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PubMed1988

Evolution of the care of the injured child.

Pediatric trauma care has become an art form practiced by pediatric surgeons who regard it as their field of special interest. The emotional and physiologic differences of young patients and the need to cope with pediatric trauma as a syndrome require special techniques and organization best provided by pediatric trauma centers. Improved outcome in trauma centers, both adult and pediatric, has been documented beyond reasonable doubt, and the trauma center movement has matured to the point where legislative and regulatory bodies and insurance carriers are directing seriously injured patients to specialized facilities. We hear so much about rare diseases that it is possible to forget that trauma kills more children than all other diseases combined. Seventy years after Dr. Ladd's vision the day may finally be at hand in which every pediatric hospital and children's service has a pediatric trauma program. The essential ingredient of pediatric trauma care is commitment to the special needs of injured children--personal, institutional, and community commitment. The future belongs to those who understand the past.

Abdominal Injuries↗
PubMed1987

Perspectives in cancer screening in the elderly.

The concern is whether physicians and the health care system make cancer screening available to the elderly. This question has special meaning in this population as it is apparent that problems in screening for cancer have not been addressed. First, primary care physicians do not emphasize cancer prevention and early diagnosis in the elderly. Second, there is a need to educate the American population about cancer prevention, methods of early diagnosis, and the problems and realities surrounding cancer. The elderly are less aware of and use significantly fewer of the available screening resources. When this is coupled with a health system that does not provide funding for preventive and screening services (Medicare, Medicaid, and most third-party insurance carriers), the potential to deal with this problem becomes extremely difficult. High-quality primary care is the key to cancer screening in the elderly. The physician must take responsibility for health promotion while concentrating on screening. Two good rules of thumb are 1) to screen all patients for cancer and other diseases on a routine basis based upon screening recommendations in the current literature; and 2) to evaluate a normal patient who comes to the physician with a complaint (to assure early diagnosis). It is difficult to decide when an aggressive work-up is needed since older patients are at risk of complications from diagnostic procedures. The elderly are singularly under-represented in most studies of screening and prevention. We are therefore left with the reality that, no matter what set of recommendations is put forward, the physician is acting from incomplete information. The published guidelines are not directed at the elderly. Omission of the elderly from these studies leaves unknown the risks, benefits, and even the actual ability to screen. There is a need for better screening methods. There is evidence in the literature that both the physician and the patient need to be educated. The need for research in screening efficacy is coupled with a need to define methodologies to educate the provider and the patient and to determine how to reach high-risk populations. In the interim, the implementation of the guidelines discussed, with consideration of the current literature, is recommended to the physician as a rational approach.

Age Factors↗
PubMedDate not supplied

Management of patients with multiple chemical sensitivities at occupational health clinics.

The difficult task of managing patients with MCS requires a multidisciplinary effort involving the occupational medicine physician, social worker, occupational therapist, physical therapist, psychologist, vocational rehabilitation specialist, industrial hygienist, and other involved professionals. Important objectives of management include complete review of the history and clinical findings, appropriate choice of diagnostic tests, search for additional exposure information, emphasis of "well" behavior, health education of the patient and prevention of further illness. Because of the chronic nature of MCS and the difficulty many patients have in coping with MCS, pharmacologic and psychologic interventions should be considered. Interaction of the clinic with the patients employer, insurance carrier, or attorney must be carefully planned and communicated only after receiving the patient's informed consent. Patient education should include general principles of toxicology, industrial hygiene measures to reduce hazardous exposures, factors which may aggravate the illness, and resources available to obtain further information and assistance.

Humans↗
PubMed1988

AIDS: mortality.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗