Pediatrics
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A randomized comparison of surfactant dosing via a dual-lumen endotracheal tube in respiratory distress syndrome. The Spanish Surfactant Collaborative Group.
To determine if 1-minute instillation of Curosurf via a dual-lumen endotracheal tube without interruption of mechanical ventilation could decrease the incidence of hypoxia (drop in oxygen saturation [SaO2] to <80%, or of transcutaneous partial pressure of oxygen [PtcO2] to <50 mm Hg [6.6 kPa]) and bradycardia (heart rate below 80 beats/minute) at dosing, without affecting the efficacy of the standard bolus delivery. ⋯ A simplified 1-minute Curosurf dosing procedure via a dual-lumen endotracheal tube without fractional doses, ventilator disconnection, changes in the infant's position, or manual bagging was found to reduce the number of dosing-related adverse transient episodes of hypoxia. Although the simplified method appeared to be as effective as bolus delivery, this should be confirmed in a larger trial.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The collaborative UK ECMO (Extracorporeal Membrane Oxygenation) trial: follow-up to 1 year of age.
To evaluate the clinical effectiveness of neonatal extracorporeal membrane oxygenation (ECMO), in terms of mortality and morbidity, in the treatment of cardiorespiratory failure in term infants. ⋯ These results are in accord with the earlier preliminary findings that a policy of ECMO support reduces the risk of death without a concomitant rise in severe disability. However, 1 in 4 survivors had evidence of impairment with or without disability. Further follow-up is planned at the age of 4 and 7 years.
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A 3-week-old infant awoke with a fever. He was taken to the doctor who noted that the child was irritable. The doctor took him to the hospital where a resident performed a spinal tap, started an intravenous (IV) line, and ordered antibiotics. ⋯ Juries would be empowered (as they are currently) to determine exactly where on this curve substandard care lies, but at least the debate would share the same description of reality. Recent US Supreme Court guidelines regarding expert testimony provide an opportunity to expand the use of databases in medical negligence cases. The Court restricted expert testimony to "scientific knowledge ... based on generating hypotheses and testing them to see if they can be falsified ... (ABSTRACT TRUNCATED)
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To review special issues related to pediatric residency training in managed care organizations, the effects of the changing health care system on the demand for pediatricians and the potential impact on financial support for residency training, current methods of financing graduate medical education (GME), possible future approaches to financing GME, and policy directions to support training of pediatricians well prepared for future practice. ⋯ Although reforms in federal GME financing have been limited to date and other significant changes have been largely state-based, it is likely in the future that explicit funds will be targeted to specialties in demand that prepare physicians well for future practice. Pediatricians and medical educators must intensify their voices in the financing debate to ensure a productive future for quality pediatric residency training.