Colonoscopy preparation in children: Safety, efficacy, and tolerance of high- versus low-volume cleansing methods

Background: The use of large-volume electrolyte balanced solutions as preparation for colonoscopy often results in poor patient compliance and acceptance. The tolerance, safety, and efficacy of high-versus low volume colon-cleansing methods as preparation for colonoscopy in children were compared by randomized operator-blinded trial. Methods: Twenty-nine children ages 3.6-14.6 years had either high-volume nasogastric balanced polyethylene glycol electrolyte lavage (20 ml/kg/h) until the effluent was clear (n = 15), or two oral doses of sodium phosphate solution (22.5-45 ml) separated by oral fluid intake (n = 14). Results: Both preparations were equally effective. The low-volume preparation was better tolerated and caused less discomfort that the high-volume preparation, judging by serial nurse observations. The incidence of abdominal symptoms, diarrhea, sleep disturbance, and vomiting was not significantly different between the two groups. Both groups had a small reduction in mean hematocrit and serum calcium levels. The sodium phosphate preparation caused increases in mean serum sodium concentrations from 140 to 145 mmol/L and serum phosphate concentrations from 1.41 to 2.53 mmol/L. Ten hours after the commencement of the preanesthetic fast, these concentrations had returned to normal. Conclusions: There are advantages in terms of tolerance, discomfort, and case of administration with acceptable colonic cleansing with the use of the less-invasive oral sodium phosphate low-volume colon-cleansing preparation in children. Safe use requires ensuring an adequate oral fluid intake during the preparation time and avoidance of use in patients with renal insufficiency.

Comparación de dos esquemas de preparación intestinal en niños llevados a colonoscopia: experimento clínico multicentrico

Objetivo: Comparar eficacia de PEG 3350 sin electrolitos y fosfato de sodio oral en preparación intestinal de niños previo a colonoscopia. Materiales y métodos: participaron 64 pacientes entre dos y dieciocho años, de ambos géneros, con indicación clínica de colonoscopia que acudieron a tres hospitales de Bogotá y asignados aleatoriamente a uno de dos brazos de intervención. Un grupo expuesto número 1 recibió PEG oral 2.5gr/kg/día por 2 días, un grupo control número 2 recibió Travad 133 ml/m2sc/día por 2 días, ambos grupos recibieron dieta líquida los días de preparación. Se evaluaron efectos adversos clínicos (cefalea, dolor abdominal, náuseas, vómito), adherencia y efectividad de cada uno de los manejos; se diligenció formulario en papel para cada participante, donde se interrogó efectos secundarios, días de preparación, cumplimiento de dieta e ingesta del medicamento y calidad de preparación. Resultados: 36 pacientes recibieron PEG y 28 fosfato de sodio, con edad media de 8.4 años y desviación estándar de 4.1. El 64.1% del género femenino. El 5.6% de pacientes con PEG no siguió las recomendaciones de dieta y un 10.7% del grupo de Travad. Un 61% del grupo de PEG y un 43% del grupo de Travad no tuvieron efectos adversos sin diferencias significativas (X²=0,14 p=0,073). La evaluación de calidad de la preparación entre los dos grupos no encontró diferencia significativa en su distribución, utilizando la prueba de X²=0,551 y una p=0,907. Conclusión: no hubo diferencias significativas entre los dos grupos. La adherencia fue en general buena y no hubo efectos adversos significativos.

Successful colonoscopy; completion rates and reasons for incompletion

Factors such as poor bowel preparation or obstructing colonic disease may confound the reporting of colonoscopy completion rates, as these factors are outside of the control of the endoscopist performing the procedure. By adjusting for these factors when calculating a colonoscopy completion rate, it may be possible to make a more accurate assessment of a unit's or individuals' competence. Details of two thousand two hundred and sixteen colonoscopies performed by four consultants and their trainees between 1993-2000 were analysed retrospectively from a prospective endoscopy database. Crude (all cases) and adjusted (excluding poor bowel preparation and disease as causes of incompletion) rates were recorded for each sex, and by age according to cause. Overall crude and adjusted completion rates were 77.9% and 85.0% respectively. There was a significant difference between male and female completion rates due to a difference in the incidence of excess looping and intolerance of the procedure (adjusted rate 88.9% in males vs. 81.6% in females, p

Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy:a randomized controlled trial

Background: Small adenomas may be missed during colonoscopy, but chromoscopy has been reported to enhance detection. The aim of this randomized-controlled trial was to determine the effect of total colonic dye spray on adenoma detection during routine colonoscopy.

Methods: Consecutive outpatients undergoing routine colonoscopy were randomized to a dye-spray group (0.1% indigo carmine used to coat the entire colon during withdrawal from the cecum) or control group (no dye).

Results: Two hundred fifty-nine patients were randomized, 124 to the dye-spray and 135 to the control group; demographics, indication for colonoscopy, and quality of the preparation were similar between the groups. Extubation from the cecum took a median of 9:05 minutes (range: 2:4824:44 min) in the dye-spray group versus 4:52 minutes (range: 1:42-15:21 min] in the control group (p <0.0001). The proportion of patients with at least 1 adenoma and the total number of adenomas were not different between groups. However, in the dye-spray group significantly more diminutive adenomas (

Conclusions: Dye-spray increases the detection of small adenomas in the proximal colon and patients with multiple adenomas, but long-term outcomes should be studied to determine the clinical value of these findings.

New dimeric supramolecular structure of mixed (phthalocyaninato)(porphyrinato)-europium(III) sandwiches : preparation and spectroscopic characteristics

The mixed double-decker Eu\[Pc(15C5)4](TPP) (1) was obtained by base-catalysed tetramerisation of 4,5-dicyanobenzo-15-crown-5 using the half-sandwich complex Eu(TPP)(acac) (acac = acetylacetonate), generated in situ, as the template. For comparative studies, the mixed triple-decker complexes Eu2\[Pc(15C5)4](TPP)2 (2) and Eu2\[Pc(15C5)4]2(TPP) (3) were also synthesised by the raise-by-one-story method. These mixed ring sandwich complexes were characterised by various spectroscopic methods. Up to four one-electron oxidations and two one-electron reductions were revealed by cyclic voltammetry (CV) and differential pulse voltammetry (DPV). As shown by electronic absorption and infrared spectroscopy, supramolecular dimers (SM1 and SM3) were formed from the corresponding double-decker 1 and triple-decker 3 in the presence of potassium ions in MeOH/CHCl3.

Efficient microwave hydrothermal preparation of nanocrystalline anatase TiO2 colloids

Titanium dioxide nanocrystals are an important commercial product used primarily in white pigments and abrasives, however, more recently the anatase form of TiO2 has become a major component in electrochemical and photoelectrochemical devices. An important property of titanium dioxide nanocrystals for electrical applications is the degree of crystallinity. Numerous preparation methods exist for the production of highly crystalline TiO2 particles. The majority of these processes require long reaction times, high pressures and temperatures (450–1400 °C). Recently, hydrothermal treatment of colloidal TiO2 suspensions has been shown to produce quality crystalline products at low temperatures (<250 °C). In this paper we extend this idea utilising a direct microwave heating source. A comparison between convection and microwave hydrothermal treatment of colloidal TiO2 is presented. The resulting highly crystalline TiO2 colloids were characterised using Raman spectroscopy, XRD, TEM, and electron diffraction. The results show that the microwave treatment of colloidal TiO2 gives comparable increases in crystallinity with respect to normal hydrothermal treatments while requiring significantly less time and energy than the hydrothermal convection treatment.

Polymer nanocomposites based on P3OT, TPU and SWNT: preparation and characterization

Single walled carbon nanotubes (SWNTs) were incorporated in polymer nanocomposites based on poly(3-octylthiophene) (P3OT), thermoplastic polyurethane (TPU) or a blend of them. Thermogravimetry demonstrated the success of the purification procedure employed in the chemical treatment of SWNTs prior to composite preparation. Stable dispersions of SWNTs in chloroform were obtained by non-covalent interactions with the dissolved polymers. Composites exhibited glass transitions, melting temperatures and heat of fusion which changed in relation to pure polymers. This behavior is discussed as associated to interactions between nanotubes and polymers. The conductivity at room temperature of the blend (TPU-P3OT) with SWNT is higher than the P3OT/SWNT composite.

Principal preparation and training : a look at China and its issues

Purpose: The purpose of this paper is to provide an understanding of principal preparation and training in China by providing a background discussion of principal preparation in a number of countries. As an illustration, it provides an overview of the curriculum used in the initial preparation of school principals at Beijing Normal University.-----Design/methodology/approach: The paper draws mainly on writing and research from China, Australia and the USA to explore principal preparation and training in China.-----Findings: In addition to providing a rich description of principal preparation in China, the paper's main findings comprise seven key challenges that confront China as it endeavours to provide quality principal preparation. These challenges include China's diversity and uneven social, cultural and educational development; limited resources in some regions throughout China; the place and importance of study tours for principal preparation; the teaching approach used to train principals; the process used for assessing principal learning during their training programs; the limited transfer of learning from the classroom to the school environment; and the timing of training for principals.-----Practical implications: Each of the challenges arising here raises important practical implications for developers of principal training programs.-----Originality/value: The paper paints a picture of principal preparation in China and raises a number of issues and challenges with which it continues to grapple. Of note is that China is not alone in facing some of these ongoing concerns.

Preservice teachers’ perceptions of their middle schooling teacher preparation

The middle schooling movement in Australia has gained momentum in the past 10 to 15 years (Pendergast & Bahr, 2005) with much of the literature recognising that preservice teachers need to graduate with theoretical and pedagogical knowledge to engage middle years students (Education Queensland, 2004). This qualitative study analysed the responses of preservice teachers towards their completion of a four-year Bachelor of Education primary degree that included a middle years pathway (or electives). The study aims to investigate the final years’ perceptions of their confidence and preparedness to teach in the middle-school context as a result of their university learning. Data were gathered using open-ended one-to-one interviews of approximately 45 minutes duration. Seven of the twenty-two final-year preservice teachers were involved in the study that represented 32% of the cohort. Results indicated the need for increased school-based units, the importance of pedagogical approaches employed by the lecturer and the preference for further linkages between middle school theories and middle school teaching practices. Those who provide teacher education courses need to consider the importance of how they deliver middle years courses as well as the content of the course. Furthermore, teacher education institutions need to evaluate and re-shape their courses to ensure preservice teachers are provided with real-world experiences related to both the literature and the profession.

Skin preparation with alcohol versus alcohol followed by any antiseptic for preventing bacteraemia or contamination of blood for transfusion (Review)

Background: Blood for transfusion may become contaminated at any point between collection and transfusion and may result in bacteraemia (the presence of bacteria in the blood),severe illness or even death for the blood recipient. Donor arm skin is one potential source of blood contamination, so it is usual to cleanse the skin with an antiseptic before blood donation. One-step and two-step alcohol based antiseptic regimens are both commonly advocated but there is uncertainty as to which is most effective.----- Objectives: To assess the effects of cleansing the skin of blood donors with alcohol in a one-step compared with alcohol in a two-step procedure to prevent contamination of collected blood or bacteraemia in the recipient.----- Search strategy: We searched the Cochrane Wounds Group Specialised Register (March 10 2009); The Cochrane Central Register of Controlled Trials(CENTRAL) The Cochrane Library 2009, Issue 1; Ovid MEDLINE - (1950 to February Week 4 2009); Ovid EMBASE - (1980 to 2009 Week 9); and EBSCO CINAHL - (1982 to February Week 4 2009). We also searched the reference lists of key papers.----- Selection criteria: All randomised trials (RCTs) comparing alcohol based donor skin cleansing in a one-step versus a two-step process that includes alcohol and any other antiseptic for pre-venepuncture skin cleansing were considered. Quasi randomised trials were to have been considered in the absence of RCTs.----- Data collection and analysis: Two review authors independently assessed studies for inclusion.----- Main results: No studies (RCTs or quasi RCTs) met the inclusion criteria. Authors’ conclusions We did not identify any eligible studies for inclusion in this review. It is therefore unclear whether a two-step, alcohol followed by antiseptic skin cleansing process prior to blood donation confers any reduction in the risk of blood contamination or bacteraemia in blood recipients, or conversely whether a one-step process increases risk above that associated with a two-step process.

Prevention of postnatal distress or depression : an evaluation of an intervention at preparation for parenthood classes.

Determined the effectiveness of a psychosocial intervention, provided to expectant couples in routine antenatal classes, on the postpartum psychosocial adjustment of women and men. Preparation for Parenthood programs were randomly allocated to one of three conditions: usual service ('control'), experimental ('empathy'), or non-specific control ('baby-play'). The latter condition controlled for the non-specific effects of the intervention, these being: the provision of an extra class; asking couples to consider the early postpartum weeks; and receiving booster information after the antenatal class, and again shortly after the birth. Women and men were categorised into three levels of self-esteem, as measured antenatally: low, medium and high. 268 participants were recruited antenatally. Interview data and self-report information was collected from 202 of these women at 6 weeks postpartum, and 180 women at 6 months postpartum. The intervention consisted of a session focusing on psychosocial issues related to becoming first-time parents. Participants discussed possible postpartum concerns in separate gender groups for part of the session, and then discussed these issues with their partners

Internationalisation and international students : creating an internationalised learning context for international students’ study preparation via CMC

Australian universities have been phenomenally internationalised because of significant numbers of international students in their student cohorts. The international students make up 17.3 percent (OECD 2007) of all the university enrolment, and some universities have much more international student enrolments than the average. From a truly internationalisation perspective, however, there is far more demand of integration with Australian students and international students, the internationalising learning content and context. There have not been much discussion and effort of understanding and practicing of internationalising the learning context from international students’ cultural background and internationalised learning environment. There are many factors which interfere with internationalisation in the learning context such as English proficiency, culture difference and academic staff unawareness. This paper argues the concepts of cultural dimensions and the characteristics of CMC (Computer-Mediated Communication) in a multicultural learning context of Australian higher education. This paper aims to develop a framework of international students’ preparation program for their Western university study based on technology-driven learning models, especially targeting those students who have an Asian cultural background. The program is expected to help international students bridge the gap of cultural differences and better preparation for their active participation and engagement in a new learning environment in order to realise truly internationalisation in Australian higher education