Pediatrics
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To examine the current delivery of inpatient hospital services to a statewide population of rural children, define the types of pediatric conditions currently treated in rural hospitals or transferred to urban centers, and explore the role of rural pediatricians and family practitioners in the care of children in rural hospitals. ⋯ Most rural children in Washington who require hospitalization for common problems receive their care in local rural hospitals staffed with pediatricians and family practitioners, although those with illnesses requiring a high level of specialty care are predominantly cared for in urban centers. Rural pediatricians make a substantial contribution to the care of rural children, especially in the area of neonatal care, although their presence in rural hospitals does not in itself create local referral centers. Inpatient volumes are higher for pediatricians, but their case mix is similar to that of rural family practitioners, except in the area of neonatology. These data support the recommendations that family practitioners contemplating rural practice receive training in general inpatient pediatrics (regardless of whether they are going to a site with pediatricians) and that pediatricians in rural practice be trained for a high volume of inpatient cases, including problems of low birth weight infants. Because systems of hospital care for rural children depend on regionalized programs, clinical and educational linkages between urban centers and rural providers should be developed and supported.
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Child abuse and wife abuse are linked. Studies indicate 30% to 59% of mothers of children reported for child abuse also are battered. In homes where domestic violence occurs, the children are at increased risk of physical abuse or neglect. Children who witness battering of their mothers are at risk for psychosocial sequelae including developmental delays and posttraumatic stress disorder. ⋯ Battered mothers are rarely identified in the pediatric emergency department even though the physicians report handling a significant number of child abuse/neglect cases. Education on domestic violence, including the implications of woman battering for childrens' health, should be incorporated in the training curricula of pediatric emergency department physicians to raise awareness of the need to explore for the presence of concurrent abuse in both children and their mothers. Identifying battered women through their children will impact greatly on the welfare of both mother and child.
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Randomized Controlled Trial Comparative Study Clinical Trial
Long-term appearance of lacerations repaired using a tissue adhesive.
Histoacryl Blue (HAB), a tissue adhesive, has been shown to decrease laceration repair time, cause less pain to the child, eliminate the need for suture removal, and result in a similar short-term cosmetic outcome compared with conventional suturing. Reports suggest that poor correlation can exist between the short-term and long-term cosmetic outcomes for lacerations repaired by conventional suturing. Therefore, this study compares the long-term cosmetic outcome of HAB to conventional suturing for laceration repair in children. ⋯ The use of HAB is an ideal alternative to conventional suturing for the cutaneous closure of low tension lacerations in children with a long-term cosmetic outcome comparable to conventional suturing.
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Randomized Controlled Trial Clinical Trial
C-reactive protein is a useful marker for guiding duration of antibiotic therapy in suspected neonatal bacterial infection.
To determine whether C-reactive protein (CRP) can be used as a parameter to identify the time point when antibiotic treatment can safely be discontinued in a defined major subgroup of neonates treated for suspected bacterial infection. ⋯ We conclude that CRP could be a key parameter for individually guiding the duration of antibiotic treatment in a major subgroup of newborns with suspected bacterial infection. This approach would allow considerably shorter courses of antibiotic therapy.
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To assess pediatricians' knowledge about the epidemiology of childhood drowning, their opinions and current practices regarding its prevention, and their interest in taking on more responsibility for its prevention. ⋯ Pediatricians have been effective child advocates in many areas of injury prevention. If the prevention of drowning is made a priority in pediatric practice, many more children's lives will be saved.