Pediatrics
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British pediatricians who diagnose and treat child abuse cases have come under attack by the British press and by parents who have been investigated for possible abuse. Now the General Medical Council also is intimidating these pediatricians. ⋯ This has resulted in fewer pediatricians being willing to care for abused children or to testify in child abuse cases. In the United States, the recent recognition of the pediatric subspecialty of child abuse pediatrics should help set standards for child abuse medical evaluation and testimony.
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The objective of this study was to report suggestions for improving the informed consent process from the perspective of parents of children with leukemia. ⋯ Through the incorporation of parental perspectives that provide an authentic stakeholder voice, our research represents a true partnership approach to improving the consent process. Parents provided practical advice for improving informed consent that can be applied to most adult and pediatric patient populations.
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The objective of this study was to determine whether children who sought care for a head injury were at greater risk of having a subsequent head injury within the following 6 and 12 months compared with children who sought care for an injury other than to the head. ⋯ These results provide evidence that having a head injury increases a child's risk of having a subsequent head injury. Although age, gender, and history of previous head injury confound the relationship, the effect remains substantial.
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The objectives of this study were to describe the patient and hospital characteristics of pediatric sports injury hospitalization and to determine the hospital characteristics that are associated with length of stay and total hospital charges (per discharge). ⋯ The findings provide an empirical basis for future research on the magnitude of sports-related injuries that result in hospitalization among children. More research is needed to identify contributing factors that are associated with length of stay and total hospital charges for sports injury hospitalization. Intervention efforts also should be directed toward preventing severe sports injuries and to reducing the hospitalization and cost.
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Review Practice Guideline
Self-injectable epinephrine for first-aid management of anaphylaxis.
Anaphylaxis is a severe, potentially fatal systemic allergic reaction that is rapid in onset and may cause death. Epinephrine is the primary medical therapy, and it must be administered promptly. This clinical report focuses on practical issues concerning the administration of self-injectable epinephrine for first-aid treatment of anaphylaxis in the community. ⋯ This report also describes several quandaries in regard to management, including the selection of dose, indications for prescribing an autoinjector, and decisions regarding when to inject epinephrine. Effective care for individuals at risk of anaphylaxis requires a comprehensive management approach involving families, allergic children, schools, camps, and other youth organizations. Risk reduction entails confirmation of the trigger, discussion of avoidance of the relevant allergen, a written individualized emergency anaphylaxis action plan, and education of supervising adults with regard to recognition and treatment of anaphylaxis.