Biomedical subjects
D Glotzer
Publications and source records attributed to D Glotzer.
Unsuspected cocaine exposure in young children.
OBJECTIVE: To determine the prevalence of cocaine exposure among preschool children with clinically unsuspected signs and/or symptoms. DESIGN: Prevalence study. SETTING: Pediatric emergency department in an inner-city hospital. PARTICIPANTS: 250 children aged 2 weeks to 5 years who underwent urine assays for cocaine prior to discharge from the emergency department. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Six (2.4%) of the 250 urine assays (95% confidence interval, 0.5% to 4.3%) were positive for benzoylecgonine, the major urinary cocaine metabolite. Four of the positive urine assays were from children younger than 1 year and all children with positive urine assays were younger than 24 months. None of these children presented with a complaint or was identified as having clinical problems currently associated with childhood exposure to cocaine. Possible exposure routes include breastfeeding, intentional administration, accidental ingestion of cocaine or cocaine-contaminated household dust via normal hand-to-mouth activity, and passive inhalation of "crack" vapors. CONCLUSION: Among the inner-city children served by this hospital, significant numbers of infants and young children are being exposed to cocaine, and this exposure occurs in a clinically unsuspected population.
Prior approval in the pediatric emergency room.
Managed-care plans for low-income Americans are widely promoted to improve the quality and control the cost of medical care by reducing unnecessary specialty and emergency room (ER) care through the use of primary care physicians as case managers/gatekeepers. The purpose of this study was to evaluate one element of managed care, gatekeeping prior approval, for children who use the pediatric ER of one urban public hospital. Over a 6-month period, 518 children and adolescents insured under managed-care plans that required authorization from the primary care physician to receive treatment presented to the ER. Of the 385 records reviewed for this study, the majority (87%) received their primary care at community health centers or the hospital's own outpatient clinics. Most ER visits (72%) were made when primary care sites were closed. According to nursing triage assessment, 57% presented with urgent or emergent conditions, and 26% had a history of chronic illness. Nine percent required hospitalization. Although an elaborate system for gatekeeping was established, only 13 (3%) patients' requests for ER care were denied. Of these, 3 were seen in the ER without authorization, 6 received the recommended follow-up, and 4 were not seen in follow-up. Twenty-nine participating primary care physicians (74%) and 19 ER staff (63%) responded to a survey of their experience with and attitudes toward prior approval. For a variety of reasons, the majority of primary care physicians and ER staff found the gatekeeping policies for after-hours visits burdensome and inappropriate.(ABSTRACT TRUNCATED AT 250 WORDS)
Childhood injuries: issues for the family physician.
Injuries are the most frequent cause of death during childhood. Nonfatal injuries occur at least 1,300 times more frequently than fatal injuries, and in any given year about one in every five children sustains an injury that requires medical attention. The injuries for which a child is at risk are influenced by age, cognitive and motor skills, and environment. Childhood injury prevention counseling by physicians can be effective in altering both the parent's and the child's behavior and in modifying the environment to reduce the risk of injury. Family physicians provide a large portion of the preventive and injury-related health care of children and should make office-based safety education a prominent part of their practices.