.
Burton G, Blair M, Crown N, 1998, A new look at the health and homeless experience of a cohort of five-year olds, Children & Society, Vol: 12, Pages: 349-358, ISSN: 0951-0605
Burton G, Blair M, Park N, et al., 1998, A New Look at the Health and Homeless Experience of a Cohort of Five-year Olds, Children & Society, Vol: 12, Pages: 349-358, ISSN: 0951-0605
Nathan D, Blair M, 1997, Computer aided learning and paediatric education, Ambulatory Child Health, Vol: 3, Pages: 199-204, ISSN: 1355-5626
The trend towards student centred learning and the incorporation of geographically diverse teaching centres, as the number of students has increased over time, has resulted in a number of innovative teaching methods. The advent of progressively cheaper and more powerful computers, together with an increasingly computer literate student body, has produced a demand for computer based teaching. We describe the use of computer aided learning within paediatric undergraduate education. The principles are also applicable to postgraduates. The report is a summation of our experiences in developing our own CAL packages and provides advice for those devising their own packages.
Nathan D, Blair M, Maynard P, 1997, A novel smoking cessation programme in 13- to 14-year-old schoolchildren, Ambulatory Child Health, Vol: 3, Pages: 231-239, ISSN: 1355-5626
Objectives. To establish the prevalence of smoking in 13-14-year-olds and ascertain where they obtain their cigarettes. To initiate an intervention programme based on peer support, focused health education and self-generated health promotion material which aimed to reduce the prevalence of smokers. Design and setting. Questionnaire administered to 115 13-14-year-olds from a comprehensive school in an area of urban deprivation to establish the prevalence of smoking by self-report, attitudes and source of cigarettes. Salivary cotinine validation. Interventions. (1) Teacher incorporating anti-smoking lectures in the curriculum; (2) student generated health promotion material based on existing Health Education Council information; (3) modification of peer pressure by competition between tutor sets; and (4) confidential weekly quit smoking counsellor sessions concurrently conducted within the school. The teenagers themselves regularly monitored the prevalence of smokers. Results. Of the 107 respondents, 86 agreed to cotinine screening. Of the 86, 27 (31.4%) reported regular smoking. Most obtained cigarettes from friends (12), followed by local shops (9), supermarkets (3), machines (2) and parents (1). They were screened prior to intervention, and 3 and 8 months later by confidential self-reported questionnaire. All 86 (100%) completed the project at 3 months. Of the 27 smokers, 8 gave up, 4 smoked less and 7 smoked more, with no change in the remainder. Two new smokers started over that period, thus giving a reduction in group prevalence of 7% (-0.1% to 14.1%; 95% confidence interval) with 12 of the 27 reducing or stopping. Follow-up at 8 months demonstrated a rise in prevalence compared to the 3 month values but remained lower than the original prevalence. Conclusion. This is an acceptable method of determining the prevalence of smokers and the intervention was successful in reducing prevalence in the short term. A larger study is needed to validate these findings.
Glaser A, Nathan D, Blair M, 1997, Childhood developmental examination: a novel approach to teaching, Medical Education, Vol: 31, Pages: 272-275
Blair M, Horn N, Polnay L, 1997, General practitioners use of hospital and community based paediatric out-patient services in Nottingham, Public Health, Vol: 111, Pages: 97-100, ISSN: 0033-3506
The paper compares and contrasts the referral patterns of general practitioners in Nottingham for paediatric specialist opinion in a hospital and community setting. Data were collected from case notes review and medical activity data returns on 100 consecutive referrals made by GPs to a hospital paediatric consultant out-patient clinical and 100 consecutive referrals to a community based consultant clinic. Multiple diagnoses are more commonly made and recorded by community based paediatricians with a bias towards behavioural, nutrition, growth and neurodevelopmental problems. Hospital clinic staff made more system and disease based diagnoses with more investigations arranged than the community staff [53 cf. 15 (OR 6.39, 95% CI; 3.25-12.55, P = < 0.0001)]. More children under five were seen in the community clinic sample compared to the hospital sample [75 cf. 57 under fives (OR 2.26, 95% CI; 1.24-4.13, P = 0.01)]. Patients are more likely to be discharged from the hospital clinic than the community clinic after the initial visit. [59 cf. 33 (OR 2.92, 95% CI; 1.64-5.20, P = 0.0004)]. Costs per new case consultation were substantially less in the community clinic than the hospital setting. A broadly similar range of clinic problems are referred to both hospital and community based paediatricians in Nottingham. The educational and liaison value of local community paediatric clinics together with relatively easier access by parents and lower per case costs is an advantage. Commissioners of paediatric and child health services need to take into consideration these factors when purchasing out-patient specialist paediatric opinion. Further research is required into the quality and desirability of these developments.
Blair M, Horn N, Polnay L, 1997, General practitioners use of hospital and community based paediatric out-patient services in Nottingham, Public Health, Vol: 111, Pages: 97-100, ISSN: 0033-3506
Blair M, 1996, Poverty and child health - Spencer,N, PUBLIC HEALTH, Vol: 110, Pages: 388-388, ISSN: 0033-3506
Polnay L, Blair M, Horn N, et al., 1996, Manual of Community Paediatrics, Publisher: Churchill Livingstone
Hutter CD, Blair ME, 1996, Carbon monoxide–does fetal exposure cause sudden infant death syndrome?, Medical hypotheses, Vol: 46, Pages: 1-4
The epidemiological features of sudden infant death syndrome (cot death) include a peak incidence between 8 and 13 weeks of age, a time of death or conception occurring during the winter months and an excess of deaths in infants born to young multiparous women of low socioeconomic status who smoke. We suggest that, through hypoxia, carbon monoxide in tobacco smoke and in the home exerts a noxious effect on the developing central respiratory control mechanism of the fetal brain which then remains particularly susceptible to further insults in the early postnatal period from infection and hyperthermia, resulting in death from central respiratory dysfunction.
Wreghitt T, Behr S, Hodson J, et al., 1995, Gourmet lunches boost staff morale, Lancet, Vol: 346, Pages: 1716-1716, ISSN: 0140-6736
Walker DA, Stephenson T, Blair M, 1995, Child health education for the year 2000., Archives of disease in childhood, Vol: 73, Pages: 261-263, ISSN: 0003-9888
Glaser A, Blair M, 1995, Gourmet lunches boost staff morale, Lancet, Vol: 346, ISSN: 0140-6736
Blair M, 1995, NHS information strategy and its impact on child health., Archives of disease in childhood, Vol: 72, Pages: 355-357, ISSN: 0003-9888
Blair M, Billingham K, 1993, Information, children and power, Primary Health Care, Vol: 3, Pages: 14-15, ISSN: 0264-5033
MacMahon P, Mayne PD, Blair M, et al., 1990, Calcium and phosphorus solubility in neonatal intravenous feeding solutions., Archives of disease in childhood, Vol: 65, Pages: 352-353, ISSN: 0003-9888
The limited solubility of calcium and phosphorus in standard parenteral nutrition formulations has restricted the ability to provide sufficient minerals to preterm infants to prevent substrate deficient metabolic bone disease. We determined the solubility limits of calcium and phosphorus in a total of 160 formulations under carefully controlled conditions. By increasing the concentrations of dextrose, amino acids, and by using Addiphos instead of 8.7% dipotassium hydrogen phosphate as the phosphorus source, higher concentrations of both calcium and phosphorus were held in solution. This should permit the delivery of increased concentrations of these minerals at rates which approximate fetal accretion.
MacMahon P, Mayne PD, Blair M, et al., 1990, Acid-base state of the preterm infant and the formulation of intravenous feeding solutions., Archives of disease in childhood, Vol: 65, Pages: 354-356, ISSN: 0003-9888
An acidic intravenous source of phosphorus (Addiphos) was compared with dipotassium hydrogen phosphate in 25 preterm infants to study acid-base state. Eight infants were given either Addiphos or dipotassium hydrogen phosphate alternately for 48 hour periods and similar amounts of calcium and phosphorus were delivered. There were no significant differences in calcium and phosphorus intake, calcium and phosphate plasma concentrations, or acid-base state between study periods on the two solutions. Seventeen infants were given the two solutions alternately for 72 hour periods; Addiphos was used to increase the amounts of calcium and phosphorus being delivered. Calcium and phosphorus intake was decreased on dipotassium hydrogen phosphate, but Addiphos significantly increased calcium and phosphorus intake and plasma calcium and phosphate concentrations. It also lowered the pH of the urine and raised the titratable acidity. Acid-base state, however, was not significantly different. It is therefore possible to increase intake of calcium and phosphorus in preterm infants without causing a significant metabolic acidosis.
Macmahon P, Blair M, Kovar I, 1989, Hypothyroidism and unusual rickets in a very preterm infant., Postgraduate medical journal, Vol: 65, Pages: 312-315, ISSN: 0032-5473
Two separate episodes of rickets developed in a female infant of 25 weeks gestation and birthweight 690 g, who had congenital hypothyroidism and required parenteral nutrition for more than 100 days. We speculate that there is a relationship between metabolic bone disease of prematurity and the preterm infant’s thyroid status.
MacMahon P, Blair ME, Treweeke P, et al., 1989, Association of mineral composition of neonatal intravenous feeding solutions and metabolic bone disease of prematurity., Archives of disease in childhood, Vol: 64, Pages: 489-493, ISSN: 0003-9888
To assess the effects of increasing the mineral content of parenteral nutrition solutions on the biochemical and radiological indicators of metabolic bone disease of prematurity 27 neonates who required parenteral nutrition were sequentially allocated to receive either a standard solution (group 1) or one with an increased mineral content (group 2). The 13 patients in group 1 received 0.68 mmol/kg/day of calcium and 0.61 mmol/kg/day of phosphorus, and the 14 in group 2 received 1.25 and 1.20 mmol/kg/day, respectively. The two groups did not differ significantly in the severity of their illness measured by birth weight, gestational age, duration of parenteral nutrition or ventilation, or the amount of supplementary oxygen required. In patients in group 2 the median plasma phosphate concentration was higher, the plasma alkaline phosphatase activity was lower, and there was less radiological evidence of rickets. There were no complications caused by excess calcium and phosphorus, and the rate of growth was similar in both groups. We conclude that an increased mineral content in parenteral nutrition solutions reduces the severity of metabolic bone disease in sick infants who require this form of nutrition.
MacMahon I, 1989, Hydrogen Ion (H)* Load and Calcium Phosphate Solubility in IV Nutrition and the Preterm Infant (PTI), Paediatric Research, Vol: 26, Pages: 507-507
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.