Pediatrics
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Randomized Controlled Trial Comparative Study
Randomized pilot study comparing oral ibuprofen with intravenous ibuprofen in very low birth weight infants with patent ductus arteriosus.
We conducted a prospective, randomized, single-masked pilot study with the principal aim of comparing efficacy and tolerance between oral and intravenous ibuprofen in early closure of patent ductus arteriosus in very low birth weight infants. The possibility of ductal closure with only 1 or 2 doses of treatment was a secondary objective. ⋯ In very low birth weight infants, the rate of early ductal closure with oral ibuprofen is at least as good as with the intravenous route. Ductal closure may be obtained with an incomplete course of ibuprofen. Oral ibuprofen is associated with fewer adverse effects. However, a larger sample is needed for more definitive conclusions.
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Comparative Study
Screening for environmental tobacco smoke exposure among inner-city children with asthma.
The goals were (1) to develop an index measure of environmental tobacco smoke based on parent self-report of smoking behaviors and (2) to determine whether the index score was associated with children's present and future cotinine levels. ⋯ An index measure with combined information regarding primary caregiver smoking and household smoking restrictions helped to identify children with asthma with the greatest exposure to environmental tobacco smoke and could predict which children would have elevated cotinine levels 7 to 9 months later.
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Review
Medical diagnoses commonly associated with pediatric malpractice lawsuits in the United States.
In this article we discuss the medical diagnoses underlying the most common lawsuits involving pediatricians in the United States. Where applicable, specific and general risk-management techniques are noted as a means of increasing patient safety and reducing the risk of medical malpractice exposure.
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Multicenter Study
Estimated savings from paid telephone consultations between subspecialists and primary care physicians.
Pediatric subspecialists are not routinely reimbursed by Medicaid or insurance payers for telephone consultations. Generally, access to pediatric subspecialists is limited because of the small number of providers, their concentration in academic medical centers, and increasing demand for their services. Little is known about the nature of such consults, the time required to provide them, or whether there is a positive economic impact for payers. ⋯ Telephone consultations with pediatric subspecialists provide a valuable service to primary care physicians providing medical homes to Medicaid patients. Rewarding physicians for telephone consults seems to be cost-effective because of reduced use of costly services and reported improvements in quality of care.
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Multicenter Study
Epidemiological features of Clostridium difficile-associated disease among inpatients at children's hospitals in the United States, 2001-2006.
Clostridium difficile is the main cause of nosocomial and antibiotic-associated diarrhea in adults. Recently, the incidence and severity of C difficile-associated disease in adults have been increasing. Whether similar phenomena are occurring among children remains unknown. Our study describes the epidemiological features of C difficile-associated disease in hospitalized children. ⋯ The annual incidence of C difficile-associated disease in hospitalized children increased significantly from 2001 to 2006. However, the rates of colectomy and in-hospital death have not increased in children with C difficile-associated disease as they have among adults. The risk factors and outcomes for children with C difficile-associated disease remain to be defined in future studies.