Pediatrics
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Randomized Controlled Trial Comparative Study
Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol.
Several studies have evaluated dexamethasone for prevention of hearing loss in childhood bacterial meningitis, but results have varied. We compared dexamethasone and/or glycerol recipients with placebo recipients, and measured hearing at 3 threshold levels. ⋯ With bacterial meningitis, the child's presenting status and young age are the most important predictors of hearing impairment. Little relief is obtained from current adjuvant medications.
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Comparative Study
Delayed identification of pediatric abuse-related fractures.
Because physicians may have difficulty distinguishing accidental fractures from those that are caused by abuse, abusive fractures may be at risk for delayed recognition; therefore, the primary objective of this study was to determine how frequently abusive fractures were missed by physicians during previous examinations. A secondary objective was to determine clinical predictors that are associated with unrecognized abuse. ⋯ One fifth of children with abuse-related fractures are missed during the initial medical visit. In particular, boys who present to a primary care or a general emergency department setting with an extremity fracture are at a particularly high risk for delayed diagnosis.
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Comparative Study
Patterns of work and retirement among pediatricians aged >or=50 years.
This study examined patterns of work and retirement among older pediatricians, including the determinants of part-time work and retirement, as well as extended participation in the pediatrician workforce. ⋯ Part-time work and reduced work hours in anticipation of retirement are options that are used and desired by older pediatricians. Results of this study suggest that making provisions for gradual reduction in work hours or other forms of phasing out of the workforce could benefit the practice of pediatrics by extending the career length of the most experienced pediatricians.
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Comparative Study
Can the OSA-18 quality-of-life questionnaire detect obstructive sleep apnea in children?
Polysomnography is the best tool available for diagnosing obstructive sleep apnea (OSA) in children. However, polysomnography is relatively inaccessible and costly, and studies are needed to evaluate other diagnostic approaches. It has been suggested that the OSA-18 quality-of-life questionnaire (OSA-18) is a useful measure that could replace polysomnography. The purpose of our study was to determine if the OSA-18, is an accurate measure for the detection of moderate-to-severe OSA. ⋯ Among children who are referred to a sleep laboratory, the OSA-18 does not accurately detect which children will have an abnormal MOS and cannot be used to exclude moderate-to-severe OSA. The OSA-18 should not be used in the place of objective testing to identify moderate-to-severe OSA in children.
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Comparative Study
Bruising characteristics discriminating physical child abuse from accidental trauma.
Our objective was to conduct a pilot study to identify discriminating bruising characteristics and to model those findings into a decision tool for screening children at high risk for abuse. ⋯ Discriminating differences exist in bruising characteristics for abusive versus accidental trauma. The body region- and age-based bruising clinical decision rule model functions as a clinically sensible screening tool to identify young children who require further evaluation for abuse.