Arch Pediat Adol Med
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To determine the incidence of group A beta-hemolytic streptococcus (GABHS) carriers in children who are well, in children seen with presumed and documented viral illnesses with sore throat, and in children after treatment of acute GABHS tonsillopharyngitis with 10 days of oral penicillin V potassium, oral cephalosporins, or macrolides. ⋯ A small percentage of children seen in private pediatric practices who are well or who have apparent viral upper respiratory tract infections with sore throat are GABHS carriers. Penicillin treatment of acute GABHS tonsillopharyngitis results in a higher GABHS carriage rate than occurs following treatment with cephalosporins and macrolides.
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Arch Pediat Adol Med · Jun 1999
A pediatric clinical skills assessment using children as standardized patients.
To develop and implement a pediatric clinical skills assessment (PCSA) for residents, using children as standardized patients (SPs); to assess the psychometric adequacy of the PCSA and use it to evaluate the performance of residents; and to evaluate the feasibility of using child SPs and the response of the residents and the child SPs to participation in the PCSA. ⋯ Our development method gives content validity to our PCSA, and resident scores give indication of PCSA construct validity. Reliabilities are in the acceptable range. Residents found the PCSA challenging and realistic but less than enjoyable and fair. Use of child SPs is feasible. Resident performance scores were low relative to the performance criteria of the PCSA development group. The adequacy of clinical skills teaching and assessment in residency programs needs to be reviewed. Deficits in specific skills and overall performance of residents identified by a PCSA could be used to guide individual remediation and curricular change.
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Arch Pediat Adol Med · Jun 1999
Determinants of counseling in primary care pediatric practice: physician attitudes about time, money, and health issues.
To assess pediatrician goals and practice in preventive counseling, and to use social learning theory to examine physician attitudes about preventive health issues, time, and reimbursement to explain physician counseling behavior. ⋯ Physician goals in child health supervision were primarily biomedical, with psychosocial and safety issues of lesser importance. Concern about time for preventive counseling was associated with less reported counseling. Physician attitudes regarding the importance of a health issue and their confidence and effectiveness in counseling were more predictive of physician practice than their attitudes about time and reimbursement for preventive care.
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Arch Pediat Adol Med · Jun 1999
Bacterial infections in infants 60 days and younger: epidemiology, resistance, and implications for treatment.
To establish what might be more optimal initial antibiotic therapy for suspected invasive bacterial infections in infants 60 days or younger who are evaluated in the emergency department (ED). ⋯ Our results reveal 2 important facts: (1) during a 4-year period, no isolates of Listeria were identified from any patients 60 days or younger; and (2) of the 96 GNRs isolated from patients in the ED, more than 60% were ampicillin resistant. These data suggest that in similar centers with a low incidence of infection with Listeria and high levels of ampicillin resistance among GNRs, empiric use of ampicillin as part of a combination for presumed bacterial infections in patients 60 days or younger initially evaluated in the ED may be neither necessary nor beneficial. Consideration should be given to empiric initial antibiotic therapy using a third-generation cephalosporin with or without gentamicin.