Pediatrics
-
Multicenter Study Comparative Study
Child abuse training and knowledge: a national survey of emergency medicine, family medicine, and pediatric residents and program directors.
The objective of this study was to determine the level of knowledge, comfort, and training related to the medical management of child abuse among pediatrics, emergency medicine, and family medicine residents. ⋯ By analyzing the relationship between program characteristics and residents' child abuse knowledge, we found that pediatric programs provide far more training and resources for child abuse education than emergency medicine and family medicine programs. As leaders, pediatricians must establish the importance of this topic in the pediatric education of residents of all specialties.
-
Review Meta Analysis
The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: a systematic review.
Pediatric and intensive care patients are particularly at risk for medication errors. Computerized physician order entry systems could be effective in reducing medication errors and improving outcome. Effectiveness of computerized physician order entry systems has been shown in adult medical care. However, in critically ill patients and/or children, medication prescribing is a more complex process, and usefulness of computerized physician order entry systems has yet to be established. ⋯ Introduction of computerized physician order entry systems clearly reduces medication prescription errors; however, clinical benefit of computerized physician order entry systems in pediatric or ICU settings has not yet been demonstrated. The quality of the implementation process could be a decisive factor determining overall success or failure.
-
We conducted a prospective, observational study in a tertiary care pediatric center to determine risk factors for the development of and outcomes from ventilator-associated pneumonia. ⋯ In mechanically ventilated, critically ill children, those with ventilator-associated pneumonia had a prolonged need for mechanical ventilation, a longer ICU stay, and a higher mortality rate. Female gender, postsurgical diagnosis, the use of narcotics, and the use of enteral feeds were associated with an increased risk of developing ventilator-associated pneumonia in these patients.
-
The diagnostic labeling of presumed nonbacterial lower respiratory tract infection is unclear. Our objective was to identify patterns of specific diagnoses and treatments that were given to children who presented with lower respiratory tract infection to US academic emergency departments. ⋯ For children who are age <2 years and present to an emergency department with lower respiratory tract infection symptoms, there is large variability in the assigned diagnosis. Children who present to emergency departments that more commonly diagnose lower respiratory tract infection as "asthma" are more likely to receive corticosteroids. As clinicians, we need to develop evidence- and outcome-based definitions for lower respiratory tract infections to guide diagnosis and treatment better.
-
Mass screening for celiac disease is controversial. The objective of this study was to determine whether detection of childhood celiac disease by mass screening improves long-term health status and health-related quality of life. ⋯ Identification by mass screening led 10 years later to health improvement in 66% of children without deterioration of generic health-related quality of life. There is a good compliance after mass screening. In a research setting, delaying treatment for children without symptoms seems to be an option after a positive screening test. Long-term follow-up studies are needed to assess possible long-term complications in untreated, nonsymptomatic celiac disease.