Arch Pediat Adol Med
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Arch Pediat Adol Med · Feb 1995
Multicenter StudyVariations in pediatric pneumonia and bronchitis/asthma admission rates. Is appropriateness a factor?
To explore through a pilot study the relationship between appropriateness (medical necessity) and variations in pediatric hospital admission rates across several communities in the Boston (Mass) area for two common pediatric conditions with extremely variable admission rates: pneumonia and bronchitis/asthma. ⋯ Our results suggest that higher pediatric admission rates may not be associated with higher rates of inappropriateness. Further research is needed, with a larger number of communities, to differentiate practice patterns more precisely and explore patient and family preferences.
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Arch Pediat Adol Med · Feb 1995
Comparative Study Clinical TrialOutcome and cost at a children's hospital following resuscitation for out-of-hospital cardiopulmonary arrest.
To determine the outcome and cost for children resuscitated following out-of-hospital cardiopulmonary arrest. ⋯ Aggressive treatment does not lead to intact survival for victims of out-of-hospital cardiopulmonary arrest who present to the pediatric emergency department with a preterminal rhythm and absence of spontaneous circulation. Resuscitation efforts in the emergency department are commonly successful but lead to death or severe neurological sequelae at discharge with extremely high cost of care.
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To determine whether coins located in different portions of the esophagus differ in their likelihood of spontaneous clearance, and to determine the frequency of asymptomaticity among children with esophageal coins. ⋯ Proximal and middle esophageal coins should be promptly removed, as per present practice. Children with distal esophageal coins should be observed up to 24 hours before an invasive removal procedure, since many will spontaneously clear their coins. Since esophageal coins may be asymptomatic, all children who have swallowed coins should undergo roentgenographic evaluation.
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Arch Pediat Adol Med · Jan 1995
Echocardiographic-guided internal jugular venous cannulation in children with heart disease.
To determine if cannulation of the internal jugular vein (IJV) with echocardiographic guidance increases the success and decreases the complications of the procedure when performed in children with heart disease. ⋯ As in the adult population, IJV cannulation with the assistance of echocardiography increases the success of the procedure and decreases the number of complications. Furthermore, echocardiographic guidance allows for repeated IJV cannulation in pediatric patients, regardless of age.
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Arch Pediat Adol Med · Jan 1995
Cardiopulmonary resuscitation in the delivery room. Associated clinical events.
To determine (1) what percentage of infants require chest compressions and medications as part of resuscitation in the delivery room, (2) the associated clinical events contributing to neonatal depression, and (3) the neonatal outcome of such children. ⋯ Cardiopulmonary resuscitation in the delivery room, resulting in administration of chest compressions and medications, is a rare event. Approximately one third of the infants had evidence of severe FA; in the remaining two thirds, ineffective or improper initial ventilatory support was the presumed mechanism for the continued neonatal depression. The appropriate therapeutic response to continuing neonatal depression should be to optimize ventilatory support before administering chest compressions or medications.