Pub Date : 1991-02-01DOI: 10.1001/ARCHPEDI.1991.02160020051015
B. White, G. Hickson, R. Theriot, R. Zaner
Few pediatric training programs offer formal instruction or have ethics consultants to assist residents with ethical dilemmas. Moreover, even if such assistance were available, it is not clear that educators have an adequate understanding of (1) the range and frequency of possible ethical dilemmas residents may encounter, (2) residents' most troublesome concerns, (3) their use of resources to resolve issues, and (4) their own ethics belief systems. A sample of convenience (51 residents) at five midsouth residency programs was queried during 25-minute open-ended interviews to answer ethical questions; there were no refusals to participate. The "most troublesome" cases cited by the residents were related to life-and-death issues (withholding and withdrawing life support), child abuse and neglect cases, and disputes regarding patient care that arise between services. Two thirds of those surveyed indicated that they are still somewhat troubled by these difficult ethical problems. Surprisingly, residents stated that they relied on their peers more often than their attending physicians for effective assistance in resolving their most troublesome dilemmas. We support continuing education and research efforts to help residents and educators feel "more comfortable" in resolving ethical dilemmas.
{"title":"A medical ethics issues survey of residents in five pediatric training programs.","authors":"B. White, G. Hickson, R. Theriot, R. Zaner","doi":"10.1001/ARCHPEDI.1991.02160020051015","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160020051015","url":null,"abstract":"Few pediatric training programs offer formal instruction or have ethics consultants to assist residents with ethical dilemmas. Moreover, even if such assistance were available, it is not clear that educators have an adequate understanding of (1) the range and frequency of possible ethical dilemmas residents may encounter, (2) residents' most troublesome concerns, (3) their use of resources to resolve issues, and (4) their own ethics belief systems. A sample of convenience (51 residents) at five midsouth residency programs was queried during 25-minute open-ended interviews to answer ethical questions; there were no refusals to participate. The \"most troublesome\" cases cited by the residents were related to life-and-death issues (withholding and withdrawing life support), child abuse and neglect cases, and disputes regarding patient care that arise between services. Two thirds of those surveyed indicated that they are still somewhat troubled by these difficult ethical problems. Surprisingly, residents stated that they relied on their peers more often than their attending physicians for effective assistance in resolving their most troublesome dilemmas. We support continuing education and research efforts to help residents and educators feel \"more comfortable\" in resolving ethical dilemmas.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"15 1","pages":"161-4"},"PeriodicalIF":0.0,"publicationDate":"1991-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85059768","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 : 1991-01-01DOI: 10.1001/ARCHPEDI.1991.02160010046014
Sally L. Davidson Ward, S. Schuetz, L. Wachsman, Xylena D. Bean, Daisy B. Bautista, Sue Buckley, Sabitha Sehgal, David Warburton
Infants of substance-abusing mothers (ISAM) have significant growth and neurodevelopmental abnormalities. The origin of these abnormalities is unknown. We postulated that ISAM have increased sympathetic nervous system tone and altered catecholamine levels. Therefore, we measured plasma norepinephrine, epinephrine, and dopamine levels and the number and receptor affinity of beta-adrenoreceptor binding sites on lymphocytes and alpha-adrenoreceptor binding sites on thrombocytes in 22 otherwise healthy ISAM (age, 2.1 +/- 0.5 months; mean +/- SD) and 15 healthy controls (age, 2.5 +/- 0.8 months). Norepinephrine levels in venous blood were 1.8-fold higher in ISAM than in control infants (6.30 +/- 3.85 nmol/L vs 3.55 +/- 2.45 nmol/L). There were no differences in plasma epinephrine or dopamine levels. There were no differences in the number of binding sites or receptor affinity for beta- and alpha-adrenoreceptors. We conclude that ISAM have elevated circulating norepinephrine levels compared with controls. We speculate that this is associated with increased sympathetic nervous system tone in ISAM and that the absence of adrenoreceptor down-regulation may create catecholamine suprasensitivity.
{"title":"Elevated plasma norepinephrine levels in infants of substance-abusing mothers.","authors":"Sally L. Davidson Ward, S. Schuetz, L. Wachsman, Xylena D. Bean, Daisy B. Bautista, Sue Buckley, Sabitha Sehgal, David Warburton","doi":"10.1001/ARCHPEDI.1991.02160010046014","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160010046014","url":null,"abstract":"Infants of substance-abusing mothers (ISAM) have significant growth and neurodevelopmental abnormalities. The origin of these abnormalities is unknown. We postulated that ISAM have increased sympathetic nervous system tone and altered catecholamine levels. Therefore, we measured plasma norepinephrine, epinephrine, and dopamine levels and the number and receptor affinity of beta-adrenoreceptor binding sites on lymphocytes and alpha-adrenoreceptor binding sites on thrombocytes in 22 otherwise healthy ISAM (age, 2.1 +/- 0.5 months; mean +/- SD) and 15 healthy controls (age, 2.5 +/- 0.8 months). Norepinephrine levels in venous blood were 1.8-fold higher in ISAM than in control infants (6.30 +/- 3.85 nmol/L vs 3.55 +/- 2.45 nmol/L). There were no differences in plasma epinephrine or dopamine levels. There were no differences in the number of binding sites or receptor affinity for beta- and alpha-adrenoreceptors. We conclude that ISAM have elevated circulating norepinephrine levels compared with controls. We speculate that this is associated with increased sympathetic nervous system tone in ISAM and that the absence of adrenoreceptor down-regulation may create catecholamine suprasensitivity.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"116 1","pages":"44-8"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79468457","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 : 1991-01-01DOI: 10.1001/archpedi.1991.02160060025013
A. Pruitt
{"title":"Losing time.","authors":"A. Pruitt","doi":"10.1001/archpedi.1991.02160060025013","DOIUrl":"https://doi.org/10.1001/archpedi.1991.02160060025013","url":null,"abstract":"","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"6 1","pages":"607"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89952498","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 : 1990-12-01DOI: 10.1001/ARCHPEDI.1990.02150360055019
T. Stancin, N. Christopher, D. Coury
Improvements in the health of children have resulted in changes in the traditional role of the pediatrician. During the past two decades, pediatrics has become increasingly concerned with the social, behavioral, and developmental aspects of children. This new focus for pediatrics has been described as the "new morbidity," and recent studies have indicated that pediatricians are addressing more behavioral and developmental problems in their practices than in years past. 1 However, there is continued concern about the adequacy of training in the area of behavioral pediatrics. In 1978, the Task Force on Pediatric Education noted that residency training in pediatrics needed to emphasize behavioral and developmental issues more clearly. 2 A follow-up survey failed to demonstrate any uniformity in residency training experiences in the psychosocial aspects of pediatrics. 3 Fritz and Bergman 4 have described how pediatricians' attitudes toward mental health and methods of managing such issues correlate highly with
{"title":"Reported practices of pediatric residents in the management of attention-deficit hyperactivity disorder.","authors":"T. Stancin, N. Christopher, D. Coury","doi":"10.1001/ARCHPEDI.1990.02150360055019","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1990.02150360055019","url":null,"abstract":"Improvements in the health of children have resulted in changes in the traditional role of the pediatrician. During the past two decades, pediatrics has become increasingly concerned with the social, behavioral, and developmental aspects of children. This new focus for pediatrics has been described as the \"new morbidity,\" and recent studies have indicated that pediatricians are addressing more behavioral and developmental problems in their practices than in years past. 1 However, there is continued concern about the adequacy of training in the area of behavioral pediatrics. In 1978, the Task Force on Pediatric Education noted that residency training in pediatrics needed to emphasize behavioral and developmental issues more clearly. 2 A follow-up survey failed to demonstrate any uniformity in residency training experiences in the psychosocial aspects of pediatrics. 3 Fritz and Bergman 4 have described how pediatricians' attitudes toward mental health and methods of managing such issues correlate highly with","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"478 1","pages":"1329-33"},"PeriodicalIF":0.0,"publicationDate":"1990-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76337437","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 : 1990-11-01DOI: 10.1001/ARCHPEDI.1990.02150350010005
C. Kandall
Sir .—The article by Alexander et al 1 that appeared in the January issue of AJDC is one of several in the recent pediatric and radiological literature demonstrating both the morbidity and mortality associated with the whiplash shaken infant syndrome (WLS) and the risk of repetitive injury. Unfortunately, neither the force needed to produce an acute injury nor the incidence of latent WLS resulting from clinically inapparent recurrent battery is known. Under these circumstances, parental education delineating the unique vulnerability of the cranial contents of young infants should be routine. Pediatricians and other medical personnel should listen for unasked questions and masked frustrations when parents discuss colic or other feeding problems, since these behaviors are antecedents in a significant proportion of cases of WLS. The plea for an educational campaign is not new, 2 and while such an effort may not avert the unfortunate outcomes discussed in the case reports,
{"title":"Education concerning whiplash shaken infant syndrome: an unmet need.","authors":"C. Kandall","doi":"10.1001/ARCHPEDI.1990.02150350010005","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1990.02150350010005","url":null,"abstract":"Sir .—The article by Alexander et al 1 that appeared in the January issue of AJDC is one of several in the recent pediatric and radiological literature demonstrating both the morbidity and mortality associated with the whiplash shaken infant syndrome (WLS) and the risk of repetitive injury. Unfortunately, neither the force needed to produce an acute injury nor the incidence of latent WLS resulting from clinically inapparent recurrent battery is known. Under these circumstances, parental education delineating the unique vulnerability of the cranial contents of young infants should be routine. Pediatricians and other medical personnel should listen for unasked questions and masked frustrations when parents discuss colic or other feeding problems, since these behaviors are antecedents in a significant proportion of cases of WLS. The plea for an educational campaign is not new, 2 and while such an effort may not avert the unfortunate outcomes discussed in the case reports,","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"1 1","pages":"1180"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86326021","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 : 1990-08-01DOI: 10.1097/00006254-199008000-00014
P. Accardo, B. Whitman
Early reports on the quality and duration of marriages that involve adults with mental retardation have documented both problems and possibilities. 1-5 Today, adults with mental retardation are marrying and having children, and adult unmarried women with mental retardation (even moderate to severe mental retardation) are having children. The true prevalence of parents with severe intellectual limitation is unknown and possibly unknowable. An accurate differential diagnosis of the cause of cognitive deficiency in an adult who is living in the community is difficult to obtain in the absence of records of formal childhood testing. Nevertheless, in a key informer survey performed in the city of St Louis, Mo, the number of children of mentally retarded mothers, who were identified, suggested that adults with mental retardation were having children on the same order of magnitude as the rate in the general population, with a mean number of 2.8 children per retarded
{"title":"Children of mentally retarded parents.","authors":"P. Accardo, B. Whitman","doi":"10.1097/00006254-199008000-00014","DOIUrl":"https://doi.org/10.1097/00006254-199008000-00014","url":null,"abstract":"Early reports on the quality and duration of marriages that involve adults with mental retardation have documented both problems and possibilities. 1-5 Today, adults with mental retardation are marrying and having children, and adult unmarried women with mental retardation (even moderate to severe mental retardation) are having children. The true prevalence of parents with severe intellectual limitation is unknown and possibly unknowable. An accurate differential diagnosis of the cause of cognitive deficiency in an adult who is living in the community is difficult to obtain in the absence of records of formal childhood testing. Nevertheless, in a key informer survey performed in the city of St Louis, Mo, the number of children of mentally retarded mothers, who were identified, suggested that adults with mental retardation were having children on the same order of magnitude as the rate in the general population, with a mean number of 2.8 children per retarded","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"14 1","pages":"69-70"},"PeriodicalIF":0.0,"publicationDate":"1990-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75484529","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 : 1990-05-01DOI: 10.1001/ARCHPEDI.1990.02150290013007
S. Stine
Sir .—The article by Tirosh and Rabino 1 that appeared in the May 1989 issue of AJDC reviewed the few published studies on the benefit of physical therapy for patients with cerebral palsy. The results are dismal on several accounts, and the need for more scientifically rigorous study is past due. Nonetheless, is this outcome to date really so different from our therapy results in some other conditions? Much time and money is spent rehabilitating normal brains of people that have been injured in various accidents. However, many children with congenital brain lesions (including cerebral palsy) have greater "potential" than those injured later in life. I personally follow up a large cohort of children with cerebral palsy who have normal IQs and who, through therapy—physical or otherwise, are learning to compensate for their disability. If a child was born with a limb defect, all sorts of resources could be brought
{"title":"Therapy--physical or otherwise--in cerebral palsy.","authors":"S. Stine","doi":"10.1001/ARCHPEDI.1990.02150290013007","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1990.02150290013007","url":null,"abstract":"Sir .—The article by Tirosh and Rabino 1 that appeared in the May 1989 issue of AJDC reviewed the few published studies on the benefit of physical therapy for patients with cerebral palsy. The results are dismal on several accounts, and the need for more scientifically rigorous study is past due. Nonetheless, is this outcome to date really so different from our therapy results in some other conditions? Much time and money is spent rehabilitating normal brains of people that have been injured in various accidents. However, many children with congenital brain lesions (including cerebral palsy) have greater \"potential\" than those injured later in life. I personally follow up a large cohort of children with cerebral palsy who have normal IQs and who, through therapy—physical or otherwise, are learning to compensate for their disability. If a child was born with a limb defect, all sorts of resources could be brought","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"173 1","pages":"519-20"},"PeriodicalIF":0.0,"publicationDate":"1990-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84009745","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 : 1990-04-01DOI: 10.1001/ARCHPEDI.1990.02150280107024
J. Jason, B. Evatt
We investigated 24 completed pregnancies of 20 healthy, human immunodeficiency virus (HIV)-seropositive sex partners of 20 seropositive hemophilic men. One woman had recurrent herpes simplex type 2 infection; no woman was known to use illicit drugs or to have other purported cofactors for vertical HIV transmission. For 8 offspring, the mothers learned of their partners' serostatus and received counseling against pregnancy prior to the fifth month of gestation; for 9 offspring (37.5%), the mothers learned of their own seropositivity and received counseling prior to the fifth month. Acquired immunodeficiency syndrome developed in 7 (35%) of 20 fathers, 4 of whom died; HIV-related symptoms developed in 4; severe liver disease developed in 2; and 7 (35%) were in good health. In four mothers (20%) HIV-related symptoms developed. Five offspring were breast-fed for 2 days to more than 3 years, two while the mother was known to be seropositive; four of these were seronegative and healthy, and one was seropositive at 30 months of age and had persistent cervical lymphadenopathy at 48 months of age. Infants were born at term; median birth weight was 2.86 kg. Solely on the basis of serologic studies and symptoms for those with more than 15 months of follow-up, the minimum perinatal transmission rate for this group of women without putative transmission cofactors (drug usage, promiscuity, malnutrition, HIV symptoms) was at least 25%, a rate comparable to that reported for women in other risk groups.
{"title":"Pregnancies in human immunodeficiency virus-infected sex partners of hemophilic men. The Hemophilia-AIDS Collaborative Study Group.","authors":"J. Jason, B. Evatt","doi":"10.1001/ARCHPEDI.1990.02150280107024","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1990.02150280107024","url":null,"abstract":"We investigated 24 completed pregnancies of 20 healthy, human immunodeficiency virus (HIV)-seropositive sex partners of 20 seropositive hemophilic men. One woman had recurrent herpes simplex type 2 infection; no woman was known to use illicit drugs or to have other purported cofactors for vertical HIV transmission. For 8 offspring, the mothers learned of their partners' serostatus and received counseling against pregnancy prior to the fifth month of gestation; for 9 offspring (37.5%), the mothers learned of their own seropositivity and received counseling prior to the fifth month. Acquired immunodeficiency syndrome developed in 7 (35%) of 20 fathers, 4 of whom died; HIV-related symptoms developed in 4; severe liver disease developed in 2; and 7 (35%) were in good health. In four mothers (20%) HIV-related symptoms developed. Five offspring were breast-fed for 2 days to more than 3 years, two while the mother was known to be seropositive; four of these were seronegative and healthy, and one was seropositive at 30 months of age and had persistent cervical lymphadenopathy at 48 months of age. Infants were born at term; median birth weight was 2.86 kg. Solely on the basis of serologic studies and symptoms for those with more than 15 months of follow-up, the minimum perinatal transmission rate for this group of women without putative transmission cofactors (drug usage, promiscuity, malnutrition, HIV symptoms) was at least 25%, a rate comparable to that reported for women in other risk groups.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"33 1","pages":"485-90"},"PeriodicalIF":0.0,"publicationDate":"1990-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78935003","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 : 1990-03-01DOI: 10.1001/ARCHPEDI.1990.02150270035021
T. Vesikari, T. Rautanen, T. Varis, G. Beards, A. Kapikian
Live attenuated oral rhesus Rotavirus candidate vaccine (strain MMU 18006 [lot RRV-1]) was evaluated for immunogenicity, safety, and clinical protection in a double-blind, placebo-controlled trial involving 200 infants aged 2 to 5 months when vaccinated. Vaccine-induced fourfold or greater rise of Rotavirus antibodies was seen in 62% of the infants. Febrile reactions of short duration on days 3 and/or 4 after vaccination occurred in 26% of the vaccine recipients. The clinical follow-up covered two Rotavirus seasons, in which serotypes 1 and 4 were prevalent. There were 16 cases of confirmed Rotavirus diarrhea in the placebo-treated group and 10 in the vaccine-treated group; from this a vaccine protection rate of 38% was derived. Clinical severity of Rotavirus diarrhea was assessed by a score; 13 cases in the placebo-treated group and 5 in the vaccine-treated group were regarded as severe or moderately severe, giving a vaccine protection rate of 67%. The rhesus Rotavirus vaccine induces partial protection against heterotypic Rotavirus disease, but the level of protection achieved with the present vaccine dose in this age group appears to be insufficient for a general Rotavirus vaccination.
{"title":"Rhesus Rotavirus candidate vaccine. Clinical trial in children vaccinated between 2 and 5 months of age.","authors":"T. Vesikari, T. Rautanen, T. Varis, G. Beards, A. Kapikian","doi":"10.1001/ARCHPEDI.1990.02150270035021","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1990.02150270035021","url":null,"abstract":"Live attenuated oral rhesus Rotavirus candidate vaccine (strain MMU 18006 [lot RRV-1]) was evaluated for immunogenicity, safety, and clinical protection in a double-blind, placebo-controlled trial involving 200 infants aged 2 to 5 months when vaccinated. Vaccine-induced fourfold or greater rise of Rotavirus antibodies was seen in 62% of the infants. Febrile reactions of short duration on days 3 and/or 4 after vaccination occurred in 26% of the vaccine recipients. The clinical follow-up covered two Rotavirus seasons, in which serotypes 1 and 4 were prevalent. There were 16 cases of confirmed Rotavirus diarrhea in the placebo-treated group and 10 in the vaccine-treated group; from this a vaccine protection rate of 38% was derived. Clinical severity of Rotavirus diarrhea was assessed by a score; 13 cases in the placebo-treated group and 5 in the vaccine-treated group were regarded as severe or moderately severe, giving a vaccine protection rate of 67%. The rhesus Rotavirus vaccine induces partial protection against heterotypic Rotavirus disease, but the level of protection achieved with the present vaccine dose in this age group appears to be insufficient for a general Rotavirus vaccination.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"2 1","pages":"285-9"},"PeriodicalIF":0.0,"publicationDate":"1990-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90569651","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 : 1990-01-01DOI: 10.1001/ARCHPEDI.1990.02150250017012
Peter B. Jones
Sir .—I read with interest the article by Berezin et al 1 that appeared in the March 1989 issue of AJDC . It was commendable that the authors obtained informed consent from the legal guardian(s) of the infants before undertaking colonoscopy. It was also commendable that the protocol for the study was approved by the institutional review board for the protection of human subjects at the center involved. Another strong point of the study was the precise definition of a case of diarrhea. The authors conclude that the presence of hematochezia is an indication for colonoscopy with videotape in infants and that the procedure is the most effective means of definitive diagnosis. The accepted method of withdrawal and challenge is definitely more cost-effective and potentially less risky than colonoscopy with videotape in infants. The issues of cost-effectiveness and morbidity were not considered by the authors before recommending the adoption of colonoscopy
{"title":"Gastrointestinal milk intolerance of infancy.","authors":"Peter B. Jones","doi":"10.1001/ARCHPEDI.1990.02150250017012","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1990.02150250017012","url":null,"abstract":"Sir .—I read with interest the article by Berezin et al 1 that appeared in the March 1989 issue of AJDC . It was commendable that the authors obtained informed consent from the legal guardian(s) of the infants before undertaking colonoscopy. It was also commendable that the protocol for the study was approved by the institutional review board for the protection of human subjects at the center involved. Another strong point of the study was the precise definition of a case of diarrhea. The authors conclude that the presence of hematochezia is an indication for colonoscopy with videotape in infants and that the procedure is the most effective means of definitive diagnosis. The accepted method of withdrawal and challenge is definitely more cost-effective and potentially less risky than colonoscopy with videotape in infants. The issues of cost-effectiveness and morbidity were not considered by the authors before recommending the adoption of colonoscopy","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"5 1","pages":"15-7"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90572144","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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