: The clinical algorithm is a text format that is specially suited for presenting a sequence of clinical decisions, for teaching clinical decision making, and for guiding patient care. Clinical algorithms are compared as to their clinical usefulness with decision analysis. We have tried to make clinical algorithm for managing status epilepticus in children that can be applicable to our conditions. Most of the algorithms that are made on this subject include drugs and procedures that are not available at our hospital. We identified performance requirement, defined the set of problems to be solved as well as who would solve them, developed drafts in several versions and put them in the discussion with experts in this field. Algorithm was tested and revised and graphical acceptability was achieved. In the algorithm we tried to clearly define how the clinician should make the decision and to be provided with appropriate feedback. In one year period of experience in working we found this algorithm very useful in managing status epilepticus in children, as well as in teaching young doctors the specifities of algorithms and this specific issue. Their feedback is that they find that it provides the framework for facilitating thinking about clinical problems. Sometimes we hear objection that algorithms may not apply to a specific patient. This objection is based on misunderstanding how algorithms are used and should be corrected by a proper explanation of their use. We conclude that methods should be sought for writing clinical algorithms that represent expert consensus. A clinical algorithm can then be written for many areas of medical decision making that can be standardized. Medical practice would then be presented to students more effectively, accurately and understood better.

OBJECTIVE To assess growth and prevalence of anaemia in hospitalised children during the war in Sarajevo. DESIGN A random sample of children who were patients in the paediatric clinic over a period of six months (1 June to 31 December 1993) were anthropometrically measured and blood samples taken to determine prevalence of anaemia. SETTING The study was conducted at the paediatric clinic, Kosevo Hospital, Sarajevo. SUBJECTS The sample comprised 542 children aged from 0 to 14 years of whom 50.6% were boys and 49.4% were girls. INTERVENTIONS The children were weighed and had their heights measured. Nutritional status was assessed through calculating the weight for height percentile and comparing these with international standards. Blood samples were taken and low haematocrit and haemoglobin values were used to indicate nutritional anaemia. The cut-off points used were: haematocrit < 0.34 (6 months-5 years) and < 0.35 (6-14 years); haemoglobin < 105 g/l (6 months-5 years) and < 110 g/l (6-14 years). RESULTS On average, 69% of boys and 71% of girls fell within the 10th to 90th percentile range (weight for height). 7% of boys and 5% of girls were below the 5th percentile. A total of 24.7% children aged from six months to five years and 16% of children aged from six to 14 years had haematocrit values below the cut-off points. The highest percentage of children with low haematocrit values came from the six months to one year age group. Anaemia as defined by haemoglobin value was diagnosed in 10.6% of children aged from six months to five years and 9.6% of six to 14 year olds. CONCLUSIONS War and disruption of the food supply have not had the expected negative impact of child growth and prevalence of anaemia. Reasons for this may include: increased levels of breast feeding, distribution of supplementary food commodities enriched with micronutrients, and good parental care.

In this study we analyzed the quality of metabolic control in 42 diabetic children aging 5-20 years (x 14 + 5.1) during the war 92/93 year. We estimated metabolic control in these patients by traditional methods: 24 hours glycaemia (every 3 months), 24 hours glycosuria and home monitoring of glycosuria (self-control 4 times daily) Glicolizated HbA1C and the other up to date laboratory findings we were not able to do in any of diabetics. Metabolic control in all analysed patients was unsatisfactory metabolic control only in 19.1% of diabetics. High level of blood glucose were influenced by in coordinated doses of human insulin and bad correlated food intake during the war. Long duration of hyperglycaemia would have high influence onto early development of microvascular complications.