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Biomedical subjects

G S Liptak

Publications and source records attributed to G S Liptak.

At least 37 records · Page 2Linked to original sources
PubMed1995

The role of the pediatrician in caring for children with developmental disabilities: overview.

Pediatricians can help children with developmental disabilities to reach their potential. In addition to the issues relating to direct care outlined above and in the other articles in this issue of Pediatric Annals, clinicians should advocate on a community-wide level. This includes working with neighborhood schools, community health nurses, disease-oriented volunteer groups, and neighborhood agencies to provide access to services, support, and education for children and their families. It also includes championing the cause of children with disabilities with local and state governments. Because of the respect that pediatricians command in the community, they can play a major role in the lives of these children and their families.

Child, Preschool↗
PubMed1995

Helping families with children with developmental disabilities.

The physician can help the child with developmental disabilities maximize his or her potential and minimize the adverse effects on the family by understanding the emotional and other impacts of a developmental disability; providing information about diagnosis, prognosis, and associated problems; providing nonjudgmental listening; providing information about community resources, including parent-support groups; ensuring adequate communication with everyone involved in the care of the child; and referring the family to appropriate agencies and providers.

Child↗
PubMed1995

Children with chronic conditions need your help at school.

As they try to make the most of their opportunities at school, children with chronic conditions need a pediatrician's advocacy. Use your knowledge of the illness, the law, and the resources in your community to play an active role.

Adolescent↗
PubMed1994

Nurse practitioners' effectiveness in NICU.

The effectiveness of Neonatal Nurse Practitioners (NNPs) in a Level III Neonatal Intensive Care Unit (NICU) was evaluated by using a retrospective medical records review. Two groups of infants received care in a Transitional Care Unit (TCU), one by house officers and the second cared for by NNPs. Medical diagnoses, lengths of stay, hospital charges, discharge/transfer disposition and hospital readmissions were studied. No differences were found in DRG codes, discharge disposition, hospital readmission or number of infants transferred from TCU to NICU because of deteriorating condition. Though the infants cared for by the NNPs had significantly lower birth weight and lower gestational age, they averaged 2.4 fewer days in the hospital and $3,491 less in total hospital charges than the group cared for by house officers. This study confirms that NNPs can provide care comparable to house officers in a Level III NICU and be more cost effective.

Efficiency, Organizational↗
PubMed1993

Screening for urinary tract infection in children with neurogenic bladders.

Urinary tract infections (UTIs) are a frequent and potentially disabling problem for children with neurogenic bladders. Frequent monitoring for UTIs using bacterial culture is expensive and troublesome; thus an inexpensive, dependable screening method is desirable. Three hundred and twenty-nine urine specimens were obtained from 141 children with neurogenic bladders, 86% of whom had meningomyelocele. During the 11-month study period, 43% of the children had at least one positive culture (> or = 100,000 CFU/ml). The results of bacterial culture were compared with the occurrence of signs and symptoms, the presence of reflux and the results of a dipstick test for nitrite and leukocyte esterase. Analysis of the data revealed that (1) UTIs were significantly more common in children with reflux; (2) the presence of signs and symptoms was neither sensitive nor specific (positive predictive value (PPV) = 0.44, negative predictive value (NPV) = 0.84); (3) urinalysis was an unreliable screening tool (PPV = 0.63, NPV = 0.73); and (4) the combination of nitrite and leukocyte esterase was more sensitive and specific than either by itself (combined PPV = 0.69, NPV = 0.88). Children with neurogenic bladders who have reflux or have signs and symptoms should continue regular bacterial cultures, whereas others can be screened dependably using the combined leukocyte esterase and nitrite test.

Adolescent↗
PubMed1992

Management of bowel dysfunction in children with spinal cord disease or injury by means of the enema continence catheter.

Because bowel dysfunction in children with spinal cord impairment is a common and disabling problem that does not have adequate treatment, we evaluated the enema continence catheter developed in Toronto, Canada. Thirty-one children and their families were taught to administer a 20 ml/kg saline enema through this device. The children's bowel functions were evaluated 18 and 20 months after the start of the program. Six of the children dropped out of the study in the first 2 weeks and nine dropped out after between 18 and 30 months. For those remaining in the study, the proportion of continent stools rose from 28% to 94% (p less than 0.01); constipated stools dropped from 55% to 15% (p less than 0.01). Satisfaction with the bowel program increased, and five children were able to switch from diapers to lined underwear. No adverse effects were reported, and the amount of time required for toileting did not increase. Although compliance with the regimen was difficult for some families and its use carries potential risks, we believe that it can provide significant improvement in the bowel care of selected persons with spinal cord impairment.

Adolescent↗
PubMed1992

Mobility aids for children with high-level myelomeningocele: parapodium versus wheelchair.

The optimal method for providing mobility for children with myelomeningocele remains controversial. 39 children using a parapodium were compared with 29 children in wheelchairs. There were no significant differences between the two groups for medical complications, use of health-care services or activities of daily living, although there were differences in the patterns of complications. Children using the parapodium were more likely to develop lesions of the lower extremities, to have dislocated hips, to be more obese and to watch more television; children using wheelchairs were more likely to develop lesions of the gluteal region, to have knee-flexion contractures and to have fewer fecal accidents. The parapodium was judged by families to be less effective as a mobility aid; however, the upright posture it allows was considered extremely advantageous. A combined approach allowing upright posture and wheeled mobility would appear to be optimal.

Activities of Daily Living↗
PubMed1992

Isosorbide in the medical management of hydrocephalus in children with myelodysplasia.

Fourteen children with hydrocephalus associated with myelodysplasia were given isosorbide (8 to 12 g/kg/day) and compared with 17 children managed without it. Three of the treated and three of the untreated children did not require shunting. The mean interval between back closure and shunt placement was 33 days for the controls and 115 days for the treated children. Two of the treated children developed gastro-intestinal symptoms that necessitated withdrawal of the isosorbide. Although isosorbide did extend the interval between back closure and shunt placement, its side-effects and the availability of alternative treatments render it unsuitable for the management of hydrocephalus in children with myelodysplasia.

Female↗
PubMed1991

Understanding the child with special health care needs: a developmental perspective.

Children with special health care needs and their families are becoming a greater part of pediatric nursing practice, and often present with major health and psychosocial needs that interfere with their ability to function. Optimal intervention with these children requires an understanding of their chronic conditions as well as their unique developmental needs. This paper reviews the characteristics of children with special health care needs and introduces some of the most salient theories of child development in order to provide a perspective from which to view this population. A case example that illustrates some of the features discussed is presented. Because a knowledge of theories of child development can improve the care provided to children with special health care needs, it should be included as part of nursing curricula.

Child Development↗
PubMed1989

Community physician's role in case management of children with chronic illnesses.

There is general agreement that case management should be provided to children with chronic illnesses, yet it is not clear who should provide this service. A survey of physicians and parents of children with chronic illnesses was conducted to evaluate the practice and views of pediatricians and compare their assessments with those of parents. Surveys were mailed to 360 physicians and 519 families with response rates of 39% and 63%, respectively. The majority of physicians (74%) thought that the primary care physician should provide case management. When compared with parents, physicians underestimated the parental need for information about the child's diagnosis (8% vs 52%, P less than .001), treatments (3% vs 54%, P less than .01), and prognosis (30% vs 78%, P less than .01). They also overestimated parental needs for information regarding financial aid (70% vs 58%, P less than .01), vocations (78% vs 54%, P less than .01), and insurance (62% vs 51%, P less than .05). Four services ranked by need by parents in the top 10 were not ranked in the top 10 by physicians. Rural physicians noted that services were more difficult to obtain than did those in nonrural areas. The physicians surveyed made several recommendations for steps that could be implemented to facilitate their role as case managers. If primary care physicians are to be effective case managers, alterations in the current system of care will be required including continuing education related to chronic illness, information about community resources, reimbursement for the time required to perform case management, and better communication between physician and parents.

Attitude↗
PubMed1988

Improving pediatricians' compliance-enhancing practices. A randomized trial.

Previous evaluations of continuing medical education (CME) have yielded conflicting results regarding its effects on physician knowledge, performance, and subsequent patient outcomes. Poor adherence by mothers to prescribed pediatric regimens is a separate, but well-documented, problem. In the present study we assessed the ability of CME to: (1) increase the knowledge of pediatricians about compliance-enhancing strategies; (2) increase the performance of these practices by pediatricians; and (3) improve mothers' compliance with antibiotic regimens for their children's otitis media. Ninety pediatricians were randomly assigned to either a control group or one of two CME interventions: tutorial plus printed materials or mailed printed materials only. Following the interventions, data on compliance and on reported behaviors of pediatricians were gathered from a random sample of mothers (N = 771) whose children were being treated for otitis media. Findings indicated that CME increased physician knowledge and compliance-enhancing practices and resulted in improvement in mothers' adherence to therapy.

Child↗
PubMed1988

The management of children with spinal dysraphism.

Improvements in technology have dramatically increased the survival of children with spinal dysraphism. Because this complex condition affects multiple organ systems as well as the psychosocial functioning of the child and family, these children require care from a host of specialists in order to achieve optimum functioning. This article reviews the pathophysiology and discusses the current management of the medical and psychosocial effects of spinal dysraphism. It also briefly discusses strategies for intervention, long-term outcomes, and some controversies regarding care and screening.

Child↗
PubMed1985

Ventricular shunt survival in children with neural tube defects.

Ventricular shunting has dramatically improved the care of children with hydrocephalus. Yet shunt malfunctions are extremely common and cause significant morbidity. To document shunt problems in children with a neural tube defect and hydrocephalus, 67 children born since 1973 were studied via life-table analysis. 28% of the shunts failed within the first 6 months after insertion, 37% failed within the first year and 50% failed by 4 1/2 years after insertion. Shunt survival was similar in children whether or not they had previous shunt failures. The brand of shunt system and pressure rating, the level of neurological function, the interval between closure of the neural tube lesion and shunt insertion, and head circumference percentile at the time of insertion were also not correlated with shunt failure. However, shunts inserted in the first year of life were much more likely to fail than those inserted after one year of age (p less than 0.05). 68% of the revisions required replacement of the ventricular catheter. Shunt failure from all causes of hydrocephalus accounted for approximately 1% of paediatric admissions to Strong Memorial Hospital in 1982 with a mean cost of $4,543 and a mean length of stay of 9 days. Thus shunt problems remain both common and serious.

Age Factors↗