SummaryMathematical formulae to calculate body surface area from measurements of height, weight and other parameters date from the late 19th century. Drug doses, fluid therapy, caloric requirements and physiological parameters such as cardiac output, glomerular filtration rate and a variety of respiratory function parameters are all frequently expressed in terms of a body surface area. Body surface area is often used in preference to body mass (weight). However, the original rationale for using body surface area as an estimate for metabolic rate has never been tested and the algorithms used to approximate body surface area have little evidence to support their use in this role. Recent developments in technology using indirect calorimetry allow easy measurement of metabolic rate in the clinical setting. Such measurements should be used for standardisation when weight alone is considered inadequate.Keywords Body surface area. Metabolic rate. Calorimetry. Rubner's Law, published in 1883, crystallised a belief among physiologists in the mid to late 19th century that, regardless of species, the heat production (i.e. metabolic rate) of an individual was proportional to the body surface area (BSA) [1]. This law was very difficult to disprove because BSA could only be measured by very cumbersome means, such as skinning the subject. Measurement of metabolic rate via direct calorimetry was possible but not widely available. Being unable to measure the metabolic rate in a clinical setting, measuring BSA seemed to provide an acceptable alternative to metabolic rate. There was an impetus around the beginning of the 20th century to derive simpler ways of calculating BSA using mathematical manipulations of various body dimensions. Throughout the remainder of the century, investigators attempted to simplify the equations and expand the application of the formulae. Because of the importance and widespread use of BSA formulae in many areas of medicine, we undertook a literature review to determine the source of and evidence for these equations. MethodsComprehensive literature reviews of documents published around 100 years ago are difficult. The electronic database ÔMedlineÕ only includes publications from 1966 onwards, whilst its paper-based predecessor, Index Medicus, extends to only 1960. The Medline database was searched by combining a medical subject heading (MeSH) search for Ôbody surface areaÕ, which prior to 1970 was classified under ÔanthropometryÕ. The following search strategies were used: MeSH search for ÔmathematicsÕ, or keyword searches for Ôcalculat*Õ, ÔformulaÕ or ÔduBoisÕ (duBois being the author of the most widely used BSA formula). Index Medicus was searched using the ÔanthropometryÕ MeSH term. Documents prior to 1960 were found from the references in articles identified by Anaesthesia, 2003, 58, pages 50-83 Ó 2003 Blackwell Publishing LtdMedline and each relevant document prior to 1960 also had its references searched. The development of Ôheight)weightÕ formulaeThe first published equation for estimating B...

The findings of the study and the review of the CNSE in the UK revealed that the key roles of the CNSE were difficult to define. Yet, the respondents identified that there were common core features central to their contribution to care as specialist nurses.

No abstract

The National Institute for Health and Clinical Excellence (NICE) recommends that people with epilepsy and their families and carers should be ‘given and have access to’ information about sudden unexpected death in epilepsy (SUDEP). The aim of this survey was to examine what, when and how information about SUDEP is disseminated to patients by clinical nurse specialists in epilepsy (CNSEs). Method : A total of 250 postal questionnaires were sent to members of the Epilepsy Nurses Association (ESNA) in July 2006. Responses were received from 146 nurses (58%). CNSEs accounted for 103 (71%) of the respondents. The remaining responses were excluded as not being CNSEs. Results : CNSEs discussed SUDEP with most patients (50%). They tended to raise SUDEP when discussing specific risks (48%) and general risk (71%). Forty-five CNSEs would discuss the issue at diagnosis and 17 when therapy was started. Risk factors mentioned included non-compliance (84%), safety risks (78%), nocturnal seizures (68%), alcohol/drugs use (67%) and history of status epilepticus (65%). The main behavioural responses noted were, improved adherence (62%), avoidance of risk (59%) and anxiety(49%). Only 57% of CNSEs were aware that guidelines regarding SUDEP exist. Conclusions : As SUDEP appears to be related to seizures, management should include optimal drug treatment and seizure control. This may present a challenge as patients generally want to lead as normal a life as possible.

No abstract