Pediatr Ann
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Review
Developing an interdisciplinary palliative care plan for the patient with muscular dystrophy.
The care of children with MD presents many complex issues. An interdisciplinary team, focused on patient and family outcome, that incorporates palliative care initiatives can best outline and meet the goals of family-centered care. The early introduction of a palliative team allows for a relationship of trust to develop, serving as the foundation for the many interventions necessary to fill the gaps in care that arise during the care of a child with a chronic, life-threatening illness such as MD.
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Physicians systematically underidentify and underreport cases of child abuse. These medical errors may result in continued abuse, leading to potentially severe consequences. We have reviewed a number of studies that attempt to explain the reasons for these errors. ⋯ Reimbursement for time spent supporting legal proceedings should be equitable and may reduce physician concerns about lost patient revenue. Retrospective studies and vignette analyses provide much information about some of the barriers to child maltreatment reporting and describe many of the reasons why physicians do not identify and report all child maltreatment. Future prospective examinations of physician decision-making may further explain the physician's decision-making process and the barriers he or she faces when identifying and reporting child abuse.
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We have learned much about the medical evaluation of suspected child sexual abuse during the past 2 decades. The physical examination still holds an important place in the evaluation but is secondary to a well-performed history. ⋯ The physical examination rarely is diagnostic by itself, with more than 92% of cases failing to demonstrate either acute or chronic signs of injury. Thus, the 1994 quote by Adams and colleagues, "It's normal to be normal," continues to ring true, now supported by a growing body of pediatric literature.
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SE is a common neurologic emergency in children. The majority of children who present in SE have no history of epilepsy. Although the clinical outcome of SE depends on the etiology of the seizure to a great extent, timely and appropriate treatment significantly reduces morbidity and mortality. ⋯ Achieving these four goals will improve the outcome of SE in all children. Future drug trials may also consider concurrent treatment with AEDs, which prevent the later development of epilepsy. In addition, neuroprotectants to protect against cell injury, lowering the morbidity and mortality associated with SE, and medications or rehabilitation strategies to improve the morbidity of SE after hospital discharge should also be studied.