Clinical pediatrics
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Clinical pediatrics · Nov 2004
ENT and speech disorders in children with Down's syndrome: an overview of pathophysiology, clinical features, treatments, and current management.
Down's syndrome is the most commonly occurring genetic abnormality, involving about 1 in 600 births. The increasing life expectancy of individuals with Down's syndrome has revealed the presence of several unexpected pathological processes. Among these, ENT disorders hold an important place because of their high incidence and severity. ⋯ In children with Down's syndrome, ENT disorders occur frequently and are often severe. They develop owing to craniofacial, functional, and immune system abnormalities. Early screening and treatment allow improvements in long-term outcomes.
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Clinical pediatrics · Oct 2004
Idiopathic thrombocytopenic purpura: a 10-year natural history study at the childrens hospital of alabama.
Childhood idiopathic thrombocytopenic purpura (ITP) is a common disorder. However, single-institution, long-term, natural history data are limited. The objective of this paper is to review presenting features, response to therapy, and natural history of ITP treated at a single pediatric academic medical center. ⋯ Chronic cases present at an older age with higher platelet counts. Up to 50% of cases of chronic ITP will resolve with ongoing follow-up. The overall prognosis in childhood ITP is excellent.
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Clinical pediatrics · Oct 2004
Student evaluation practices in pediatric clerkships: a survey of the medical schools in the United States and Canada.
Despite the curriculum changes during the past decade, there is paucity of information regarding the structure and evaluation processes in pediatric clerkships. Information regarding the educational components of the pediatric clerkship and student evaluation practices was obtained from the pediatric clerkship directors via a paper/electronic survey. Completed surveys were received from 97 US and Canadian medical schools and were analyzed. ⋯ In 56% of programs, a student failing in clinical performance failed the entire clerkship in contrast to 21.8% or 7% of the programs where a student failed the entire clerkship if they failed in the examination for the fund of knowledge or written record evaluation, respectively. The survey demonstrated a fair amount of consistency in clerkships across programs when compared with data obtained in 1981 and 1986. There was a noticeable increase in the well-baby nursery rotation; however, there was a decline in direct observation to assess physical examination or clinical performance.
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A trend of increasing number and severity of injuries associated with use of personal watercraft (PWC) has been noted as the use and popularity of PWC also rises. The rate of injuries secondary to PWC use is greater than that from other water sports. Multiple etiologies of injury have been reported, including closed head trauma, spinal injuries, facial fractures, chest trauma, abdominal injuries, and drowning. ⋯ Recommendations to reduce morbidity and mortality include using U. S. Coast Guard-approved personal flotation devices (PFD), limiting use of PWC to trained adults, and improving recognition of significant PWC injury by medical personnel.
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The aims of this study were to identify features in the history, physical examination, and radiologic studies that were associated with the diagnosis of intussusception and to determine if there was a subset of patients being evaluated for intussusception who can be spared from undergoing a contrast enema based on a combination of historical, clinical, and radiographic findings. A retrospective cohort study at a regional children's hospital emergency department (ED) was conducted. Mean age was 1.2 years among both those with and without intussusception. ⋯ Previously identified predictors of intussusception remain important in increasing suspicion of this important diagnosis. At this point there is no reliable prediction model that can accurately identify all patients with intussusception. A prospective study may aid in the development of a clinically more useful model.