Pub Date : 1992-09-01DOI: 10.1001/ARCHPEDI.1992.02160210035016
J. A. Wright, E. Marcuse
Administration of immunizations has become complicated by issues about consent, cost, and liability. To determine if these issues have changed the immunization practices of pediatricians, we surveyed pediatricians in private practice in Washington State. The survey results show that about one half of vaccines administered in pediatricians' offices are provided by the Washington State Health Department. The mean charge for administration of each parenteral vaccine was $7.02. Respondents strongly agreed that they would administer vaccine supplied by the Washington State Health Department if it was available. They also agreed that they referred patients to Health Department clinics for vaccination because of inability to pay and not because of concern about liability.
{"title":"Immunization practices of Washington State pediatricians--1989.","authors":"J. A. Wright, E. Marcuse","doi":"10.1001/ARCHPEDI.1992.02160210035016","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1992.02160210035016","url":null,"abstract":"Administration of immunizations has become complicated by issues about consent, cost, and liability. To determine if these issues have changed the immunization practices of pediatricians, we surveyed pediatricians in private practice in Washington State. The survey results show that about one half of vaccines administered in pediatricians' offices are provided by the Washington State Health Department. The mean charge for administration of each parenteral vaccine was $7.02. Respondents strongly agreed that they would administer vaccine supplied by the Washington State Health Department if it was available. They also agreed that they referred patients to Health Department clinics for vaccination because of inability to pay and not because of concern about liability.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"10 1","pages":"1033-6"},"PeriodicalIF":0.0,"publicationDate":"1992-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88930596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-09-01DOI: 10.1001/ARCHPEDI.1992.02160210112036
Joseph M. Scheller, K. Nelson
OBJECTIVE To review the literature regarding neurologic morbidity among twins. RESEARCH DESIGN Review of medical literature and data from the National Center for Health Statistics. CONCLUSIONS The twinning rate is increasing concurrent with an increase in the survival of twins. Because twins are more often born prematurely and are of low birth weight, and premature infants are at increased risk for neurologic morbidity, twins are vulnerable to this problem. In addition, twins are more likely to develop brain abnormalities in utero, which is thought to be related to placental vascular anastomoses. Pediatricians should expect more twins in the future with congenital neurologic illness.
{"title":"Twinning and neurologic morbidity.","authors":"Joseph M. Scheller, K. Nelson","doi":"10.1001/ARCHPEDI.1992.02160210112036","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1992.02160210112036","url":null,"abstract":"OBJECTIVE\u0000To review the literature regarding neurologic morbidity among twins.\u0000\u0000\u0000RESEARCH DESIGN\u0000Review of medical literature and data from the National Center for Health Statistics.\u0000\u0000\u0000CONCLUSIONS\u0000The twinning rate is increasing concurrent with an increase in the survival of twins. Because twins are more often born prematurely and are of low birth weight, and premature infants are at increased risk for neurologic morbidity, twins are vulnerable to this problem. In addition, twins are more likely to develop brain abnormalities in utero, which is thought to be related to placental vascular anastomoses. Pediatricians should expect more twins in the future with congenital neurologic illness.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"1 1","pages":"1110-3"},"PeriodicalIF":0.0,"publicationDate":"1992-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73339495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-09-01DOI: 10.1001/archpedi.1992.02160210027014
B. Wood
{"title":"Radiology in the dark.","authors":"B. Wood","doi":"10.1001/archpedi.1992.02160210027014","DOIUrl":"https://doi.org/10.1001/archpedi.1992.02160210027014","url":null,"abstract":"","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"20 1","pages":"1025"},"PeriodicalIF":0.0,"publicationDate":"1992-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79119681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-08-01DOI: 10.1001/archpedi.1992.02160200028021
Corrigan Jj
{"title":"The 'new' curriculum: is it new?","authors":"Corrigan Jj","doi":"10.1001/archpedi.1992.02160200028021","DOIUrl":"https://doi.org/10.1001/archpedi.1992.02160200028021","url":null,"abstract":"","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"38 1","pages":"909"},"PeriodicalIF":0.0,"publicationDate":"1992-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89830501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-06-01DOI: 10.1097/00132586-199206000-00050
E. Thilo, B. Park-Moore, E. R. Berman, B. S. Carson
Pulse oximetry is a valuable, noninvasive technique for assessing oxygen saturation that has gained wide clinical acceptance despite little available information concerning normal values in the newborn, especially at an altitude different than sea level. We performed serial pulse oximetry studies on 150 term, appropriate-weight-for-gestational-age, clinically healthy infants at an altitude of 1610 m (5280 ft) at 24 to 48 hours, 1 month, and 3 months of age to define a reference range for oxygen saturation as a guideline in clinical care. We found that mean oxygen saturation at 24 to 48 hours of age is 92% to 93% and varies little with infant activity. With increasing postnatal age, there is a tendency for increased oxygen saturation during the awake states to 93% to 94%, while oxygen saturation during sleep stays the same or even decreases slightly. The lower end of the reference range (2 SDs below the mean) is as low as 85% during feeding at 24 to 48 hours of age, and as low as 86% during quiet sleep at 1 and 3 months of age, with 88% to 89% the lower limit in other activities at all ages.
{"title":"Oxygen saturation by pulse oximetry in healthy infants at an altitude of 1610 m (5280 ft). What is normal?","authors":"E. Thilo, B. Park-Moore, E. R. Berman, B. S. Carson","doi":"10.1097/00132586-199206000-00050","DOIUrl":"https://doi.org/10.1097/00132586-199206000-00050","url":null,"abstract":"Pulse oximetry is a valuable, noninvasive technique for assessing oxygen saturation that has gained wide clinical acceptance despite little available information concerning normal values in the newborn, especially at an altitude different than sea level. We performed serial pulse oximetry studies on 150 term, appropriate-weight-for-gestational-age, clinically healthy infants at an altitude of 1610 m (5280 ft) at 24 to 48 hours, 1 month, and 3 months of age to define a reference range for oxygen saturation as a guideline in clinical care. We found that mean oxygen saturation at 24 to 48 hours of age is 92% to 93% and varies little with infant activity. With increasing postnatal age, there is a tendency for increased oxygen saturation during the awake states to 93% to 94%, while oxygen saturation during sleep stays the same or even decreases slightly. The lower end of the reference range (2 SDs below the mean) is as low as 85% during feeding at 24 to 48 hours of age, and as low as 86% during quiet sleep at 1 and 3 months of age, with 88% to 89% the lower limit in other activities at all ages.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"21 1","pages":"1137-40"},"PeriodicalIF":0.0,"publicationDate":"1992-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75034803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-06-01DOI: 10.1001/ARCHPEDI.1992.02160180125031
D. Durbin, B. Wood
{"title":"Radiological case of the month. Acute iron poisoning and gastrointestinal decontamination procedure.","authors":"D. Durbin, B. Wood","doi":"10.1001/ARCHPEDI.1992.02160180125031","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1992.02160180125031","url":null,"abstract":"","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"34 1","pages":"765-6"},"PeriodicalIF":0.0,"publicationDate":"1992-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89165109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-05-01DOI: 10.1001/ARCHPEDI.1992.02160170021008
T. Cheng
Sir .—Now that the regulatory change in New York State restricting the number of hours worked by resident physicians has been in existence for more than 2 years, the article by Cheng 1 is timely and interesting. But "what the residents want" may not be "what the residents get or should get." Continuity of care remains the most important characteristic of high-quality patient care 2,3 ; it is the best and only way the physician can remain familiar with pertinent data concerning a patient's illness. This is particularly true when unexpected problems arise. A very dangerous situation exists when a patient develops an unexpected complication at night or on a weekend when the physician in charge is off duty. This lack of continuity of care consequent to the regulatory change in New York State not only poses a hazard to the patient but also proves detrimental to the education of the
{"title":"Working hours for pediatric residents.","authors":"T. Cheng","doi":"10.1001/ARCHPEDI.1992.02160170021008","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1992.02160170021008","url":null,"abstract":"Sir .—Now that the regulatory change in New York State restricting the number of hours worked by resident physicians has been in existence for more than 2 years, the article by Cheng 1 is timely and interesting. But \"what the residents want\" may not be \"what the residents get or should get.\" Continuity of care remains the most important characteristic of high-quality patient care 2,3 ; it is the best and only way the physician can remain familiar with pertinent data concerning a patient's illness. This is particularly true when unexpected problems arise. A very dangerous situation exists when a patient develops an unexpected complication at night or on a weekend when the physician in charge is off duty. This lack of continuity of care consequent to the regulatory change in New York State not only poses a hazard to the patient but also proves detrimental to the education of the","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"1 1","pages":"541"},"PeriodicalIF":0.0,"publicationDate":"1992-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80199219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-03-01DOI: 10.1097/00132586-199304000-00042
S. Jones, D. Fiser, R. Livingston
OBJECTIVE The purposes of this study were to compare the frequency and severity of manifestations of anxiety, depression, delirium, and withdrawal in pediatric patients hospitalized in intensive care unit vs ward settings and to evaluate the impact of preexisting psychopathologic disorders on the expression of these symptoms. RESEARCH DESIGN Prospective patient series. SETTING Tertiary care pediatric center. PATIENTS Forty-three subjects aged 6 to 17 years hospitalized in either the pediatric or cardiovascular intensive care unit (n = 18) or on the general wards (n = 25) were recruited to participate. Subjects were excluded if their parents were unavailable for diagnostic interview or if they could not answer interview questions themselves. SELECTION PROCEDURES Consecutive sample. INTERVENTIONS None. MEASUREMENTS AND RESULTS The Hospital Observed Behavior Scale, developed for this study, was used to describe objectively subjects' manifestations of anxiety, depression, delirium, and withdrawal. The Diagnostic Interview for Children and Adolescents and Diagnostic Interview for Children and Adolescents-Parents were used to determine the presence of preexisting psychopathologic disorders. As measured by the Hospital Observed Behavior Scale, subjects in the intensive care unit exhibited apprehension, anxiety, detachment, sadness, and weeping more often than did patients in the ward. Behavior was also significantly influenced by severity of illness, duration of hospitalization, number of previous hospitalizations, and presence of a preexisting anxiety or mood disorder. We found the Hospital Observed Behavior Scale to have good interrater reliability. CONCLUSIONS Our data indicate that critically ill children in the intensive care unit, children with prolonged or repeated hospitalizations, and children with preexisting anxiety and mood disorders are at greater risk than other hospitalized pediatric patients for psychological trauma and/or behavior problems that may warrant psychiatric intervention. The Hospital Observed Behavior Scale is a reliable tool to quantitate behaviors in hospitalized children.
{"title":"Behavioral changes in pediatric intensive care units.","authors":"S. Jones, D. Fiser, R. Livingston","doi":"10.1097/00132586-199304000-00042","DOIUrl":"https://doi.org/10.1097/00132586-199304000-00042","url":null,"abstract":"OBJECTIVE\u0000The purposes of this study were to compare the frequency and severity of manifestations of anxiety, depression, delirium, and withdrawal in pediatric patients hospitalized in intensive care unit vs ward settings and to evaluate the impact of preexisting psychopathologic disorders on the expression of these symptoms.\u0000\u0000\u0000RESEARCH DESIGN\u0000Prospective patient series.\u0000\u0000\u0000SETTING\u0000Tertiary care pediatric center.\u0000\u0000\u0000PATIENTS\u0000Forty-three subjects aged 6 to 17 years hospitalized in either the pediatric or cardiovascular intensive care unit (n = 18) or on the general wards (n = 25) were recruited to participate. Subjects were excluded if their parents were unavailable for diagnostic interview or if they could not answer interview questions themselves.\u0000\u0000\u0000SELECTION PROCEDURES\u0000Consecutive sample.\u0000\u0000\u0000INTERVENTIONS\u0000None.\u0000\u0000\u0000MEASUREMENTS AND RESULTS\u0000The Hospital Observed Behavior Scale, developed for this study, was used to describe objectively subjects' manifestations of anxiety, depression, delirium, and withdrawal. The Diagnostic Interview for Children and Adolescents and Diagnostic Interview for Children and Adolescents-Parents were used to determine the presence of preexisting psychopathologic disorders. As measured by the Hospital Observed Behavior Scale, subjects in the intensive care unit exhibited apprehension, anxiety, detachment, sadness, and weeping more often than did patients in the ward. Behavior was also significantly influenced by severity of illness, duration of hospitalization, number of previous hospitalizations, and presence of a preexisting anxiety or mood disorder. We found the Hospital Observed Behavior Scale to have good interrater reliability.\u0000\u0000\u0000CONCLUSIONS\u0000Our data indicate that critically ill children in the intensive care unit, children with prolonged or repeated hospitalizations, and children with preexisting anxiety and mood disorders are at greater risk than other hospitalized pediatric patients for psychological trauma and/or behavior problems that may warrant psychiatric intervention. The Hospital Observed Behavior Scale is a reliable tool to quantitate behaviors in hospitalized children.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"179 1","pages":"375-9"},"PeriodicalIF":0.0,"publicationDate":"1992-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80054383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-01-01DOI: 10.1001/archpedi.1992.02160150019011
A. Bedrick
{"title":"Driving home at 5 AM.","authors":"A. Bedrick","doi":"10.1001/archpedi.1992.02160150019011","DOIUrl":"https://doi.org/10.1001/archpedi.1992.02160150019011","url":null,"abstract":"","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"45 1","pages":"281-2"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79947238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-01-01DOI: 10.1001/archpedi.1992.02160130023012
V. Fulginiti
{"title":"What is pediatrics?: prenatal medicine to young adult care.","authors":"V. Fulginiti","doi":"10.1001/archpedi.1992.02160130023012","DOIUrl":"https://doi.org/10.1001/archpedi.1992.02160130023012","url":null,"abstract":"","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"22 1","pages":"17-8"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84405280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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