Previous studies of respiratory rate in children have had a number of methodological problems. The aim of this study was to construct age specific reference ranges for respiratory rate. Respiratory rate in children attending childcare centres, kindergartens, and schools was measured using a nasal thermocouple to obtain respiratory waveforms. Reference ranges were constructed using data from 293 awake children between 12 and 84 months, and from 123 sleeping children between 12 and 60 months. performed on some of the children and there was no record of whether respiratory symptoms or signs were present. The method of determining rate is not recorded, although it was probably based on the counting of chest wall movements. Children of different ages were measured in different arousal states. The heterogeneity of these subjects' arousal states raises doubts about the validity of the results. It is widely accepted that ventilatory control and respiratory rate are altered in both rapid eye movement and non-rapid eye movement sleep when compared with the awake state.5 6 The utility of the quoted reference ranges remains in doubt because of these methodological problems.Respiratory rate is traditionally measured by counting observed chest wall movements while timing with a watch. While this method is simple, and should not alter the variable being measured, its accuracy is questionable. A study comparing the counting of observed chest wall movements by nurses to respiratory inductive plethysmography in 10 mechanically ventilated adult patients found that on 34% of occasions manual counting of respiratory rate produced an error of 20% or more.7 Another study comparing simultaneous respiratory rate counts, as determined by observation of chest wall movement and by transthoracic impedance (pneumogram), in children under 5 years of age found a wide variation between these two methods.8 The method that produced a respiratory rate per minute that varied least from that obtained with the pneumogram, was where the counted respiratory rates for two 30 second periods were added, rather than using a single 60 second period or a single 30 second period doubled.
Based on the findings, structured teaching about cerebral palsy is necessary within the medical curriculum at the University of Melbourne. Greater promotion of positive attitudes toward people with cerebral palsy and other disabilities is required.
A short stay unit (SSU) was opened at the Children's Hospital, Boston, with the aim of better fulfilling the needs of pediatric patients with straightforward diagnoses. Using historical and simultaneous comparison groups and controlling for disease severity, the opening of the SSU led to a decrease of between 16.5 and 28.4 percent in the mean length of stay for asthma patients without any increase in the rate of hospital readmission.
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