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Biomedical subjects

C DeAngelis

Publications and source records attributed to C DeAngelis.

At least 37 records · Page 2Linked to original sources
PubMed1992

Subspecialization within pediatric practice: a broader spectrum.

This study was undertaken to describe subspecialty characteristics and practices of the population of pediatricians given the ongoing controversy regarding a projected manpower oversupply of general pediatricians. A questionnaire was mailed to a national random sample of 1620 United States physicians listed in the American Medical Association's Physician Masterfile as being in office-based pediatric practice. The final response rate was 63%. Seventy percent of respondents designated their practices as "general pediatrics" versus 17% as "general pediatrics with a specific subspecialty interest" and 13% as "subspecialty practice." The general pediatricians with a specific subspecialty interest were intermediate in the proportion that had some training in a pediatric fellowship program (general pediatricians with a specific subspecialty interest, 63% versus general pediatricians, 14%, P < .0001, and pediatricians with a subspecialty practice, 92%, P < .0001) and that were certified in a pediatric subspecialty by the American Board of Pediatrics (general pediatricians with a specific subspecialty interest 16% versus general pediatricians, 2%, P < .0001, and pediatricians with a subspecialty practice, 62%, P < .0001). They were also intermediate in the proportion involved in various academic pursuits. Their practices, however, more closely resembled general pediatricians than pediatricians with a subspecialty practice in their location, setting, associates, and commitment to primary care. They were more likely than general pediatricians to utilize or provide specialized tests or procedures. A large percentage of pediatricians incorporate subspecialty elements into their general pediatric practices. Models of current and projected pediatric manpower supply need to be reassessed in light of this form of practice.

Adult↗
PubMed1992

Cost-effectiveness of erythromycin versus mupirocin for the treatment of impetigo in children.

A new topical antibiotic, mupirocin, has been found to be as effective as erythromycin for the treatment of impetigo, but concerns about its expense have been raised. This controlled clinical trial sought to compare the cost-effectiveness of erythromycin (E) and mupirocin (M). Ninety-three children, aged 3 months to 16 years, were randomly assigned to receive 10 days of oral erythromycin (n = 46) or topical mupirocin (n = 47). Costs and effects were measured through structured interviews. Cost per case differed significantly by group (E = $56.85; M = $62.30; P less than .05) due chiefly to extra visits and medication changes needed by those treated with mupirocin. Erythromycin and mupirocin were equally effective. The likelihood of side effects (E = 43%, M = 22%) approached significance (P less than .07); those treated with erythromycin were willing to pay more for a different medicine to avoid the side effects experienced (P less than .05). Working parents and school-age children were more likely to alter their daily activities when the patient was taking erythromycin (P less than .04). Compliance and parental satisfaction did not differ by treatment group; however, parents of children treated with erythromycin were more likely to prefer the alternate drug regimen. It is concluded that the type of medication prescribed can be based on parental preference because the increased cost of mupirocin is offset by increased side effects and number of schooldays and workdays lost with erythromycin.

Baltimore↗
PubMed1991

Effectiveness of an antihistamine-decongestant combination for young children with the common cold: a randomized, controlled clinical trial.

We tested the hypothesis that antihistamine-decongestant combinations cause no clinically significant relief of the symptoms of upper respiratory tract infections in young children by randomly assigning 96 children to one of three treatment groups: antihistamine-decongestant, placebo, and no treatment. There were no differences among the three study groups in the proportion of children considered "better" overall by the parent 48 hours after the initial assessment (drug, 67%; placebo, 71%; no treatment, 57%; p = 0.53). There were no differences among groups in individual or composite symptom score changes. Two thirds of parents whose children were eligible for the drug trial believed that their child needed medicine for cold symptoms. In the proportion of parents believing that their child needed medicine, there was no difference between those who consented to participate and those who refused. Parents who wanted medicine at the initial visit reported more improvement at follow-up, regardless of whether the child received drug, placebo, or no treatment. We conclude that there is no clinically significant improvement in symptoms of upper respiratory tract infection, including no significant placebo effect, in young children for whom an antihistamine-decongestant is prescribed.

Brompheniramine↗
PubMed1991

Compatibility of dexamethasone sodium phosphate with hydromorphone hydrochloride or diphenhydramine hydrochloride.

The stability and compatibility of dexamethasone sodium phosphate and hydromorphone hydrochloride or diphenhydramine hydrochloride at various concentrations at room temperature was studied. Solutions containing equal volumes in the following ranges of concentrations were prepared: dexamethasone sodium phosphate 0-10 mg/mL, diphenhydramine hydrochloride 0-50 mg/mL, and hydromorphone hydrochloride 0-40 mg/mL. Samples of each combination were analyzed immediately after mixing and at 7 and 24 hours using a stability-indicating high-performance liquid chromatographic assay. The pH of each solution was measured, and each combination was visually inspected. Precipitation occurred in solutions containing dexamethasone and hydromorphone hydrochloride or diphenhydramine hydrochloride when equal volumes of the most concentrated solutions were mixed. Some of the combinations at lower concentrations were visually compatible, and more than 90% of the initial concentrations of both drugs (i.e., dexamethasone-hydromorphone and dexamethasone-diphenhydramine) remained in these compatible solutions. Dexamethasone is visually compatible with diphenhydramine or hydromorphone but only within specific concentration ranges. In visually compatible solutions, both drug combinations are stable for up to 24 hours at room temperature.

Chromatography, High Pressure Liquid↗
PubMed1991

Preparedness of practicing pediatricians to manage emergencies.

To determine pediatrician preparedness to manage emergencies, a nationally representative random sample of 1000 non-hospital-based pediatricians was surveyed about (1) types of emergencies encountered and methods of transport to an emergency facility, (2) availability and use of equipment and medications in the office, and (3) determinants of pediatrician confidence in managing emergencies. The proportion of pediatricians who had encountered specific emergencies ranged from 86% for meningitis to 22% for cardiopulmonary arrest. The majority transported acutely ill children to an emergency department by ambulance. Availability of individual pieces of equipment and medications in offices ranged from 97% for epinephrine 1:1000 to 11% for bone marrow needles for intraosseous access. Combination of equipment available to manage particular emergencies ranged from 61% for severe dehydration to 11% for cardiopulmonary arrest. The equipment available in a pediatrician's office was significantly related to the type of primary work setting. Pediatrician confidence in managing the initial stabilization of emergencies ranged from 58% for seizures to 25% for epiglottitis. Confidence was related significantly to year residency was completed, Advanced Cardiac or Advanced Pediatric Life Support training, work setting, and the availability of equipment in the office. Continuing education regarding initial office management of and equipment for common emergencies should improve the pediatrician's confidence and competence in this area.

Adult↗
PubMed1991

Do postpartum nursery visits by the primary care provider make a difference?

A prospective, randomized, clinical trial was conducted to investigate whether a postpartum visit between a mother and her neonate's future primary care provider combined with telephone access would improve health care utilization, enhance identification of the provider as a source of advice, increase maternal knowledge of infant care, and decrease maternal anxiety and depression. Of 251 mother-neonate pairs, 122 were randomized to the control group and 129 to the intervention group. Outcome variables included health care utilization and results of maternal interviews. More mothers in the intervention group made a scheduled clinic visit in the first 30 days (P = .003), were more likely to seek some form of care at the clinic (P = .006), and tried to reach their physician by phone more often than the control group (P less than .001). There were no differences between the groups' emergency room utilization, the percent who received immunizations by 90 days of age, maternal knowledge of infant care, maternal anxiety, or postpartum depression. The intervention succeeded in improving some measures of health care utilization and results suggest that the relationship between the mother and clinician was strengthened.

Adult↗
PubMed1990

Intravenous immunoglobulin in minimal change nephrotic syndrome: a crossover trial.

To determine whether intravenous immunoglobulin (IVGG) would be an efficacious adjunct in the treatment of childhood minimal change nephrotic syndrome (MCNS), we enrolled ten patients with frequently relapsing or steroid-dependent MCNS in a double-blind crossover clinical trial. At the time of relapse of the nephrotic syndrome, patients were assigned to treatment with a single outpatient infusion of IVGG (800 mg/kg) or intravenous albumin as a control. The relapse was treated concurrently with standard doses of oral prednisone. At the time of the next relapse, patients who had first received IVGG were treated with albumin, and vice versa. There were no significant differences in the length of remission between the IVGG and albumin treatments. The study had a power of 0.72 to detect a true difference of 45 days between the two therapies. We conclude that in the dose of drug used in this trial, administered at the time of relapse in conjunction with prednisone therapy to children with frequently relapsing or steroid-dependent MCNS, IVGG does not lead to a clinically important extension of the period of remission.

Adolescent↗
PubMed1990

Correlates of emergency room utilization in the first year of life.

We conducted a case-control study to examine the correlates of emergency room use in the first year of life, particularly the role of parental health beliefs, among the families of inner-city children enrolled in a hospital-based primary care program. Data was collected by structured interviews and by medical record review. Emergency room users were more likely to have single mothers and to have acute, recurrent medical conditions than were non-users. Health beliefs differed between groups by maternal report of worry about the kinds of illnesses that her child acquires. Emergency room use was predicted by: maternal marital status, maternal worry and concern that illness interferes with her child's activity, acute recurrent illnesses, hospitalization. This model may be applicable to other populations in designing intervention strategies to modify emergency room utilization.

Attitude to Health↗
PubMed1990

Substance abuse education in pediatrics.

Historically, physicians have received little formal education related to alcohol or other drug abuse and dependence. A survey of all pediatric programs in the United States was conducted to assess the current status of alcohol/drug education in pediatrics. At the medical student and residency training levels, only 44% and 40% of programs, respectively, required any formal instruction, and only 27% and 34%, respectively, offered an elective for medical students or residents. Although most respondents endorsed the inclusion of both required and elective alcohol and drug education in the curriculum, few programs that did not include it already had a future plan for it. Major impediments identified were curriculum time constraints (86% medical student level, 68% resident level) and the lack of a qualified instructor (55% medical student level, 50% resident level). The survey results suggest a strong need for development of faculty and structured alcohol and drug abuse educational plans specific to pediatrics.

Alcoholism↗
PubMed1990

Twenty-five years of residents: what and where are they now.

To evaluate the effectiveness of our program in meeting the subsequent career needs of our graduates and to describe their professional experiences as a microcosm of pediatrics, a survey was completed of the 419 pediatricians who had completed the Harriet Lane Residency Program at The Johns Hopkins Hospital between 1960 and 1984. Overall, the 326 respondents found the program to have been effective in the areas they deemed appropriate to be taught in residency years. In decreasing order, the chief resident, fellow house officers, and full-time faculty were rated to have had the greatest teaching effectiveness. The women respondents were less likely to be married (76% vs 89%), had fewer children on average (1.2 vs 2.31), missed more work, and were more likely to enter postresidency training (89% vs 78%) than the men. Of all respondents, 73% reported being certain of their career goals during residency and 77% of those reported a reasonable similarity with current positions. More than 93% reported being satisfied with their current careers, and 87% would still choose pediatrics. They are generally well reimbursed financially, with academician salaries matching those of private practitioners 10 years after completing residency and surpassing them, slightly, thereafter. This information provides much food for thought in preparing tomorrow's pediatricians.

Attitude of Health Personnel↗
PubMed1990

Structured encounter form: the impact on provider performance and recording of well-child care.

The impact of record format on provider performance and recording of the process of care and their concordance were examined in this study. The process of care was defined by existing sets of explicit criteria developed for quality assessment. The study was conducted in an urban teaching hospital pediatric primary care clinic. Housestaff were encouraged, but not required, to use the clinic's structured, age-specific forms for recording well-child care. Performance and recording were compared during required well-child visits using the structured form and those using the basic clinic form. Study data from 1031 visits to 68 housestaff during a 14-month period were collected using medical record abstracting of all visits and direct observation of 243 of them. Twenty-three of the providers were assigned randomly to an unobserved control group to assess the effect of observation on recording. Use of the structured form was associated with significantly higher levels of both recorded and observed performance. When performance could be merely checked off to document performance, overdocumentation was found. Record-based estimates of performance were more accurate during visits when the structured form was used. Record format can improve provider performance and recording of the process of care.

Child↗
PubMed1990

The consistency of young children's assessment of remembered painful events.

Clinicians need to know the consistency of a child's report of his pain in order to assess the intensity of that pain. To explore an age cutoff above which children are consistent in reporting their pain, we tested the consistency of children's reports of recalled pain, using a variety of scales. We interviewed 91 children, three to eight years of age, and obtained each child's report of two of his own painful experiences. In two separate sessions, we asked each child to compare those specific experiences in several ways, using two picture scales, a block-based scale, triads, and the simple question, "which hurt you more?" Results show that children older than seven years are more consistent in reporting the relative pain intensity of remembered events than younger ones (range 50-100% vs. 20-55%, p less than 0.001), and that the simple question provides the most consistent answer. However, no age group tested was consistent more than 80% of the time on all measures. We conclude that children are able to report remembered pain intensity consistently with increasing age but that we cannot establish a firm cutoff between the ages of three and eight years with our data.

Child↗