Functional assessment tools for paediatric clients with Juvenile Chronic Arthritis: An update and review for occupational therapists

Juvenile chronic arthritis (JCA) is one cause of chronic illness and disability in childhood. Traditional clinical assessment of clients with JCA include objective measures of joint deformity, joint swelling, range of motion, duration of morning stiffness, pain, walking speed, running speed and muscle strength. In many instances, these traditional measures have little or no significance or relevance to paediatric clients and their parents whereas functional skills used in everyday living are more likely to be meaningful. Measures of physical, social, and psychological functioning ensure a comprehensive health assessment. Responsible occupational therapy assessment and management of paediatric clients diagnosed with JCA requires the use of reliable, valid and sensitive measures of function. Several instruments are now available which measure a child's or adolescent's functional abilities. In this paper, JCA and the impact of JCA on functional development are reviewed. As well, seven functional assessment tools designed for use with paediatric clients with JCA which occupational therapists can use in their clinical practice will be appraised. The various characteristics of these tools are discussed in order to assist practitioners and researchers in selecting the functional instrument which best meets their needs.

Update on intrapartum fetal pulse oximetry

This article examines the current status of fetal pulse oximetry (FPO) as a means of intrapartum assessment of fetal wellbeing. FPO has been developed to a stage where it is a safe and accurate indicator of intrapartum fetal oxygenation. In general, sliding the FPO sensor along the examiner's fingers and through the cervix, to lie alongside the fetal cheek or temple is easy The recent publication of a randomised controlled trial (RCT) of FPO versus conventional intrapartum monitoring has validated its use to reduce caesarean section rates for nonreassuring fetal status. An Australian multicentre RCT is currently underway. Maternal satisfaction rates with FPO are high. FPO may be used during labour when the electronic fetal heart rate trace is nonreassuring or when conventional monitoring is unreliable, such as with fetal arrhythmias. If the fetal oxygen saturation (FSpO(2)) values are < 30%, prompt obstetric intervention is indicated, such as fetal scalp blood sampling or delivery FSpO(2) monitoring should not form the sole basis of intrapartum fetal welfare assessment. Rather, the whole clinical picture should be considered.

Synonymy of Perkinsus olseni Lester & Davis, 1981 and Perkinsus atlanticus Azevedo, 1989 and an update on the phylogenetic position of the genus Perkinsus

Sequences of the rRNA nontranscribed spacer (NTS) were determined for six isolates of Perkinsus olseni, seven isolates of Perkinsus sp. from Anadara trapezia and one isolate of Perkinsus sp. from Austrovenus stutchburyi. These sequences were compared with previously published NTS sequences for R atlanticus, P. marinus and P. andrewsi. Consensus sequences for Perkinsus olseni, the Perkinsus isolates and P. atlanticus were approximately 98-99% similar to each other but only 65-79% similar to P. marinus and P. andrewsi sequences. Some individual P. olseni sequences were less similar to each other (97.4%) than they were to P. atlanticus sequences (97.8-98.2%), therefore NTS provides further evidence that P. atlanticus, P. olseni, Perkinsus sp. from Anadara trapezia and Perkinsus sp. from Austrovenus stutchburyi are conspecific. We propose that P. atlanticus be synonymised with P. olseni Lester & Davis, 1981 which has taxonomic priority, and that Perkinsus sp. from Anadara trapezia and Perkinsus sp. from Austrovenus stutchburyi belong to R olseni sensu lato as well. A phylogenetic analysis of SSU rDNA, incorporating recently published Perkinsus sequences, supports the placement of the Perkinsus species with Parvilucifera infectans within the Dinoflagellata.

Correlates of adults' participation in physical activity: review and update

P

Cyclosporin monitoring in Australasia: 2002 update of consensus guidelines

Therapeutic drug monitoring of cyclosporin (CsA) has been established as part of the routine clinical treatment of patients following organ transplantation for more than 20 years, and based on contemporary knowledge, many consensus guidelines have been published to assist clinics and laboratories attain optimal strategies for patient care. This article addresses the newer directions in CsA monitoring, with particular reference to the Australasian situation that has evolved since the 1993 Australasian guideline (1). These changes have included the introduction of alternative assay methodologies, changed CsA formulation from Sandimmun to Neoral throughout Australasia, and alternatives to trough concentration (C0) monitoring, especially 2-hour concentration (C2) monitoring and associated validated dilution protocols to accurately quantitate the higher whole blood CsA concentrations. The revision was prepared following a recent survey of all Australasian CsA-monitoring laboratories (2) where discordant practices were evident.