RESUMEN
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is now the most common reason for a child to present to a paediatrician in Australia. Stimulant medications are commonly prescribed for children with ADHD, to reduce symptoms and improve function. In this study we investigated the factors that influence paediatricians' decisions about prescribing stimulant medications. METHOD: In-depth, semi-structured interviews were conducted with paediatricians (n = 13) who were purposively recruited so as to sample a broad demographic of paediatricians working in diverse clinical settings. Paediatricians were recruited from public outpatient and private paediatrician clinics in Victoria, Australia. The interviews were audio-recorded and transcribed verbatim for thematic analysis. Paediatricians also completed a questionnaire describing their demographic and practice characteristics. RESULTS: Our findings showed that the decision to prescribe is a dynamic process involving two key domains: (1) weighing up clinical factors; and (2) interacting with parents and the patient along the journey to prescribing. Five themes relating to this process emerged from data analysis: comprehensive assessments that include history, examination and information from others; influencing factors such as functional impairment and social inclusion; previous success; facilitating parental understanding including addressing myths and parental confusion; and decision-making model. CONCLUSIONS: Paediatricians' decisions to prescribe stimulant medications are influenced by multiple factors that operate concurrently and interdependently. Paediatricians do not make decisions about prescribing in isolation; rather, they actively involve parents, teachers and patients, to arrive at a collective, well-informed decision.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Toma de Decisiones , Médicos/psicología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Anciano , Actitud del Personal de Salud , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , Relaciones Profesional-Familia , VictoriaRESUMEN
Serum samples from 73 cases of Systemic lupus erythematosus (SLE) were studied for proteins, immunoglobulins, complement components and anti-nuclear antibodies. In fresh cases of SLE, low serum albumin, high alpha-1, alpha-2, and gamma-globulins were found. Marked elevation of serum levels of IgG was found at the time of diagnosis, but this returned to normal after regular treatment. Over 71% of SLE had serum levels of C3 and C4 lower than normal (mean - 2SD). The more severe the disease, the lower the serum levels of these two components of complement. Fluorescent anti-nuclear antibody (FANA) was found in 98.6% of the cases studied. Most (85.1%) cases and anti-double stranded deoxyribonucleic acid (anti-ds DNA) antibody levels higher than normal control (mean + 2 SD). We may conclude that FANA, C3, C4 and anti-ds DNA anatibody are immunological parameters sensitive in the early diagnosis of SLE. FANA is the most sensitive, and can be used as a screening test in SLE. The serum C3 and C4 levels correlate well with the severity of the disease.