Pediatrics
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A tetravalent vaccine against rotavirus, the most commonly identified etiologic agent of viral gastroenteritis (GE), has recently been licensed for use in the United States. ⋯ We conclude that a focused rotavirus vaccination policy using readily identifiable potential high-risk groups would be unlikely to prevent most infant hospitalizations associated with rotavirus infection. However, the safety of rotavirus vaccine in low birth weight and premature infants must be established, because these children appear to be at greater risk for hospitalization with viral GE and rotavirus.
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The way in which physicians are trained to do invasive practical procedures is an ongoing challenge for educators. Percutaneous insertion of a central line via the femoral vein using the Seldinger technique is an important practical pediatric procedure, and the need for physicians to be educated in the necessary skills is recognized in current training initiatives such as Pediatric Advanced Life Support (PALS) and Advanced Pediatric Life Support. Unfortunately, the majority of instruction in central venous access techniques is theoretic. ⋯ Before training they were asked, "Have you done a pediatric resuscitation course that taught this technique in theory?" and "Rate your confidence level for performing central vascular access in a patient from 0 to 5 (none, very little, some, moderate, good, complete)." This rating was repeated after the training session using the model. For 154 (71%) answering "yes" to a previous resuscitation course, mean scores were 1.52 (standard error [SE] +/- 0.91) after theoretic instruction and 4.06 (SE +/- 0.47) after practical education using our model. The 64 (29%) physicians
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Health care systems today are complex, technically proficient, competitive, and market-driven. One outcome of this environment is the recent phenomenon in the health care field of "consumerism." Strong emphasis is placed on customer service, with organized efforts to understand, measure, and meet the needs of customers served. The purpose of this article is to describe the current understanding and measurement of parent needs and expectations with neonatal intensive care services from the time the expectant parents enter the health care system for the birth through the discharge process and follow-up care. ⋯ Five parent satisfaction questionnaires-the Parent Feedback Questionnaire, Neonatal Index of Parent Satisfaction, Inpatient Parent Satisfaction-Children's Hospital Minneapolis, Picker Institute-Inpatient Neonatal Intensive Care Unit Survey, and the Neonatal Intensive Care Unit-Parent Satisfaction Form-are critically reviewed for their ability to measure parent satisfaction within the framework of the neonatal care delivery process. An immense gap was found in our understanding about what matters most and when to parents going through the neonatal intensive care experience. Additional research is required to develop comprehensive parent satisfaction surveys that measure parent perceptions of neonatal care within the framework of the care delivery process.
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Delay in the provision of definitive care for critically injured children may adversely effect outcome. We sought to speed care in the emergency department (ED) for trauma victims by organizing a formal trauma response system. ⋯ Before creation of the trauma team, relevant specialists were individually called to the ED for patient evaluation. When a formal trauma response team was organized, time required for ED treatment of severe trauma was decreased, and survival was better than predicted compared with the reference Major Trauma Outcome Study population.