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PubMedDate not supplied

Pediatric dentistry workforce issues: a task force white paper. American Academy of Pediatric Dentistry Task Force on Work Force Issues.

The number of current practitioners, academicians, and researchers in Pediatric Dentistry is clearly not adequate to meet the need and demand. The shortage in academia is dire. Simply put, not enough pediatric dentists are being trained. The rate limiting factor is the number of training positions. The American Academy of Pediatric Dentistry established a "Task Force on Work Force Issues" approximately 18 months ago and charged that group to seek methods for creating more training positions. This paper reflects the Task Force deliberations, documents the shortage of pediatric dental specialists, and recommends tactics for amelioration.

Child↗
PubMedDate not supplied

Effects of changing U.S. parenting styles on dental practice: perceptions of diplomates of the American Board of Pediatric Dentistry presented to the College of Diplomates of the American Board of Pediatric Dentistry 16th Annual Session, Atlanta, Ga, Saturday, May 26, 2001.

PURPOSE: This study surveyed board-certified pediatric dentists on their opinions about changes in U.S. parenting styles and the effects on the practice of pediatric dentistry. METHODS: A questionnaire was developed, piloted, and mailed to 1,129 members of the College of Diplomates of the American Board of Pediatric Dentistry during the summer of 2000. RESULTS: A total of 577 respondents (51%) returned questionnaires, equally distributed across AAPD districts, with male:female ratio of 4:1 and 90% married. A majority perceived parenting styles had changed during their practice lifetime (88% "absolutely or probably changed"), with older practitioners significantly more likely to say so. Ninety-two percent felt changes were "probably or definitely bad" and 85% felt that these changes had resulted in "somewhat or much worse" patient behavior. Practitioners report performing less assertive behavior management techniques than in the past due to these changes. CONCLUSIONS: Diplomates report that parenting changes have occurred and they believe these are negative (bad) and have adversely influenced behavior and caused changes in pediatric dentists' behavior management.

Adult↗
PubMed2005

Assessment of the Pediatric Index of Mortality (PIM) and the Pediatric Risk of Mortality (PRISM) III score for prediction of mortality in a paediatric intensive care unit in Hong Kong.

OBJECTIVE: To compare two models (The Pediatric Risk of Mortality III score and Pediatric Index of Mortality) for prediction of mortality in a paediatric intensive care unit in Hong Kong. DESIGN: Prospective case series. SETTING: A five-bed paediatric intensive care unit in a general hospital in Hong Kong. PATIENTS: All patients consecutively admitted to the unit between April 2001 and March 2003. MAIN OUTCOME MEASURES: Scores for both models compared with observed mortality. RESULTS: A total of 303 patients were admitted to the paediatric intensive care unit during the study period. The median age was 2 years, with an interquartile range of 7 months to 7 years. The male to female ratio was 169:134 (55.8%:44.2%). The median length of hospital stay was 3 days. The overall predicted number of deaths using The Pediatric Risk of Mortality III score was 10.2 patients whereas that by Pediatric Index of Mortality was 13.2 patients. The observed mortality was eight patients. The area under the receiver operating characteristics curve for the two models was 0.910 and 0.912, respectively. CONCLUSION: The predicted mortality using both prediction models correlated well with the observed mortality.

Child↗
PubMed2006

Pediatric obesity: are we under-diagnosing? Assessing pediatric obesity at an urban community health clinic.

Pediatric care providers are often discouraged by the scope and magnitude of our current childhood overweight epidemic. Numerous studies have shown the adverse consequences of pediatric obesity, ranging from short-term physical and psychosocial consequences to long-term consequences that manifest in adulthood. In this study we investigated rates of overweight and at-risk for overweight children in a community health center in urban Honolulu, Hawai'i which serves a large multi-cultural and multi-ethnic population with a large presence of Asians and Pacific Islanders. This was done by conducting a chart review of the pediatric patients in the clinic. Twenty-four children had been formally diagnosed and recorded in their charts as obese/overweight during the last 2 years, out of 4,640 pediatric patients seen (less than 0.5%). However, according to this study roughly 140 overweight children are seen monthly at this clinic, indicating a prevalence of more than 50%. Samoan and Micronesian children were found to be primarily impacted.

Adolescent↗
PubMed1987

The future of pediatrics. Implications of the changing environment of medicine. Council on Long Range Planning and Development in cooperation with the American Academy of Pediatrics.

We present the results of an environmental analysis by the American Medical Association Council on Long Range Planning and Development to determine the key factors that are likely to affect the pediatric specialty in the future. Three factors were identified that are particularly salient to future pediatric practice: demographic trends, decisions by third-party payers, and public attitudes toward services for children. Less than half as many children per pediatrician is predicted for the year 2000 compared with 1970. Pediatricians are likely to face future constraints on reimbursement, particularly for cognitive services and for providing care to the growing number of children in poverty. One moderating effect may be laws enacted at the state or federal level mandating basic insurance coverage for child health supervision services. The public interest in children's services will influence future access to pediatric care for children and the compensation that pediatricians receive for children in poverty. In light of these issues, organized medicine may seek means to adjust to and also to shape the environment in which pediatric practice is to occur in the future.

American Medical Association↗
PubMed1978

[Pediatric bibliometrics: II. Descriptive statistics on pediatric periodicals and papers (author's transl)].

A descriptive statistic study about journals and pediatric articles at international level is presented. Three of the main international repetories of medical bibliography, have been used as sources, collecting a total of three hundred periodical pediatric publications. A distribution of these publications by languages, places or impression, periodicity of appearance and percent of sub-specialization is made. In relation with pediatric papers, we have studied their presence in non medical scientific journals, medical but non pediatric journals and in those of the speciality, analizing the percentage of these papers in each one of them.

Pediatrics↗
PubMed1982

Teaching behavioral pediatrics and to pediatric residents: the state o the art and description of a program.

In 1978, the Task Force on Pediatric Education strongly recommended that all pediatric residency programs include at least one full-time rotation and biosocial pediatric, preferably in the 1st or 2nd year. Since 1977, the University of Maryland has had a structured, integrated, required program in Behavioral Pediatrics, including 2 months in both the PL-1 and PL-2 years for a total of 4 months addition of elective experience is available in the PL-3 year. The development and description of this program is presented as well as a review to the relevant literature.

Behavioral Medicine↗
PubMed2006

The pediatric end-stage liver disease (PELD) model as a predictor of survival benefit and posttransplant survival in pediatric liver transplant recipients.

The pediatric end-stage liver disease (PELD) model accurately estimates 90-day waitlist mortality for pediatric liver transplant candidates, but it has been unclear if PELD can identify patients who will derive survival benefit from undergoing liver transplantation (LT), if it correlates with posttransplant survival, or if it can identify patients for whom LT would be futile. Pediatric patients who underwent LT between 2001 and 2004 were enrolled through the United Network for Organ Sharing Organ Procurement and Transplant Network database. Survival benefit was measured in terms of life-years gained during the first year after LT. Complete data were available for 1,247 patients: 53% were listed as Status 1 at the time of orthotopic liver transplantation (OLT), while the remaining 47% had PELD scores. Only in patients with a PELD of 17+ or those designated as United Network for Organ Sharing Status 1 derived a survival benefit within 1 year of LT; patients with a PELD score of < or = 16 did not. In addition, a statistically significant association was seen between 1-year post-OLT survival and PELD at LT (P = 0.03). No "threshold" PELD score, beyond which risk of post-LT mortality increased dramatically, was apparent. In conclusion, pediatric patients with a PELD score of 17+ derive survival benefit early after LT, and increasing PELD scores are associated with increasing transplant benefit after liver transplantation. PELD does correlate with posttransplant survival but should not be used as a marker for futility.

Algorithms↗
PubMed2004

The management of pediatric appendicitis: a survey of North American Pediatric Surgeons.

BACKGROUND/PURPOSE: Variation exists among pediatric surgeons in the management of pediatric appendicitis. The goal of this study was to determine current practice patterns and provide a foundation for evidence-based outcome studies that would standardize patient care. METHODS: Members of the American Pediatric Surgical Association (APSA) were surveyed. Data included preference of imaging, timing of operation, and opinions on interval appendectomy. Intraoperative principles surveyed included use of cultures, antibiotic irrigation, transperitoneal drains, and method of wound closure. Spectrum and duration of antibiotic coverage were assessed, as were discharge criteria. RESULTS: Survey response was 70%. A majority prefers computerized tomographic (CT) imaging and favors interval appendectomy in appropriate candidates. Seventy percent indicate a stable child with suspected appendicitis would be operated on in a semiurgent manner rather than emergently in their practice. Discrepancy exists in the type and duration of antibiotic coverage, impact of clinical parameters on antibiotic use, and utility of discharge criteria. CONCLUSIONS: This study consolidates current opinions on appropriate management of pediatric appendicitis, providing a foundation for evidence-based outcome studies capable of bringing conformity to the management of this surgical disease. Such studies would establish clinical practice guidelines that optimize resource utilization while maintaining quality care.

Adolescent↗
PubMed2006

Factors influencing pediatric Injury Severity Score and Glasgow Coma Scale in pediatric automobile crashes: results from the Crash Injury Research Engineering Network.

BACKGROUND/PURPOSE: Motor vehicle crashes account for more than 50% of pediatric injuries. Triage of pediatric patients to appropriate centers can be based on the crash/injury characteristics. Pediatric motor vehicle crash/injury characteristics can be determined from an in vitro laboratory using child crash dummies. However, to date, no detailed data with respect to outcomes and crash mechanism have been presented with a pediatric in vivo model. METHODS: The Crash Injury Research Engineering Network is comprised of 10 level 1 trauma centers. Crashes were examined with regard to age, crash severity (DeltaV), crash direction, restraint use, and airbag deployment. Multiple logistic regression analysis was performed with Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) as outcomes. Standard age groupings (0-4, 5-9, 10-14, and 15-18) were used. The database is biases toward a survivor population with few fatalities. RESULTS: Four hundred sixty-one motor vehicle crashes with 2500 injuries were analyzed (242 boys, 219 girls). Irrespective of age, DeltaV > 30 mph resulted in increased ISS and decreased GCS (eg, for 0-4 years, DeltaV < 30: ISS = 10, GCS = 13.5 vs DeltaV > 30: ISS = 19.5, GCS = 10.6; P < .007, < .002, respectively). Controlling for DeltaV, children in lateral crashes had increased ISS and decreased GCS versus those in frontal crashes. Airbag deployment was protective for children 15 to 18 years old and resulted in a lower ISS and higher GCS (odds ratio, 2.1; 95% confidence interval, 0.9-4.6). Front-seat passengers suffered more severe (ISS > 15) injuries than did backseat passengers (odds ratio, 1.7; 95% confidence interval, 0.7-3.4). A trend was noted for children younger than 12 years sitting in the front seat to have increased ISS and decreased GCS with airbag deployment but was limited by case number. CONCLUSION: A reproducible pattern of increased ISS and lower GCS characterized by high severity, lateral crashes in children was noted. Further analysis of the specific injuries as a function and the crash characteristic can help guide management and prevention strategies.

Accidents, Traffic↗
PubMed2003

Pediatric trauma care: an overview of pediatric trauma systems and their practices in 18 US states.

PURPOSE: The aim of this study was to describe the state of pediatric trauma system development in the United States in 1997 and 1998 and to characterize the hospitalization patterns of injured children in states with different types of pediatric trauma systems. The authors also investigated the impact of sociodemographic, injury, and geographic characteristics on those hospitalization patterns. METHODS: The authors combined statewide hospital discharge data on hospitalized trauma patients less than 15 years old with data from the American Hospital Association, the Area Resource File, the Office of Management and Budget, the states' Departments of Health, and the US Census. Besides conducting descriptive analyses, the authors evaluated the role of several parameters in determining the likelihood of treatment in trauma and nontrauma centers using multivariate multinomial logistic regression models. RESULTS: There were 15 states with adult and pediatric trauma designation systems; 9 of them had statewide hospital discharge data available. In these 9 states, 77% of the discharges were from trauma centers with no pediatric designation. More severely injured children and children with injuries to the head, face, thorax, and abdomen were more likely to be discharged from trauma centers, although large percentages of these children were treated in nontrauma centers. Older children and children with commercial insurance were less likely to be treated at trauma centers, even when injury severity, body region injured, and other factors were accounted for. CONCLUSIONS: Even in states with trauma systems, a large proportion of severely injured children are treated in nontrauma center facilities.

Adolescent↗
PubMed2002

Defibrillation threshold and cardiac responses using an external biphasic defibrillator with pediatric and adult adhesive patches in pediatric-sized piglets.

Before recommendations for using an automatic external defibrillator on pediatric patients can be made, a protocol for the energy of a biphasic waveform energy dosing needs to be determined that will allow ventricular defibrillation of 8 year olds while causing only a minimal amount of cardiac damage to infants. Pediatric- and adult-sized electrode patches were alternately applied to 10 isoflurane-anesthetized piglets weighing 3.8-20.1 kg to approximate the body weights of newborns to children < 8 years old. The defibrillation threshold (DFT) was determined for biphasic truncated exponential waveform shocks. Additional shocks, varying from the DFT to 360 Joules (J), were delivered during sinus rhythm or following 30 s of ventricular fibrillation (VF). The DFT was 2.4+/-0.81 and 2.1+/-0.65 J/kg for pediatric and adult patches, respectively (P = N.S.). The change in left ventricular (LV) dP/dt from baseline as a function of shock strength was significantly different at 1 and 10 s after shocks of increasing energy that were delivered in sinus rhythm, and 1, 10, 20, and 30 s after defibrillation shocks. There was no significant difference in LV dP/dt with increasing shock energy at 60 s with either patch size. The time to return of sinus rhythm, ST-segment deviation, and cardiac output were also not significantly different from baseline 60 s following shocks of up to 360 J delivered during sinus rhythm or VF with either patch. The same amount of energy delivered with a biphasic external defibrillator successfully defibrillated VF whether adult or pediatric patches were used. Cardiac rhythm and hemodynamic variables were unaltered at 60 s after shocks delivered at energies of up to 360 J. These data suggest that there is a substantial safety margin above a DFT strength shock for this biphasic waveform in piglets.

Age Factors↗
PubMed1997

Multicenter prospective evaluation of proposed pediatric migraine revisions to the IHS criteria. Pediatric Headache Committee of the American Association for the Study of Headache.

Eighty-eight children and adolescents were prospectively evaluated at eight specialty clinics comparing the diagnostic criteria of the International Headache Society (IHS) and the proposed revised (IHS-R) classification to the clinical diagnosis. The proposed revisions to the IHS classification for pediatric migraine include: duration-1 hour to 48 hours; location--bifrontal/bitemporal or unilateral; and symptoms--to include photophobia or phonophobia. A comparison of the diagnostic rates of pediatric migraine with and without aura of the total sample revealed IHS (66%) versus IHS-R (93%) and comparison of a subset of those patients less than 12 years of age (n = 39) revealed IHS (49%) versus IHS-R (87%). Significant improvement in the diagnostic sensitivity of migraine in the pediatric population was obtained by specific modifications to the IHS criteria pertaining to duration, location, and the symptoms of photophobia and phonophobia in an ongoing multicenter prospective study. These revisions may help to form the basis for future research guidelines and for further modifications to improve the diagnostic sensitivity of pediatric migraine maintaining the IHS model.

Adolescent↗
PubMed1993

National acceptability of American Association of Blood Banks Pediatric Hemotherapy Committee guidelines for auditing pediatric transfusion practices.

In 1989, guidelines for the auditing of pediatric transfusion practices were developed by the Pediatric Hemotherapy Committee of the American Association of Blood Banks (AABB) and made available to AABB members. A survey of members who requested the guidelines was conducted to determine how consistent the guidelines were with local transfusion practices and how useful they were for the conduct of audits. The majority of respondents indicated that the recommended audit criteria agreed with local practices and that most of them could be applied to their transfusion practice audits with little or no modification. An exception was that criteria for the transfusion of platelets to premature infants were considered by some to be too liberal. However, after review of the comments and the published information available, the committee elected not to revise the guidelines pertaining to platelet transfusions for premature infants. Bearing in mind that audit criteria are intended to identify circumstances in which transfusions are acceptable as reasonable therapy without need for further justification, rather than to serve as indications for transfusions, the AABB Pediatric Hemotherapy Committee guidelines for auditing pediatric transfusion practices are fairly representative of national practice.

Blood Banks↗
PubMedDate not supplied

[Organization of the Pediatric Tumor Cell Bank of the Society of Pediatric Oncology and Hematology (GPOH)].

Characterized cell lines are absolutely necessary in applied research of cell biology and medicine. For the completion of diagnosis and therapy especially in pediatric oncology we are establishing a Cell Bank for Pediatric Tumors. The Cell Bank for Pediatric Tumors collects tissue samples of different types of solid malignant tumors from children and young adults. The specimens are transferred to in vitro culture (guidelines of the American Type Culture Collection-ATCC), the resulting cells are characterized to assure accordance with the histogenesis of the original tumor and stored in liquid nitrogen. The cell cultures are characterized morphologically (phase contrast microscopy) and immunocytochemically (ABC-method). To prove the malignancy of cells in primary culture the amount of hypertetraploid cells was determined (DNA-Scanning-Cytophotometry). Cell lines are checked to find out whether they develop tumors in nude mice followed by an analysis of the karyotype. Additional investigations (e.g. in vitro test of cytostatic drug resistance) are carried out on request by the sender. Part of the tumor tissue which is used to start the cell culture is in parallel diagnosed histopathologically at the Children's Tumor Register, Kiel and/or at the Charité. By the end of the year 1995 the Cell Bank for Pediatric Tumors had received 183 different specimens including 123 solid tumors (e.g. 24 neuroblastomas, 18 osteosarcomas, 12 Wilms' tumors, 13 rhabdomyosarcomas), 44 tissue specimens without any malignant cells, 8 probes without vital cells and 8 leukemias and lymphomas. We were able to establish primary cell cultures of 50% of the sterile tumor tissue probes, to cultivate them for a minimum of 5-10 passages, to characterize and freeze them. Six out of these tumor cell lines were already cultivated for one year and are available to the scientific community.

Adolescent↗
PubMed2002

Prophylactic intravenous use of milrinone after cardiac operation in pediatrics (PRIMACORP) study. Prophylactic Intravenous Use of Milrinone After Cardiac Operation in Pediatrics.

BACKGROUND: Many pediatric patients undergoing cardiac surgery involving cardiopulmonary bypass have a predictable fall in the cardiac index 6 to 18 hours after surgery, the so-called low cardiac output syndrome (LCOS). Because patients who have LCOS require more monitoring and support and have a prolonged stay in the intensive care unit, the syndrome is associated with a costly morbidity. Milrinone, a phosphodiesterase III inhibitor, improves cardiac muscle contractile force and vascular muscle relaxation through positive inotropic and vasodilatory effects. The purpose of the Prophylactic Intravenous Use of Milrinone After Cardiac Operation in Pediatrics (PRIMACORP) study is to evaluate the safety and efficacy of the prophylactic use of milrinone in pediatric patients at high risk for development of LCOS after undergoing cardiac surgery. METHODS: Patients in the multicenter, randomized, double-blind, placebo-controlled, parallel treatment study will be randomized to 1 of 3 treatment arms: (1) low-dose milrinone (25 microg/kg intravenous bolus over 60 minutes followed by a 0.25 microg/kg/min infusion for 35 hours), (2) high-dose milrinone (75 microg/kg intravenous bolus over 60 minutes followed by a 0.75 microg/kg/min infusion for 35 hours), or (3) placebo. RESULTS: The primary end point for efficacy evaluation will be based on a composite variable consisting of death or development of LCOS requiring additional mechanical or pharmacologic support, up to 36 hours after randomization. A 2-sided test with a 0.025 type I error will be used for the primary end point analysis. The PRIMACORP study will enroll a total of 240 patients. Six additional secondary end points will be analyzed. CONCLUSIONS: The PRIMACORP study will address several questions regarding the safety and efficacy of prophylactic milrinone use in pediatric patients at high risk for development of LCOS after cardiac surgery.

Cardiac Output, Low↗
PubMedDate not supplied

Pediatric oncology at the National Institute of Pediatrics in Mexico City.

The Instituto Nacional de Pediatría (National Institute of Pediatrics) is a referral, non-profit, teaching hospital. This government-funded institution is dedicated only and exclusively for clinical and research in pediatrics. In their 29 years, it has dictated the norms for patient care through a multitude of research projects in all fields of pediatrics. The purpose of our institution is to continue developing human professional resources in order to improve patient care across the country, especially in pediatric oncology, in which there is a tremendous shortage of professionals. We believe that all Mexican children with this disease have the right to have as good treatment and prognosis as the children from developed countries.

Child↗
PubMed2001

Complications of pediatric trauma: effects on pediatric trauma anesthesia.

Pediatric trauma is a significant problem worldwide. The complications of pediatric trauma affect the emergency medical services provider, emergency physician, trauma surgeon, and anesthesiologist in different and challenging ways. Children have unique airway concerns, and require distinctive and safe approaches to protection of the airway. Moreover, the resuscitation of infants, children, and adolescents involved in trauma is complex and can be stressful for many caregivers. Therefore, the provision of anesthesia for acute pediatric trauma requires a synthesis of the usual issues of pediatric anesthesia with the overlying complications of trauma to effect an ideal anesthetic technique for each patient.

Journal Article↗