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This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2002;156:5.
Family Perspectives on the Quality of Pediatric Palliative Care
In most institutions, the transition from curative to palliative care
lacks a comprehensive, coordinated, and evidence-based approach. To learn
ways of improving care at the end of life, Contro and colleagues interviewed
44 families with children who had died. Issues regarding communication about
treatment or prognosis, preventable oversights in policies, and concern
about the pain children suffered were recurring themes. Community hospice
programs are frequently poorly prepared to serve pediatric patients. The issues
identified should serve to guide the development of pediatric palliative care
programs in the future.
(SEE ARTICLE)
Urine Testing and Urinary Tract Infections in Febrile Infants Seen
in Office Settings: The Pediatric Research in Office Settings' Febrile Infant Study
While urinary tract infections are the most commonly identified serious
bacterial infection in infants with fever younger than 3 months, it is unknown
whether urine testing is done in practice in these infants. This prospective
study of 573 pediatric practitioners from 219 practices in the American Academy
of Pediatrics Pediatric Research in Office Settings research network collected
data on 3066 infants 3 months or younger with fever. Urine was tested in 54%
of infants, of whom 9.7% had urinary tract infections. Among 807 infants not
initially tested or treated, only 2 had subsequent documented urinary tract
infections. Selective urine testing with close follow-up was associated with
few late urinary tract infections in this study of a large cohort.
(SEE ARTICLE)
Effect of Rapid Diagnosis of Influenza Virus Type A on the Emergency
Department Management of Febrile Infants and Toddlers
A rapid, specific test for a viral infection has the potential to reduce
the amount of diagnostic testing and empiric antibiotic usage and decrease
hospitalization. This study determined the effect of rapid diagnosis on the
clinical management of febrile infants and toddlers in a pediatric emergency
department. Patients for whom the test results were available before discharge
from the emergency department were less likely to undergo other diagnostic
testing and less likely to receive parenteral antibiotics as compared with
children for whom the test results were not available until after discharge.
The study indicated that rapid viral testing should be explored as a routine
emergency department procedure.
(SEE ARTICLE)
Long-term Consequences of Kawasaki Disease Among First-Year Junior
High School Students
This study compared 860 students at age 13 years who had a history of
Kawasaki disease, with 308 29 students without a history of disease.
While there was no difference in the average height and weight of students
in the 2 groups, 10% of adolescents with a history of Kawasaki disease had
an abnormal electrocardiogram compared with 3.3% of students with no history.
This study provides important information about the long-term consequences
of the disease.
(SEE ARTICLE)
Pediatric Violence-Related Injuries in Boston: Results of a City-Wide Emergency Department Surveillance Program
Violence-related injury is an important cause of morbidity and mortality
for American children. Previous incidence estimates have relied on criminal
justice information, surveys, and estimates derived from the experiences of
single hospitals. This study sought to establish a city-wide surveillance
to measure the incidence of violence-related injury to children. The annual
incidence of violence-related injuries that required emergency department
care was 52.7 per 10 000 person-years, with 59 emergency department visits
and 4 hospitalizations for each violence-related death. The decline in criminal
violence and homicide seemed to extend to the much more common minor injuries
typically seen in pediatric emergency departments. The incidence of violence-related
injuries in Boston, Mass, was 12% lower during each successive year of the
4-year study period.
(SEE ARTICLE)
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