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Biomedical subjects

H Bauchner

Publications and source records attributed to H Bauchner.

At least 55 records · Page 3Linked to original sources
PubMed1996

Sixth and eighth graders and acquired immunodeficiency syndrome: the results of focus group analysis.

OBJECTIVE: To determine young adolescents' range of factual knowledge and beliefs about human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) among those who have received AIDS education. DESIGN: Focus group analysis. SETTING: Urban middle school. PARTICIPANTS: Two male and two female groups consisting of 4-7 students each, ages 11-15 years. RESULTS: The predominant responses in all four groups relating to factual knowledge of HIV transmission and mechanisms of prevention were correct. However, responses indicated that factual information had not been integrated into students' plans for situations involving relationships and sexual activity. All four groups shared the image of AIDS as a disease of adults. The girls frequently gave responses which included discussion and use of condoms, whereas only a few boys could realistically visualize using condoms. Many students, predominantly boys, identified with media figures such as Magic Johnson and saw themselves to be at risk for HIV, but the girls almost exclusively saw Magic Johnson as a rich, famous person and did not identify with him. Students gave suggestions about ways to improve AIDS education and recommended that AIDS education begin in the early grades. CONCLUSION: Standard AIDS education may be effective in teaching factual information about AIDS, but it may have little effect on students' future behavior. The format of AIDS education may need to be modified to better address adolescents' beliefs and behaviors regarding HIV and AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Care-seeking patterns of inner-city families using an emergency room. A three-decade comparison.

OBJECTIVES: Since World War II, the urban hospital emergency room has been a major source of medical care for inner-city poor families, many of whom receive Medicaid. Given the expensive and episodic nature of emergency room care, there has been renewed interest in enrolling Medicaid recipients into managed care plans to increase access to care and to reduce medical costs. Thus, the primary care physician, in many managed care plans, is expected to give prior approval for emergency room care in nonurgent situations. The goals of managed care may create tension between its requirements and historical patterns of inner-city families seeking care in an emergency room. In 1964, Alpert developed a typology that categorized inner-city families' patterns of seeking medical care in a pediatric emergency department (PED) by describing the relation between regular source of medical care and reliance on this source before the PED visit. In 1976, using the same typology, Alpert and Scherzer updated care-seeking patterns in Boston after the introduction of neighborhood health centers (NHCs) and Medicaid. In 1993, the typology is a method that can be used to assess the impact of managed care on PED utilization by inner-city families. This article compares the 1993 pattern of seeking PED care with that measured in 1964 and 1976. METHODS: In 1964, 1976, and 1993 families were interviewed as they sought care in a PED. Families were asked if they had a regular source of care, defined as the place where families take their child most often for either well or sick visits. A judgment was made as to whether or not the PED visit was coordinated with their regular source of care. Coordinated care was defined as having a regular source of care and attempting to contact the source before the PED visit. Uncoordinated care occurred when the family had a regular source and did not attempt contact, or had no regular source. RESULTS: In 1964, 63% of families reported a regular source of care compared with 89% in 1976 and 95% in 1993. The hospital was reported as the regular source of care by 57% of the respondents in 1964, by 31% in 1976, and 43% in 1993. Community-based sources (physicians and NHCs) were identified as a regular source of care by 43% in 1964, 69% in 1976, and 57% in 1993. In 1964, 55% of the families engaged in an uncoordinated pattern of seeking care compared with 64% in 1976 and 72% in 1993. CONCLUSIONS: Efforts to provide access to care through Medicaid, NHCs, and hospital-based primary care resulted in a greater percentage of families reporting a regular source of care; however, a majority of families continue to exhibit an uncoordinated pattern of seeking care. More families in 1993 did not contact their regular source before seeking care in the PED when compared with 1964 and 1976. For managed care plans to increase access and reduce costs, a shift in PED utilization patterns remains necessary. The primary care system must have the capacity to accommodate these changes and considerable patient education must occur if urgent care is to be provided outside the PED.

Adolescent↗
PubMed1996

Parents and procedures: a randomized controlled trial.

INTRODUCTION: Previous work has shown that parents prefer to be present when their children undergo common invasive procedures, although physicians are ambivalent about parental presence. PURPOSE: To determine the effect of a parent-focused intervention on the pain and performance of the procedure, anxiety of parents and clinicians, and parental satisfaction with care. POPULATION: Children younger than 3 years old undergoing venipuncture, intravenous cannulation, or uretheral catheterization. SETTING: Pediatric emergency department of Boston City Hospital. DESIGN: Randomized controlled trial with three groups; parents present and given instructions on how to help their children; parents present, but no instructions given; and parents not present. INTERVENTION: The parents were instructed to touch, talk to, and maintain eye contact during the procedure. RESULTS: A total of 431 parents was randomized to the intervention (N = 153), present (N = 147), and not present (N = 131) groups. The groups were equivalent with respect to measured sociodemographic variables and parents' previous experience in the pediatric emergency department. No differences emerged with respect to pain (3-point scale measured by parent and clinician, and analysis of cry); performance of the procedure (number of attempts, completion of procedure by first clinician, time); clinician anxiety; or parental satisfaction with care. Parents who were present were more likely to rate the pain of the children as extreme/severe (52%) in comparison to clinicians (15%, kappa .07, poor agreement) and were significantly less anxious than parents who were not present. CONCLUSION: Overall, the intervention was not effective in reducing the pain of routine procedures. Parental presence did not negatively affect performance of the procedure or increase clinician anxiety. Parents who were present were less anxious than those who were not present. CLINICAL IMPLICATION: In general, parents have indicated that they want to be present when their children undergo procedures. The results of this study challenge the traditional belief that parental presence negatively affects our ability to successfully complete procedures. We should encourage parents who want to be present to stay during procedures.

Adult↗
PubMed1995

Career choice in one general pediatric Title VII--supported residency.

The concern that there are too few generalist physicians and too many specialists is part of the ongoing health care debate. Medical educators have been challenged at the graduate and undergraduate levels to educate more generalists. While some question the actual effect of medical education on the choice of a generalist career, others strongly express the view that a generalist curriculum influences graduates to pursue a career in primary care. Residency training programs are largely based in hospitals, and pediatric practice is largely community based. The terms educational malpractice, educational mismatch, and, most recently, educational dysjunction have been used to describe the difference between the educational and practice experience.

Boston↗
PubMed1994

The core content of a generalist curriculum for general internal medicine, family practice, and pediatrics.

The authors analyzed the educational content of the curricula developed for teaching in the generalist disciplines of pediatrics, family medicine, and general internal medicine. Fifteen educational components that constitute the core content shared by the three generalist disciplines are identified, described, and referenced. Tailoring the generalist curriculum for students and residents at the different stages of learning is reviewed, along with the refinement of the curriculum to meet the special needs of each generalist discipline. The success of a generalist curriculum will ultimately be measured by generalist career choices, quality of care, and both patient and professional satisfaction. The curricular determinants of success require institutional commitment to an educational philosophy that embraces the generalist disciplines, a core curriculum that provides education and training that are correlated with the demands of clinical practice, and generalist faculty who serve as role models, mentors, and teachers.

Adult↗
PubMed1994

Evaluation of an office- and hospital-based intervention to increase the use of cloth diapers.

To evaluate an office-based educational intervention to promote the use of cloth diapers, we randomly assigned parents of 193 infants either to the intervention group or to a control group. The intervention consisted of physician advice and written material on cloth and disposable diapers at the 2-week office visit. Midway through the study, one of the birth hospitals switched to the exclusive use of cloth diapers. The results indicate that the diapering decisions of parents can be influenced by practices in hospitals and by office-based physician and nurse counseling.

Adult↗
PubMed1994

Serious bacterial infections in febrile infants and children selected for lumbar puncture.

Lumbar puncture (LP) is performed frequently in pediatric emergency departments to diagnose meningitis in infants and young children with fever. Children selected to have LP who do not have meningitis may, however, have other serious bacterial infections. We surveyed lumbar punctures performed in the Boston City Hospital Pediatric Emergency Department and monitored the incidence of meningitis and other serious bacterial infections. Meningitis was diagnosed in 8% of children who underwent LP. An additional 10.5% of children who underwent LP and had normal cerebrospinal fluid had positive cultures of blood (3.1%), urine (4.1%) or stool (3.3%). The decision to perform lumbar puncture identifies children at risk of having not only meningitis but other serious bacterial illnesses. Those children 2 years of age and younger with normal cerebrospinal fluid should be considered for cultures of blood, urine and possibly stool.

Adolescent↗
PubMed1994

Screening for childhood lead poisoning: a cost-minimization analysis.

Decision analysis was used to compare the costs of three screening strategies for childhood lead poisoning: (1) venipuncture; (2) capillary sample with venipuncture confirmation if the blood lead level is elevated; (3) stratification by risk, with venipuncture for high-risk children and capillary sample for low-risk children. Under baseline conditions, the cost of screening by the venipuncture, stratification, and capillary strategies is $22, $25, and $27, respectively. Venipuncture remains the least expensive strategy unless the cost of venipuncture is more than three times that of capillary sampling. The annual cost of a national lead screening program that uses a single venipuncture sample would be $352 million. Initial screening with a capillary sample would cost $432 million, 23% more than venipuncture.

Blood Specimen Collection↗
PubMed1993

Sleep problems in childhood.

Sleep, like eating and toileting, is an individual physical requirement that changes with time as the child matures. Although much about a child's sleep is biologically determined, extrinsic factors, usually through the parents, also mold the child's sleep behavior. Normal sleep for a child is restful to the child and not excessively disruptive to others. Sleep problems interfere with the quality of the child's sleep and frustrate or frighten caretakers. Several sleep problems have their origins in normal sleep behavior from an earlier age. Some, the parasomnias, are caused by self-limited biologic diatheses. Many sleep problems have psychosocial triggers. Sleep disorders only rarely are a primary medical problem that is adequately treated with medication (e.g., narcolepsy). Good history-taking, often accompanied by diary-keeping, will usually identify the problem--the first step in effective treatment. Treatment of a sleep disorder in the pediatrician's office can start with educating caretakers about normative sleep for the age of the child and providing information regarding the cause and natural course of the problem. Treatment also may involve behavioral or psychological intervention or both, but medication is generally not indicated. When needed for short-term treatment, mild sedatives such as antihistamines are used most often. More serious sleep or behavioral problems should be acknowledged by the primary care pediatrician, followed by referral to an appropriate specialist. Inquiry into a child's sleep habits at each well-child visit, coupled with appropriate anticipatory guidance, could make an important contribution to the child and family by preventing problems with sleep and identifying sleep problems early in their evolution. Pediatricians and parents can work together to help children develop good sleep habits that fulfill the child's evolving sleep requirements within the context of the family's needs and expectations.

Child↗
PubMed1992

Use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units.

The purpose of this study was to assess the use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units. The directors of 38 pediatric units and 31 neonatal units reported that analgesics were infrequently used for intravenous cannulation (10%), suprapubic bladder aspiration (8%), urethral catheterization (2%), or venipuncture (2%). Analgesics were used significantly more regularly in pediatric than in neonatal intensive care units for arterial line placement, bone marrow aspiration, central line placement, chest tube insertion, paracentesis, and lumbar puncture.

Analgesia↗
PubMed1992

Management of childhood lead poisoning: a survey.

Published recommendations (1985) for the management of childhood lead poisoning suggest the use of ethylenediaminetetraacetic acid (EDTA) provocation testing and chelation as the mainstay of treatment for blood lead levels between 25 and 55 micrograms/dL. Since 1985 evidence has accumulated indicating that (1) levels of blood lead less than 25 micrograms/dL are detrimental to cognitive development, (2) EDTA provocation testing may result in potentially harmful shifts in the body lead burden, and (3) oral agents such as penicillamine and 2,3-dimercaptosuccinic acid are effective in reducing elevated lead levels. To determine how this evidence impacts on the management of childhood lead poisoning, the authors surveyed the lead poisoning clinics of pediatric departments in the cities estimated by the United States Public Health Service to have the largest number of children affected by lead poisoning. Thirty (70%) of 43 surveys were completed. Respondents indicated that the lowest blood lead level for which they would use a chelating agent to reduce the lead burden was as follows: 50 micrograms/dL (3%), 45 micrograms/dL (3%), 40 micrograms/dL (13%), 35 micrograms/dL (3%), 30 micrograms/dL (27%), 25 micrograms/dL (47%), and 20 micrograms/dL (3%). For all blood lead levels from 20 through 55 micrograms/dL, EDTA was the most frequently recommended chelating agent (chelation and provocation testing). Fifteen percent of responding lead clinics do not use the provocation test under any circumstances. For a child with a negative EDTA provocation test, the percentage of respondents recommending the use of any chelation therapy ranged from 16% for blood lead levels of 25 through 29 micrograms/dL to 66% for levels of 50 through 55 micrograms/dL.(ABSTRACT TRUNCATED AT 250 WORDS)

Chelating Agents↗
PubMed1992

Fever phobia: the pediatrician's contribution.

Fever phobia, the exaggerated fear of fever, is found among parents of all socioeconomic classes. Pediatricians may inadvertently contribute to fever phobia if their practice and educational message are incongruent. To determine how pediatricians treat fever in their practice, the authors sent a self-administered questionnaire to a sample of members of the American Academy of Pediatrics who lived in Massachusetts. Pediatricians were asked (1) how dangerous they believed fever to be, (2) how they treated fever in their practice, and (3) what types of educational information they gave families regarding fever. One-hundred seventy-two of the 234 (74%) eligible pediatricians returned the survey; 151 were completed. Sixty percent of the respondents were male, and 75% practiced some form of primary or episodic care. Ninety-eight (65%) believed that fever itself could be dangerous to a child, with 58 (60%) of the original 98 citing that a temperature of 104 degrees F or greater could lead to complications such as seizures, brain damage, or death. In practice, 108 (72%) always or often recommended treatment to reduce fever and 96 (89%) of the 108 did so at temperatures between 101 degrees and 102 degrees F. One hundred thirty-one (88%) respondents agreed that a sleeping child with fever should be left undisturbed. One hundred twenty-one (80%) pediatricians always or often tried to educate families about fever during sick-child visits, yet only 38% addressed the dangers of fever.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1992

Reducing night waking in infancy: a primary care intervention.

Approximately 25% of infants wake regularly at night and need help in resettling. The purpose of this study was to implement and evaluate a brief intervention to prevent such night waking. The study used a prospective cohort design with historical controls. Information from the control group was collected at the 9-month visit. The intervention group was enrolled at the 4-month visit. The intervention consisted of information about sleep-onset associations, completion of a sleep chart, and discussion about sleep with the pediatrician. The outcome was also measured at the 9-month visit. To obscure the purpose of the study, the outcome questionnaire for both groups addressed feeding and sleeping. One hundred twenty-eight (74%) of 172 eligible infant-parent pairs comprised the control group and 164 (74%) of 222 the intervention group. The majority of families were white, married, and well-educated. The groups were similar with regard to sociodemographic variables and factors thought to be related to night waking such as current breast-feeding, thumb/pacifier sucking, maternal isolation, and parental perception of difficult child. At 9 months of age, the intervention infants were reported to experience 36% less night waking per week compared with those in the control group (2.5 vs 3.9 wakings per week, P = .02). Frequent night waking was twice as common in control infants (27% vs 14%, P = .01). It is concluded that this pediatric intervention can help parents reduce night waking in infants.

Cohort Studies↗