American journal of diseases of children (1960)
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Residency training programs are the appropriate milieu in which physicians should receive specialized training in the diagnosis and management of child abuse. The purposes of the present study were to assess and compare residents' knowledge of child abuse and their attitudes toward the propriety of different forms of childhood discipline. We surveyed 192 residents from seven different training programs with questionnaires probing their knowledge of child abuse and their attitudes toward childhood disciplinary measures; 161 (84%) of the questionnaires were satisfactorily completed by residents in pediatrics (n = 87), family medicine (n = 51), and surgery (n = 23). ⋯ Scores were not related to year of training or attitudes toward childhood discipline but were correlated with self-reports of previous child abuse teaching. Residents' performance on a childhood disciplinary measure demonstrated wide latitude in their rating of the acceptability of 23 different modes of childhood discipline. Our findings indicate a need for a more systematic approach to residents' education in childhood intentional injuries and some value clarification of their attitudes toward various forms of childhood discipline.
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We retrospectively identified and prospectively followed up 62 patients with 78 venous-access catheters over a 30-month period (15773 catheter-days) to compare infectious complications of Broviac-Hickman catheters (n = 33) and totally implantable. venous devices (n = 45) in pediatric oncology patients. Demographic data and characteristics of catheter use were comparable for both groups. Significantly associated with the risk of a catheter-associated infection were (1) the percentage of time the patient was neutropenic and (2) a patient age of younger than 2 years. ⋯ In the implantable venous device group, 13 infections occurred in 24% of patients using catheters for an infection rate of 0.14/100 catheter-days. The relative risk of infection from Broviac-Hickman catheters compared with implantable venous devices was 1.5, which was not significant (95% confidence interval, 0.7 to 3.2). Thus, the incidence of infectious complications was comparable for both catheter types.
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An analysis of 63 pediatric diabetic patient visits to an emergency department for diabetic ketoacidosis was performed. Of 27 patients with a serum pH less than 7.20 or bicarbonate concentration less than 10 mmol/L (10 mEq/L) at admission, 25 (92%) had persistence of metabolic acidosis after three hours of outpatient therapy and were hospitalized. Of 36 patients with a serum pH greater than or equal to 7.20 or a bicarbonate concentration greater than or equal to 10 mmol/L (10 mEq/L) at admission, 34 (94%) had resolution of metabolic acidosis within three hours of initiating outpatient therapy and were discharged from the emergency department. ⋯ The initial serum glucose concentration accurately predicted duration of therapy necessary to resolve metabolic acidosis in the majority of patients discharged. Certain diabetic children can be treated for diabetic ketoacidosis with therapy administered in an outpatient setting. Most patients with an initial serum pH of 7.20 or higher or a bicarbonate concentration of 10 mmol/L (10 mEq/L) or higher will experience resolution of acidosis and tolerate feeding within three hours of initiating treatment.
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A prospective evaluation of 103 consecutive children who received TAC (tetracaine, epinephrine [adrenaline], cocaine) liquid topical anesthetic for the repair of their minor dermal lacerations was performed. A unique method of TAC application was used that consisted of applying the medication to the inner margins of the wound cavity and allowing it to stand for several minutes prior to the application of a TAC-saturated gauze pad to the wound surface. Of 670 sutures placed, 637 (95%) were done without eliciting pain. ⋯ A single wound healing complication occurred in 103 patients. TAC is a safe, effective method for anesthetizing minor lacerations of the skin in children. Its painless method of application relieves patient discomfort and maximizes patient compliance during the repair procedure, both of which enhance the accurate approximation of lacerated tissue.
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The barium enema (BE) may be useful in the diagnosis of atypical appendicitis in children. We analyzed our experience with 18 children in whom appendicitis was suspected and BE was performed. All of the children underwent surgical exploration. ⋯ Using these criteria, 12 of 14 cases of proved appendicitis were true positive and two were equivocal. Four children were proved not to have appendicitis; one of these patients had a true-negative BE, two had equivocal BEs, and there was one false-positive BE (Schönlein-Henoch purpura). Extravasation of barium into the peritoneal cavity was noted in one patient; this was a rare complication.