American journal of diseases of children (1960)
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Comparative Study
Behavioral changes in pediatric intensive care units.
The purposes of this study were to compare the frequency and severity of manifestations of anxiety, depression, delirium, and withdrawal in pediatric patients hospitalized in intensive care unit vs ward settings and to evaluate the impact of preexisting psychopathologic disorders on the expression of these symptoms. ⋯ Our data indicate that critically ill children in the intensive care unit, children with prolonged or repeated hospitalizations, and children with preexisting anxiety and mood disorders are at greater risk than other hospitalized pediatric patients for psychological trauma and/or behavior problems that may warrant psychiatric intervention. The Hospital Observed Behavior Scale is a reliable tool to quantitate behaviors in hospitalized children.
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Night-float systems have recently been proposed as a way to reduce resident stress resulting from irregular sleep patterns. We prospectively evaluated the effects of a night-float system in which designated residents relieved on-call senior residents and interns of routine admissions of patients in medically stable condition during the late-night period (11 PM to 7 AM). Senior residents (3.7 vs 2.4 hours) and interns (3.7 vs 3.2 hours) reported sleeping more under the night-float system than under the traditional system. ⋯ When educators disagreed with residents, the most common reasons were the patient's potential educational value or medical instability. The night-float system did not affect interns' ratings of the educational value of late-night admissions or parents' ratings of satisfaction with medical care. We conclude that the night-float system can increase resident sleep with little cost to parent satisfaction, but standards for selective use may be needed to avoid compromising patient care and resident education.
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Randomized Controlled Trial Clinical Trial
Benefits of a lower hematocrit during extracorporeal membrane oxygenation?
To determine the possible benefits of maintaining a lower hematocrit than that normally used (0.35 vs 0.45) in neonates treated with extracorporeal membrane oxygenation. ⋯ Neonates' hematocrits can be maintained safely at 0.35 during extracorporeal membrane oxygenation with significantly less exposure to packed red blood cells and less clotting in the circuit.