Dunedin Public Hospital Research Articles

Oral antimicrobial therapy for cellulitis versus outpatient parenteral antimicrobial therapy: a single-centre audit of cellulitis outcomes.

Cellulitis is a common acute skin and soft tissue infection that causes substantial morbidity and healthcare costs. To audit the impact on cellulitis management, regimen tolerability and outcomes of switching from outpatient parenteral antimicrobial therapy (OPAT) using intravenous (i.v.) cefazolin once daily plus probenecid to oral beta-lactam therapy (OBLT) using oral flucloxacillin plus probenecid. We undertook a retrospective audit on cellulitis management, regimen tolerability and outcomes at the Dunedin Public Hospital Emergency Department (ED) before and after a change of the local outpatient cellulitis treatment pathway from OPAT using i.v. cefazolin once daily plus probenecid to OBLT using oral flucloxacillin plus probenecid. OPAT was used in 97/123 (78.9%) patients with cellulitis before compared to 1/70 (1.4%) after the pathway change (odds ratio (OR), 0.04, P < 0.01). OBLT was used in 26/123 (21.1%) patients with cellulitis before and 69/70 (98.6%) after (OR, 218.8, P < 0.01). Antimicrobial change due to intolerance occurred in 4/123 (3.2%) patients with cellulitis before and 4/70 (5.7%) after (OR, 1.8, P, not significant (NS)) the pathway change. Inpatient admission within 28 days occurred in 15/123 (12.2%) cellulitis patients before and 9/70 (12.9%) after (OR, 1.1, P, NS) the pathway change. Implementation of a change in outpatient cellulitis treatment pathway resulted in a significant change in prescribing practice. Our findings suggest that OBLT was both tolerable and had similar outcomes to OPAT.

Attitudes towards the mixing of COVID-19 vaccinated and unvaccinated patients in multi-bed hospital rooms.

To explore patient and staff views about the mixing of COVID-19 vaccinated and unvaccinated patients in multi-bed hospital rooms. We conducted a mixed methods study with paper surveys and structured interviews. Self-administered surveys were undertaken with inpatients on the general medicine, general surgery, orthopaedic and respiratory wards in Dunedin Public Hospital. Face-to-face interviews were conducted with ward staff including consultants, registrars, charge nurses, registered nurses and nurse managers. The study was undertaken in February 2022, at the start of the first New Zealand wave of the Omicron variant. Of 118 eligible patients, 63 agreed to participate. Sixty (95%) of these patients were vaccinated for COVID-19. Most patients (59%) thought that vaccinated and unvaccinated people should be accommodated in separate hospital rooms. Vaccinated patients felt more comfortable sharing a multi-bed room with others of the same COVID-19 vaccination status as themselves than with unvaccinated patients. Participants who thought that they were at higher risk of severe illness from COVID-19 were more likely to support separation of patients based on vaccination status. Fifteen ward staff were interviewed: most would prefer the hospital to separate patients by vaccination status but were aware this would present practical and ethical problems and thought that current arrangements were adequate. While most vaccinated patients and staff wanted patients to be separated according to their COVID-19 vaccination status, the current precautionary measures for COVID-19 were viewed by most staff members as adequate.

Food Waste

This research project explored solutions for food waste reduction and mitigation across Te Whatu Ora / New Zealand Public Hospital systems by looking at the case study of Dunedin Public Hospital. Directly relating and supporting Sustainable Development Goal (SDG) 12.3, to halve global food waste at consumer and retail levels by 2030. This research was done by analysing appropriate literature exploring food and organic waste management strategies in national and international hospital service sectors and systems, further using the Food Recovery Hierarchy as a framework, which ranks the effects of these strategies when looking at them financially, environmentally and socially. Furthermore, this research looks at the barriers and enablers of the suggested organic waste management strategies. A food waste audit was conducted at Dunedin Public Hospital to assess and quantify the current organic waste within the system. The key questions of this study are: How do we prevent organic waste in the first place (preparation strategies)? What can we do with the organic waste produced to prevent it from going to landfills? What items in the food system are the most wasted? How much Greenhouse gas (GHG) is produced by this organic waste going to landfill? Organic waste produces methane, occupies land mass and has the potential for groundwater contamination. Ten per cent of total global GHG Emissions come from food waste, 22% of which is occurring at the consumption level. The key impact of this research is to mitigate organic waste going to landfills to reduce further climate change, thus benefiting environmentally, socially and economically. Supervised by: Ray O'Brien &amp; Craig Cliff, Sustainability Office, University of OtagoScholarship funded by: Te Whatau Ora Southern

P484 Inflammatory Bowel Disease exercise and diet habits (IBDeat) study: chronic metabolic disease risk factors among IBD patients in New Zealand

Abstract Background Recent literature shows that patients with inflammatory bowel disease (IBD) are at higher risk of developing chronic metabolic diseases which may be amenable to a healthy lifestyle. However, this may be challenging for IBD patients as disease symptoms may result in unfavourable lifestyle habits such as avoidance of healthy foods and reduced physical activity. In this study, we aim to describe the nutritional status and lifestyle habits of adults with IBD in New Zealand (NZ). Methods A cross-sectional nationwide study was undertaken from December 2021 to October 2022 in NZ. Participants were recruited through social media and the Dunedin public hospital patient database. An online questionnaire collected demographics, disease severity scores (harvey-bradshaw index and simple clinical colitis activity index), quality of life (QoL), physical activity, and dietary intake data. A subset of patients living in Dunedin had anthropometrics, handgrip strength, blood pressure, body composition (bioelectrical impedance), blood nutritional markers (lipid profile, iron studies, vitamin D, vitamin B12, folate) and faecal calprotectin measured. Descriptive analysis was conducted and data were compared to population reference values. The study received University of Otago, Dunedin, NZ ethical approval (reference: H21/135). Results The questionnaire was completed by 197 adults, median age 37 (IQR 25, 51) of which 72% were female and predominantly NZ European ethnicity (82.4%). In this IBD cohort, 54% had Crohn’s disease and 46% had ulcerative colitis or IBD-unspecified with quiescent-mild disease activity. Two-thirds of patients had at least one comorbidity aside from IBD and one-third of patients had impaired QoL (defined by a score &amp;lt;45). Most patients had nutritional risk factors including low intakes of fruits (91.3%), vegetables (94.4%), fibre (38.3%), and excessive intakes of fat (73.2%) and saturated fat (98.0%). Two-thirds of patients reported IBD-related barriers to exercise mainly due to fatigue (53.9%), abdominal pain (25.7%), bowel incontinence (23.3%), and joint pain (22.3%) in which only 59.7% met national physical activity recommendations. The Dunedin cohort (n=102) had further chronic metabolic disease risk factors such as central adiposity (63.7%), high body fat percentage (43.9%), high cholesterol/HDL ratio (29.3%), high blood pressure (26.5%), and poor handgrip strength (43.9%). Conclusion Findings suggest that NZ adults with IBD have multiple risk factors for chronic metabolic diseases that could be amendable to lifestyle interventions. Future studies should explore the feasibility and efficacy of nutrition and exercise lifestyle interventions to mitigate these risk factors.

The impact of prolonged delay to loop ileostomy closure on postoperative morbidity and hospital stay: A retrospective cohort study.

AimThere is increasing evidence that delayed loop ileostomy closure is associated with an increase in postoperative morbidity. In the context of a publicly funded health service with constrained theatre access, we review the impact of delay in loop ileostomy closure.MethodA retrospective cohort study of patients undergoing loop ileostomy closure at the Dunedin Public Hospital between 2000–2017 was performed. Cases and complications were identified from the prospectively maintained Otago Clinical Audit database. Patient demographics, ASA score, indications for ileostomy, reasons for delay in closure, length of stay (LOS) after ileostomy closure and complications were collected. LOS and overall complication rate were assessed using univariable and multivariable analyses.ResultsA total of 292 patients were included in the study, of whom 74 (25.3%) were waiting for longer than 12 months for ileostomy closure. The overall complication rate was 21.5%. This was 8% up to 90 days, 20% between 90–360 days, 28% between 360–720 days and 54% after 720 days. Delay was associated with an increased risk of any complication (RR 1.06 for every 30 days with stoma, p < 0.001), including Ileus (OR [95% CI] 1.06 [1.00–1.11], p = 0.024). Overall mean LOS was 5.9 days (range 1–63), being 4.6 days up to 180 days, 5.6 between 180–720 days and 8.7 after 720 days. LOS significantly increased with increasing stoma duration (p = 0.04).ConclusionIncreasing time with loop ileostomy is detrimental for patients, being associated with an increase in complication rates, and is detrimental for hospitals due to increased length of stay. Resources should be allocated for timely closure of loop ileostomies.

Potentially Inappropriate Medications in a Psychogeriatric Inpatient Ward: An Audit Based on Beers Criteria.

IntroductionOlder adults are often prescribed a high number of medications. Overcoming inaction in health care is difficult but essential to deprescribing potentially inappropriate medications (PIMs). Curbing the use of PIMs is urgent in older adults suffering from psychiatric illness, as cognitive, emotional and psychosocial adversity makes them an especially vulnerable group. We aimed to audit PIM usage and deprescribing in an old-age psychiatry inpatient service of a university-affiliated public hospital.MethodsThe 2015 American Geriatrics Society (AGS) Beers Criteria were used in the present study. Computerized medical records were reviewed for all patients discharged from the Dunedin Public Hospital Inpatient Psychogeriatric Ward during the period January 2017 to December 2017.ResultsDuring the 1-year study period, 136 patients were discharged from our psychogeriatrics inpatient ward, including 87 women and 49 men, with a mean age of 75.4 ± 8.6 years (range: 59–95). The mean number of medications prescribed per patient at the time of admission was 7.7. At discharge, a mean of 8.9 medications were recorded. Analysis focused on 120 complete patient records. Of the 49 patients with 63 high-risk medications, 16 patients (prescribed 19 high-risk medications) had their high-risk medication stopped, 23 patients (prescribed 24 high-risk medications) had high-risk medications started and 10 (prescribed 20 high-risk medications) had no change to high-risk medications between admission and discharge. In 56 of 120 patients (47%), benzodiazepines (BZDs) were started, stopped or unchanged.ConclusionOlder adults suffering from severe psychiatric disorders are frequently prescribed PIMs. However, clinical decision-making for this vulnerable population needs to take into account safety as reflected by the Beers Criteria, but also the complexity of managing psychogeriatric problems.

A063 CT Coronary Angiography at Dunedin Public Hospital – A Retrospective Clinical Audit

A063 CT Coronary Angiography at Dunedin Public Hospital – A Retrospective Clinical Audit

595 A Single Centre Experience of Septal Myectomy

Septal myectomy remains the gold standard for treatment of severely symptomatic hypertrophic obstructive myopathy (HOCM). A retrospective study was performed to determine the efficacy of septal myectomy in reducing dynamic LVOT obstruction and evaluate the rate of complications associated with the procedure. Retrospective data from cardiac operations performed between 2000-2019 at Dunedin Public Hospital were obtained. Search terms used were septal myectomy and Morrow procedure. Twelve patients underwent septal myectomy between the years 2000-2019 however there was insufficient clinical information for two patients so only ten were included in this study. Out of the ten patients analysed, nine patients had HOCM and one patient had a subaortic membrane. All patients had reductions in LVOT velocities, peak LVOT gradients and septal thickness shown on ECHOs performed within 12 months of surgery. No patients required a permanent pacemaker after the procedure and there were no mortalities 30 days post operatively. All patients had a downgrading of NYHA classification to either II or I. One patient required alcohol septal ablation at 2 years post operatively. Despite only performing a small number of myectomies in the last two decades, complication rates were low and effectiveness, in terms of both symptomatology and ECHO parameters, was found to be high. Septal myectomy should continue to be performed for HOCM patients with severe symptoms that are refractory to medical therapy. It is a safe procedure with measurable improvements in morbidity for patients.

A078 Can We Make Aortic Valve Replacement A Zero Transfusion Procedure?

Aortic valve replacement (AVR) surgery has a moderate risk of requiring perioperative red blood cell (RBC) transfusion. It has previously been shown that there is no difference between liberal and restrictive blood transfusion protocols for short and long term outcomes after cardiac surgery. We aim to identify the rates of RBC transfusions in our cohort and any association with major complications, mortality, intubation time, ICU stay and overall hospital stay in our cohort. A retrospective study was performed on the 126 public patients who underwent isolated AVR between January 2016 and December 2019 at Dunedin Public Hospital and Mercy Hospital. Redo operations and patients who were Jehovah's Witness were excluded. Out of 126 patients, 39 patients (30.9%) underwent RBC transfusions and 25 patients (19.8%) underwent non RBC transfusions in the perioperative period. There was a positive correlation between perioperative RBC transfusions and length of ICU (p<0.01) and total hospital stay (p<0.01). Perioperative RBC transfusions were associated with prolonged ICU and hospital stay for patients undergoing isolated AVR. Adherence to a restrictive transfusion protocol will potentially reduce RBC transfusion rates, thereby reducing transfusion related costs and associated complications. Further studies are being undertaken to assess the impact of restrictive transfusion.

Measuring abdominal aortic diameters in routine abdominal computed tomography scans and implications for abdominal aortic aneurysm screening

ObjectiveThis study aimed to determine the prevalence and relevance of incidental abdominal aortic aneurysm (AAA) on routine abdominal computed tomography (CT) and to audit the performance of radiologists to identify and report AAA. MethodsA retrospective audit of all abdominal CT scans performed on men and women ≥50 years at Dunedin Public Hospital between January 2013 and September 2014 was carried out. All CT scans for planning of AAA treatment or follow-up were excluded. The maximal anterior-posterior diameter of the infrarenal abdominal aorta was measured in both the sagittal and transverse planes on the picture archiving and communication system. The radiologist reports were analyzed. All detected AAAs were reviewed for clinical relevance. ResultsA total of 3332 scans were performed, of which 86 scans were excluded, resulting in a total cohort of 3246. There were 187 incidental AAAs detected with a prevalence of 5.8%. The prevalence was 8.7% in men and 3.1% in women. Whereas the prevalence increased with age, a significant number were detected in those younger than 65 years, with a prevalence of 1.5%. Of the 187 AAAs, 122 (65%) were reported by radiologists: 100% reporting rate in AAAs ≥50 mm, 87% in AAAs ≥40 to 49 mm, and 52% in AAAs ≥30 to 39 mm. Of these, 15% were specifically recommended for referral to a vascular service. Of the incidentally detected AAAs, 72% were considered to be clinically relevant, which is an overall 4.1% prevalence of AAAs with an ability to benefit. In addition, all 3246 subjects avoided the need for further AAA screening. ConclusionsThere is a high prevalence of AAAs (5.8%) and clinically relevant AAAs (4.1%) detected on routine abdominal CT. As an opportunistic approach, it is a simple and effective way to detect AAAs and to broaden traditional screening criteria to include women and those younger than 65 years in our region. Furthermore, large numbers of subjects with normal aortic diameters are identified who will not need to be screened. Consequently, we consider routine diagnostic abdominal CT to be an important adjunct to national and community AAA screening strategies.

Rib Osteotomy Followed by Plated Fixation Facilitates Improved Exposure in Mini-Thoracotomy for Cardiac Procedures and Reduces Post-Operative Pain

Nur Azri Bin Haji Mohd Yasin , Peter Herbison , Pankaj Saxena , Igor Konstantinov 6 College of medicine and veterinary medicine, University of Edinburgh, Edinburgh, United Kingdom Cardiothoracic Department, Dunedin Public Hospital, Dunedin, New Zealand Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA School of Surgery, University of Western Australia, Perth, Australia Royal Children’s Hospital, Murdoch Children’s Research Institute, University of Melbourne, Melbourne, Australia Corresponding author.

Systematic Review & Meta-Analysis of the Clinical Role of Remote Ischaemic Preconditioning

Nur Azri Bin Haji Mohd Yasin , Peter Herbison , Pankaj Saxena , Igor Konstantinov 6 College of medicine and veterinary medicine, University of Edinburgh, Edinburgh, United Kingdom Cardiothoracic Department, Dunedin Public Hospital, Dunedin, New Zealand Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA School of Surgery, University of Western Australia, Perth, Australia Royal Children’s Hospital, Murdoch Children’s Research Institute, University of Melbourne, Melbourne, Australia Corresponding author.

Single Versus Multi-Vessel PCI in STEMI Patients with Multivessel Coronary Artery Disease in Dunedin Public Hospital

Single Versus Multi-Vessel PCI in STEMI Patients with Multivessel Coronary Artery Disease in Dunedin Public Hospital

Orthogeriatrics service for hip fracture patients in Dunedin Hospital: Achieving standards of hip fracture care

PurposeTo evaluate the orthogeriatrics service (consult liaison provided by geriatricians on an orthopedics ward) for hip fracture patients in Dunedin Hospital and to assess how well standards of hip fracture patient care were achieved. These standards (adapted from British Orthopaedics Association) include admission to ward within 4 hours, surgery within 48 hours, assessment and care to reduce pressure ulcer risk, access to orthogeriatrics services, and secondary prevention of falls and osteoporotic fractures. MethodsThis retrospective audit reviewed patients above age 65 years admitted to the orthopaedic service in Dunedin Public Hospital with a neck of femur fracture between January 1, 2010, and December 31, 2010. ResultsThere were 144 patients with median age of 86 years. 24.5% were admitted to the Orthopaedics ward within 4 hours: 70.8% had surgery within 48 hours and 73.6% had pressure ulcer assessment completed as per our hospital protocol. One-third was seen by the orthogeriatrics team on the day of surgery or earlier. History of falls was not documented in about one third of patients. Only 20.8% had postural blood pressure measured, and 35.6% of those discharged home had a home visit. About 30% did not have documentation of previous fractures, and one-quarter were not assessed for consideration of bisphosphonate therapy. Inpatient mortality was 9%. ConclusionsSeveral areas for improvement were identified from this retrospective study. Suggestions for achieving the standards of hip fracture care are provided. Further audit after implementing these changes is recommended.

Anatomical variations of the paranasal sinuses in Polynesian and New Zealand European computerized tomography scans

This study was designed to compare the incidence of anatomical variations displayed on computerized tomography scans of individuals that identify as Polynesian or New Zealand Europeans. A retrospective analysis of computerized tomography of the paranasal sinuses. All scans were examined for a number of anatomical variations and the prevalence directly compared according to ethnic group. All scans were performed at a tertiary referral center (Dunedin Public Hospital). Participants underwent computerized tomography of the paranasal sinuses for various indications. Ethnicity was determined from the electronic hospital record. There was no significant difference in the prevalence of anatomical variations between Polynesians and New Zealand Europeans. Our study results are comparable with other studies of Caucasian paranasal sinus anatomy. When performing endoscopic sinus surgery on those with Polynesian ethnicity, there are no specific anatomical variations to take into account.

Iatrogenic Pseudoaneurysms: Optimal Management and Treatment Options

Background Iatrogenic trauma is the most common cause of pseudoaneurysm. Several treatment methods are now available, including surgical repair, direct compression with the assistance of ultrasound, and ultrasound-guided thrombin injection. Each of these treatments has its own risks and advantages. Objective We sought to retrospectively assess the causes of pseudoaneurysm and the evolution of treatments and outcomes. Results Ninety-three pseudoaneurysms were diagnosed at Dunedin Public Hospital between September 1994 and December 2005, the majority resulting from cardiac catheterization. Fifteen patients were treated with ultrasound-guided compression, with a success rate of 66%. Sixty-three patients were treated with ultrasound-guided thrombin injection, with a success rate of 95%. No major or lasting complications were observed with either compression or thrombin injection; however, delayed diagnosis and treatment may have serious consequences requiring surgical salvage. Conclusions Ultrasound-guided thrombin injection is safe, effective, quick, and well tolerated by patients. It has become preferable to compression treatment and it is less invasive than surgical repair. Treatment should be given promptly upon diagnosis of the pseudoaneurysm rather than delaying with watchful expectation.

COMPARISON OF INFECTION RATE USING DIFFERENT METHODS OF ASSESSMENT FOR SURVEILLANCE OF TOTAL HIP REPLACEMENT SURGICAL SITE INFECTIONS

The surveillance of surgical site infections (SSI) has been undertaken in many centres worldwide to ascertain the extent of the problem and where possible, to improve the incidence rates, thereby decreasing the undesirable outcomes. The study investigates the processes and outcomes of total hip replacement SSI surveillance carried out in Dunedin Public Hospital in 2004. Two hundred and six patients were enlisted in the study and 189 primary replacements and 22 revision replacements were carried out. Four methods of diagnosis of SSI were applied: (i) clinician diagnosis; (ii) ASEPSIS score; (iii) presence of pus cells; and (iv) assessment by a clinical microbiologist. Infection rates were calculated according to the risk indexes. The incidence of infections varies considerably among these four methods. The infection rates for risk index 0 were 4.35% (method 1), 2.61% (method 2), 0.87% (methods 3 and 4); and for risk indexes 1 and 2 were 4.17% (method 1), 2.08% (method 2), 1.04% (methods 3 and 4). There is a need for accurate infection data so that the appropriate follow-up responses, including infection control measures for total hip replacement SSI can be carried out. The preponderance of elderly patients in the study who are frequently on 'polypharmacy' regimens adds pressure to the need to obtain true infection rates. This is because when antimicrobials are prescribed to them, drug interactions, adverse effects of the antimicrobials and the selective pressure of antimicrobials causing resistances may occur. More resources and a multidisciplinary approach are required for future studies of similar nature.

PM05 STEREOTACTIC RADIOSURGERY FOR TRIGEMINAL NEURALGIA

Stereotactic radiosurgery (SR) is effective in managing trigeminal neuralgia (TN). Over the past 15 years, over 20,000 patients (world wide) have undergone SR for TN. SR is an outpatient procedure with no associated mortality and minor morbidity (generally new facial paraesthesia: 6–16.7%). Initial success rates range from 77 to 95% (generally within 2 days of SR). The benefit then declines to 55.8%–70% (at 3 years). SR can be repeated for recurrent TN (68‐85% benefit at 13.5–43 mths: 5 published reports; N = 111). Dunedin Public hospital holds the national contract for SR in New Zealand. Since 7.5.04, 6 patients with TN have been treated with SR in Dunedin (90 gray, 0.75 cm collimator, 7 table angles and 7 arcs). Details of this experience will be presented and discussed. A summary of the SR/TN literature will be given.

Ritchie of the Whistle a New Zealand pioneer anaesthetist

John Ritchie was for 25 years from 1949 the Director of the Department of Anaesthesia at Dunedin Public Hospital and the University of Otago Medical School's Lecturer, Senior Lecture and ultimately Associate Professor of Anaesthesia. As the University of Otago Medical School was for almost all of that time the only New Zealand Medical School, he was effectively the sole person who taught all graduating doctors in New Zealand about anaesthetics, and supervised them administering the six general anaesthetics demanded by the Faculty of every graduate in those times. He was a most conscientious teacher, and as all graduates of this time attest he did not delegate this responsibility. He was also a Founder of the New Zealand Society of Anaesthetists, which was inaugurated in his house in Dunedin, its first Secretary and an early President. He was an early Board Member of the Faculty of Anaesthetists, Royal Australasian College of Surgeons undertaking the journey to Melbourne for the three meetings per year for 4 years. Ritchie was renowned as a great “gadgets man” and is most famous for the Ritchie Whistle, produced by Penlon of Abindon, England, for over 30 years. Ritchie was also responsible for a number of other inventions which improved patient safety and management. Ritchie was pivotal to the specialty in New Zealand due to his Society and Faculty of Anaesthetists' contributions, his teaching passion and commitments, his obsession with anaesthetic safety and his machining attributes and gadget mentality. As so often in medicine in New Zealand the lead was taken from Dunedin in the South with its Scottish educational heritage.

Participation in research: informed consent, motivation and influence.

To investigate the process and quality of informed consent, motivation and influence in parents who were invited to enroll their baby in a research project. A mixed quantitative/qualitative questionnaire was sent to a cohort invited to participate in a physiological research project on sudden infant death syndrome (SIDS) at the Dunedin Public Hospital, Dunedin, New Zealand. Separate questionnaires were used for parents who participated (94) and those who declined to participate (103). Response rates were 69% and 47%, respectively. All consenting parents felt they understood the purpose and procedure of the study. The majority (90%) thought the information about the study was very good; 6.5% felt more detail was required. Eighty-five per cent found the verbal explanation the most useful source of information. All participated for altruistic reasons such as to aid SIDS research. Although 27% had concerns about safety of the tests, after the tests all responders felt happy with the safety of the tests. Inconvenience was the main reason (53%) for declining to participate. Twenty-eight per cent of declining parents were concerned about the safety of the tests. Of those who responded to the questionnaire, the process for obtaining informed consent in the SIDS studies was satisfactory. Parents' motives for participating were mostly altruistic. The role of recall bias and selection bias may make the implications of this study unclear.