Clinical pediatrics
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Clinical pediatrics · Nov 2007
ReviewHypotonic versus isotonic maintenance intravenous fluid therapy in hospitalized children: a systematic review.
A systematic review of studies comparing hypotonic versus isotonic intravenous maintenance fluids in hospitalized children was conducted to determine whether hypotonic solutions increase the risk of acute hyponatremia. Studies were identified from electronic databases and hand-searched reference lists. ⋯ All authors cautioned against the routine use of hypotonic maintenance fluids, but hypotonic fluid administration did not always explain the development of acute hyponatremia. Further evidence is required as to the appropriate maintenance solution for hospitalized children.
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Clinical pediatrics · Jun 2007
Behavioral health practices in the midst of black box warnings and mental health reform.
A standard guide was readministered to 42 primary care pediatricians after community interventions to assess changes in their behavioral health practices. Among the outcome findings: increased screening of young children (6 months to 5 years); attention deficit hyperactivity disorder continued to be the most frequent diagnosis, with a high level of diagnostic comfort and use of stimulants; decreased comfort in the diagnosis and treatment of depression, with a significant decline in use of selective serotonin reuptake inhibitors; nearly all continued to offer nonmedication, behavioral health treatment; and a significant increase in use of social workers for community referrals. ⋯ Black box warnings exerted a powerful effect on prescribing practices. Systemic changes involving financial incentives, increased access to mental health providers, practice guidelines, and technology for continuing education may offer possibilities for changing practice patterns.
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Clinical pediatrics · May 2007
Parent perceptions of the specialty pediatric emergency medicine and their understanding of the provider roles in a Pediatric Emergency Department.
This study was conducted to assess parents' understanding of Pediatric Emergency Medicine and the roles of different providers in a pediatric emergency department. Parents were surveyed regarding these subjects and given a sheet explaining provider roles. Of 102 questionnaires completed, 82% of questions on attending roles were answered correctly and 70% of questions about pediatric emergency medicine were answered correctly. ⋯ Many parents were informed regarding emergency department provider roles. Certain aspects of these roles and the practice of pediatric emergency department are less well understood. An informational sheet can help educate parents about provider roles and the practice of pediatric emergency medicine.
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The recto-sigmoid index on barium enema may aid in the diagnosis of Hirschsprung's disease. However, data on its reliability in different age groups are sparse. The recto-sigmoid index and transitional zone were evaluated blindly in 107 patients with diagnostic rectal suction biopsies. ⋯ Their negative predictive values reached clinical significance in infants and children but not in neonates. Their positive predictive values were not significant in any age group. The recto-sigmoid index identified 4 patients with recto-sigmoid Hirschsprung's disease whose diagnosis was missed by evaluating the transitional zone alone.