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PubMed1994

Pediatric defibrillation: current flow is improved by using "adult" electrode paddles.

OBJECTIVE: Current flow, the major determinant of defibrillation success, depends on delivered energy and transthoracic impedance. Previous experimental data suggest that transthoracic impedance is higher using "pediatric" electrode paddles compared to the larger "adult" electrode paddles. There are few data from actual shocks to support the experimental studies. The purpose of this study was to measure transthoracic impedance during actual shock delivery and to determine the optimal electrode paddle size for pediatric defibrillation and cardioversion. METHODS: We prospectively evaluated all shocks of < or = 20 joules given to pediatric patients at the University of Iowa from 1988 to 1992. Data collected included energy selected by the operator, energy delivered by the defibrillator, peak current flow and transthoracic impedance. Data were analyzed by unpaired t test and linear regression. RESULTS: Fifty-five shocks were delivered to 20 patients, age newborn to 8 years. Thirty-seven shocks were given with "pediatric" electrode paddles (surface area 21 cm2) and 18 with "adult" electrode paddles (surface area 83 cm2). Selected energy correlated well with delivered energy (r = .98, P < .0001). Delivered energy using "pediatric" electrodes did not differ from that delivered with "adult" electrodes (8.0 +/- 0.9 joules vs 10.5 +/- 1.2 joules P > .1). However transthoracic impedance was significantly higher with "pediatric" electrodes (78.1 +/- 4.4 ohms vs 54.6 +/- 2.7 ohms P < .0008), resulting in lower peak current flow through "pediatric" electrode paddles (6.2 +/- 0.5 amps vs 8.7 +/- 0.5 amps P < .002). There was no correlation between joules/kg and peak current flow (r = .26, P > .05). CONCLUSION: Use of "pediatric" electrode paddles results in higher transthoracic impedance and thus lower peak current flow. In pediatric defibrillation, larger "adult" electrode paddles should be used as soon as chest size permits (approximately 10 kg). Lower transthoracic impedance results in higher current flow that facilitates cardioversion and defibrillation.

Child↗
PubMed1993

Intestinal permeability compared in pediatric and adult patients with inflammatory bowel disease.

Increased urinary excretion of 51Cr-EDTA after oral administration has been demonstrated in adults with active inflammatory bowel disease (IBD). Pediatric patients with Crohn's disease (CD) and ulcerative colitis (UC) were compared to pediatric and adult controls and adult patients with IBD using this technique. Seventy-five pediatric IBD patients, 51 (mean age 13.8 y) diagnosed with active CD and 24 (mean age 11.9 y) with active UC, were examined. These were compared to 26 pediatric controls with recurrent abdominal pain or chronic non-specific diarrhea. Further comparison was made to 80 adult controls (mean 32.0 y), 63 adults with active CD and 31 adults with active UC. After an overnight fast, 925 kBq of 51Cr-EDTA was given orally and urine collected for 24 h. Excretion of the probe by the pediatric controls and adult controls was 1.5%/24 h and 1.3%/24 h (median), respectively. Of the pediatric patients, 45/51 (88.2%) with active CD (median 3.9%/24 h) and 16/24 (66.7%) with active UC (median 4.8%/24 h) showed increased excretion. Pediatric patients with active IBD demonstrated increased probe excretion comparable to levels of adult patients. In the pediatric population, accuracy of the first test was 83.0%. Thus, urinary excretion of 51Cr-EDTA is a useful non-invasive test in the investigation of pediatric patients with gastrointestinal symptoms.

Adolescent↗
PubMed2002

Implementation of a program to teach pediatric residents and faculty about domestic violence.

OBJECTIVES: To obtain information about pediatric resident and staff knowledge, attitudes, and screening practices related to domestic violence (DV), to implement a domestic violence education program, and to evaluate whether the program resulted in changes in these 3 domains. DESIGN: Interventional with before and after survey evaluation. SETTING: A hospital-based, pediatric residency continuity clinic that serves families in Pittsburgh, Pa. PARTICIPANTS: Pediatric residents (n = 51), medicine-pediatric residents (n = 6), continuity clinic faculty (n = 22), and certified-registered nurse practitioners (n = 5). RESULTS: Prior to implementation of the DV education program, respondents correctly answered questions about the prevalence of DV (74 participants [90%]), the racial distribution of DV victims (66 participants [80%]), and the significant overlap between child abuse and DV (75 participants [91%]). Seventy-nine participants (96%) believed that screening for the presence of DV was part of their role as pediatric health care providers. At baseline, 17 (21%) of the 82 participants reported that they were routinely screening for signs of DV during well-child care visits compared with 39 (46%) after attending the education program (P =.005). Among participants who attended both educational session 25% (9/36) were routinely screening for the presence of DV prior to the intervention, compared with 46% (16/35) after the intervention (P =.008). At baseline, 33 (40%) of the 82 participants had identified at least 1 case of DV in the prior 6 months compared with 45 (53%) after training. Prior to training, 18 participants (22%) were aware of resources for DV victims compared with 45 (53%) after training (P<.001). CONCLUSIONS: To our knowledge, this is one of the first pediatric studies to demonstrate that using a short, multifaceted educational module, it is possible to change DV screening practices and to increase identification of DV victims among pediatric residents, continuity clinic faculty, and certified-registered nurse practitioners at a pediatric teaching hospital.

Adult↗
PubMed1986

The history of pediatric surgery in Germany.

Pediatric surgery as defined today is a very young specialty, and it was not until the middle of our century that pediatric units were established at surgical clinics in Germany. Pediatric surgery in Germany developed first in children's hospitals. The author distinguishes four stages: Stage 1: The pediatrician as operating surgeon; Stage 2: The surgeon as consultant; Stage 3: Pediatric surgical hospitals at children's hospitals; Stage 4: Pediatric surgery as an independent discipline in its own right. This chapter then relates the history of the German Society of Pediatric Surgery and the coming of age of pediatric surgery as a completely independent discipline, in which there are now 55 pediatric surgical units in the Federal Republic of Germany. The publications, textbooks, and journals listed at the end of this chapter show the advance of this discipline.

General Surgery↗
PubMed1986

100 years of pediatric surgery in Stockholm, with personal memories from the last 50 years.

The first children's hospital in Sweden (Kronprinsessan Lovisa's Children's Hospital) was established in Stockholm in 1854. In 1885 it was divided into a medical and a surgical department. This constituted the birth of pediatric surgery in Sweden. Pediatric surgery has been included in undergraduate teaching programs since 1945. A personal Associate Professorate in Pediatric Urology was instituted at the Karolinska Medical School in Stockholm for N. O. Ericsson in the late fifties. Upon his retirement in 1976 this personal chair was converted into an established Professorship in Pediatric Surgery. Pediatric surgery has been recognized as a specialty by our Medical Association since 1947. A survey of the Annual Reports from the Lovisa Hospital from 1885 to 1969 shows three phases in the development of our specialty in Sweden. The first stage extends from 1885 to 1932. During this period the disease pattern was dominated by septic and tuberculous infections, by empyemas, and by ENT diseases. Few cases of congenital malformations were reported. The bulk of general surgery in childhood was performed in the departments of general surgery. The second stage (1932-1945) was characterized by a decreasing incidence of tuberculous infections, by a successive transfer of orthopedic and ENT patients to the Departments of Orthopedic and ENT surgery respectively. During this period, a marked increase occurred in the volume of malformation surgery. This was due to the centralized treatment of congenital anomalies. The third stage started in 1945. The war had ended and we became acquainted with the dramatic development of pediatric surgery in other countries, in particular in the USA. The main advance was the possibility of opening the chest for repair of congenital anomalies of the heart and the great vessels, of the esophagus, and of the diaphragm. Soon afterwards, rectosigmoidectomy was introduced for the treatment of Hirschsprung's disease. In 1952, a second department of pediatric surgery was opened in Stockholm as a part of a new Children's Clinic at the Karolinska University Hospital. The major part of general surgery from the Stockholm area and all of the cardiovascular surgery stayed with the "Lovisa Hospital", while the major part of neonatal surgery and specific abdominal surgery was performed at the Karolinska Hospital. In order to improve the rather underdeveloped situation of pediatric urology, N. O. Ericsson was appointed to the post of Associate Head of the Karolinska Department, soon bringing this field to the frontlines of international standards. This historical review ends with some of the author's personal memories from the last 50 years.

England↗
PubMed2004

Admission and discharge guidelines for the pediatric patient requiring intermediate care.

During the past three decades, the specialty of pediatric critical care medicine has grown rapidly, leading to a number of pediatric intensive care units being opened across the country. Many patients who are admitted to the hospital require a higher level of care than the routine inpatient general pediatric care, yet not to the degree of intensity as pediatric critical care; therefore, an intermediate care level has been developed in institutions providing multiple disciplinary subspecialty pediatric care. These patients may require frequent monitoring of vital signs and nursing interventions but usually do not require invasive monitoring. The admission of the pediatric intermediate care patient is guided by physiologic parameters depending on the respective organ system involved relative to the institution's resources and capacity in caring for a patient in a general care environment. This report provides admission and discharge guidelines for intermediate pediatric care. Intermediate care promotes greater flexibility in patient triage and provides a cost-effective alternative to admission to a pediatric intensive care unit. This level of care may enhance the efficiency of care and improve the healthcare affordability for patients receiving intermediate care.

Cardiovascular Diseases↗
PubMed2005

Intraosseous access in the setting of pediatric critical care transport.

OBJECTIVE: To demonstrate safety and efficacy of intraosseous needle placement among health care provider groups in the setting of pediatric critical care transport. DESIGN: Retrospective chart review. SETTING: Pediatric critical care transports to a pediatric intensive care unit. PATIENTS: Children undergoing pediatric critical care transport between January 1, 2000, and March 31, 2002, requiring intraosseous access before arrival to the pediatric intensive care unit. INTERVENTIONS: Intraosseous access placed for emergent vascular access. MEASUREMENTS AND MAIN RESULTS: During the study period, the transport team performed 1,792 transports and identified 47 patients requiring 58 intraosseous placements. These were placed by emergency medical technician-paramedics (18%), referring emergency medicine physicians (42%), and the transport team members (40%). The intraosseous needles were placed with a mean of 1.2 attempts per placement and a first attempt success rate of 78%. Main site of placement was the proximal anterior tibia (95%). Access was maintained for a mean of 5.2 hrs. The intraosseous needle was used for fluids, medications, and laboratory studies. Admitting diagnoses included respiratory distress (28%), cardiopulmonary arrest (26%), neurologic insults (17%), dehydration (15%), sepsis (11%), and other (3%). Ages ranged from 3 wks to 14 yrs (mean 2.2 yrs) and weights from 2.1 to 60 kg (mean 12.3 kg). Complications were noted in seven of 58 (12%), all limited to local edema or infiltration. CONCLUSIONS: Intraosseous placement is frequently needed in the care of critically ill pediatric patients before they reach the pediatric intensive care unit. We have demonstrated that intraosseous needles can be placed safely with similar rates of success when comparing different provider groups. Emergency medical technician-paramedics, emergency medicine physicians, and pediatric critical care transport teams should be familiar with intraosseous placement.

California↗
PubMed2004

Admission and discharge guidelines for the pediatric patient requiring intermediate care.

During the past 3 decades, the specialty of pediatric critical care medicine has grown rapidly, leading to a number of pediatric intensive care units opening across the country. Many patients who are admitted to the hospital require a higher level of care than routine inpatient general pediatric care, yet not to the degree of intensity of pediatric critical care; therefore, an intermediate care level has been developed in institutions providing multidisciplinary subspecialty pediatric care. These patients may require frequent monitoring of vital signs and nursing interventions, but usually they do not require invasive monitoring. The admission of the pediatric intermediate care patient is guided by physiologic parameters depending on the respective organ system involved relative to an institution's resources and capacity to care for a patient in a general care environment. This report provides admission and discharge guidelines for intermediate pediatric care. Intermediate care promotes greater flexibility in patient triage and provides a cost-effective alternative to admission to a pediatric intensive care unit. This level of care may enhance the efficiency of care and make health care more affordable for patients receiving intermediate care.

Child↗
PubMed2004

Screening for domestic violence in a general pediatric clinic: be prepared!

OBJECTIVES: Exposure to violence, particularly domestic violence (DV), negatively affects children's physical, emotional, and cognitive well-being. The American Academy of Pediatrics recommends routine DV screening of female caretakers of pediatric patients. Few reports of screening in pediatric practices exist, and none have reported outcomes from a resident-run urban academic center. We set out to determine whether the use of the Partner Violence Screen (PVS) increases detection of DV and to test the mechanics of implementing large-scale DV screening in a busy, pediatric residency training clinic. METHODS: Using the PVS, we screened a sample of consecutive female caretakers/guardians of children seen for pediatric care in the general pediatric clinic of Children's Hospital of Michigan from March 1, 2002, through February 28, 2003. Positive screens obtained during the study period were compared with the number of DV referrals received by the clinic social workers from January 1, 2001, through December 31, 2001, before PVS screening began. To test the mechanics of screening, we also analyzed the number of forms returned blank or marked "no opportunity to screen" in the last 8 months of the study period. RESULTS: In the 12 months before use of the PVS, our social work department received 9 referrals because of DV from the general pediatric clinic, among a total of 5446 caretakers/guardians bringing 6380 children for a total of 13,576 patient care visits. In contrast, the social work department received 164 referrals because of positive screening results among 5445 caretakers/guardians bringing 7429 children for 17,346 patient care visits in the 12-month study period after introduction of the PVS. Fourteen of 164 positive PVSs were found to involve nondomestic violence perpetrated by nonpartners or violence with the patient as the victim, not the mother or female caretaker. A total of 150 PVSs involved true DV. The difference in identification of DV with the PVS, compared with the rate before its introduction, was highly significant. The positive predictive value for the PVS was 91.5%, and the identified prevalence rate was 3.7%. In the last 8 months of the study period, 6301 of 8055 PVS forms (78%) were completed; 1754 of 8055 PVS forms (22%) were left blank, but it was not possible to determine whether these represented duplicate screening forms for instances in which the mother or female caretaker had brought >1 child for care. CONCLUSIONS: Formal screening for DV with the PVS in this study setting of a busy, urban, academic, general pediatric clinic appeared to be very successful, in terms of increasing referrals and documentation of previously unrecognized DV situations. This increase signals the need for resources (time and/or social work services) to provide appropriate referral services. The PVS identifies nonpartner violence occasionally.

Caregivers↗
PubMed2005

Strategies for improving pediatric services in Japan.

The shortage of pediatricians and emergency medical care for children is an issue of great concern in Japan. This study attempts to identify the problems in children's medical care and their causes. With multiple secondary data sources, we found that over 80% of outpatient pediatric services were provided by clinics, that over 95% of clinics were closed on holidays, Sunday, and Saturday night, that among the children's illnesses respiratory ailments were dominant and were generally acute and required immediate treatment or consultation, and that the revenue rates from providing services for children were lower than those for adults. That fewer clinics are open on Saturday night, Sunday and holidays, and workday evenings may be the main reason why it is difficult for children to find pediatric services outside of normal working hours. Lower revenue rates may be one of the key reasons why the number and rate of clinics and hospitals providing pediatric services continue to decline, and fewer physicians are willing to provide services for children. The findings in this research would provide important information of multiple dimensions for the governments to make efforts to improve pediatric services in Japan. Our proposition is to prompt pediatric specialists and internists who can treat pediatric cases in clinics to provide pediatric service systematically and alternatively at night, and to adjust the fee-for-service scales of pediatric services.

Adolescent↗
PubMed2006

Pediatric surgical pathology: pitfalls and strategies for error prevention.

CONTEXT: Few data exist regarding quality measures for pediatric surgical pathology, types of errors, or how error-prone situations and diagnostic pitfalls can be minimized. OBJECTIVE: This review reports on survey findings regarding methodology for quality assurance and error detection measurement and classification in pediatric surgical pathology. It presents information regarding, and quality aspects of, intraoperative consultations in pediatric surgical pathology. General strategies for identifying diagnostic pitfalls in pediatric surgical pathology are briefly discussed. DATA SOURCES: A survey of children's hospitals based on a survey created by the Association of Directors of Anatomic and Surgical Pathology, literature review, and institutional quality assurance records provided information for this review. CONCLUSIONS: Approaches to quality assurance and error reduction in pediatric surgical pathology are similar to those used in general surgical pathology. The children's hospitals that were surveyed used a variety of standard quality assurance measures. Because of differences in data collection, classification, and reporting, it is not possible to provide a detailed analysis of the types of diagnostic error across institutions at this time. Intraoperative consultations are a potential source of error. Pediatric neoplasms and Hirschsprung disease account for the majority of intraoperative consultations in the pediatric setting. Further considerations include the unique aspects of pediatric medical and neoplastic disorders and special diagnostic criteria, classification, grading, and staging requirements.

Adolescent↗
PubMed1992

Job stress and burnout in acute and nonacute pediatric nurses.

OBJECTIVE: To identify predictors of burnout in pediatric nurses and to compare the incidence of burnout, job stress, anxiety and perceived social support in acute and nonacute care pediatric nurses. DESIGN: Prospective correlational-descriptive methodology was used to predict high, moderate or low burnout from length of work experience, perceived work stress and social support and anxiety. SUBJECTS AND SETTING: Registered nurses (n = 121) employed full-time in neonatal and pediatric intensive care units and pediatric intermediate care units. MEASUREMENTS AND RESULTS: Measures of job stress, anxiety, experience, social support and burnout were compared in acute and nonacute care pediatric nurses. The overall mean incidence of burnout was in a moderate range for both acute and nonacute care pediatric nurses for the emotional exhaustion and depersonalization subscales and in the high range of personal accomplishment subscales of the Maslach Burnout Inventory. Analysis of variance revealed no differences between groups. However, when nurses were grouped by high, moderate and low burnout scores, chi-square analysis revealed significant differences. More acute care nurses reported high burnout and more nonacute care nurses reported low burnout. Discriminant function analysis revealed that job stress was the strongest significant predictor of burnout, followed by state anxiety, coworker support, trait anxiety and experience on the unit. CONCLUSIONS: Even though high burnout levels are more frequent in acute care pediatric nurses, burnout is a problem in both acute and nonacute care pediatric nurses. The pattern of results suggests that efforts directed toward reducing anxiety and job stress and increasing coworker support, particularly for less experienced nurses, might reduce burnout.

Adult↗
PubMed1992

Spectrum and frequency of pediatric illness presenting to a general community hospital emergency department.

Knowledge of the range of pediatric illness presenting to a general emergency department (ED) is needed to optimize the quality of care delivered there. It was hypothesized that the pediatric population treated at a general ED exhibited a broad range of medical complaints, while differing significantly from children seen in a pediatric ED. General ED records from 1 week each season were reviewed, and patient age, chief complaint, diagnosis, time of arrival, season, and disposition were recorded. Data on 874 patients were analyzed and compared with pediatric ED data. General ED patient age affected chief complaint, diagnosis, and admission rate (9.5% less than or equal to 1 year admitted vs 2.6% greater than 1 year, P less than .001). General ED patients were older (7.9 vs 6.0 years, P less than .001) and admitted less frequently (3.8% vs 11%, P less than .001). Admission rates varied by arrival time only at the general ED, where minor trauma was more common (41% vs 22%, P less than .001). It is concluded that a wide range of pediatric illness is treated in a general ED, supporting the decision to have pediatric emergency physicians on staff, and that significant differences exist in the spectrum and frequency of pediatric illness seen in a general ED and pediatric ED.

Adolescent↗
PubMed1999

Trends in clinical education of medical students: implications for pediatrics.

OBJECTIVES: To describe current educational imperatives and trends for curricular changes in the clinical education of medical students and to delineate the nature and extent of participation in these curricular trends by departments of pediatrics. METHODS: Site visits to 26 representative US medical schools and a review of detailed information from 12 additional schools. Evaluation of the core curriculum was developed by the Council on Medical Student Education in Pediatrics within the context of the major curricular trends observed. RESULTS: The major observed curricular trends emphasized community-based ambulatory experiences, continuity of care, integration, and population-based experiences. Supporting educational principles included student-directed learning and performance-based assessments. The 3 major curricular changes were early clinical experiences (longitudinal preceptorships), community-oriented/ population-based experiences, and multispecialty clerkships. The focus of the Council on Medical Student Education in Pediatrics objectives was the year 3 clerkship, and substantive participation by pediatric faculty in the overall curriculum was primarily related to the pediatric clerkship. CONCLUSIONS: Revising the clerkship-based Council on Medical Student Education in Pediatrics guidelines according to the new educational trends will extend clinical curricular opportunities for pediatrics beyond the traditional boundaries of the clerkship. The discipline of pediatrics will, as a consequence, be able to achieve enhanced partnership in the planning, conduct, and evaluation of a clinical curriculum for medical students that is relevant to child health issues and that extends across all 4 years.

Ambulatory Care↗
PubMed1999

A pediatric clinical skills assessment using children as standardized patients.

OBJECTIVES: To develop and implement a pediatric clinical skills assessment (PCSA) for residents, using children as standardized patients (SPs); to assess the psychometric adequacy of the PCSA and use it to evaluate the performance of residents; and to evaluate the feasibility of using child SPs and the response of the residents and the child SPs to participation in the PCSA. METHODS: Ten 22-minute complete patient encounters were developed, 7 with child SPs. Fifty-six residents (10 second-year pediatric residents, 29 first-year pediatric residents, and 17 first-year family practice residents) were evaluated on the following clinical skills: history taking, physical examination, interpersonal skills, and documentation and interpretation of clinical data/patient note. MAIN OUTCOME MEASURES: Patient encounter checklists, focus groups, and questionnaires. RESULTS: Average skill scores for the 56 residents were 68% (SD, 12%) for history taking, 56% (SD, 26%) for physical examination, 46% (SD, 12%) for patient note, and 68% (SD, 16%) for interpersonal skills. Second-year pediatric residents scored significantly higher on history taking than first-year pediatric and first-year family practice residents; first-year pediatric residents scored significantly higher on interpersonal skills than second-year pediatric and first-year family practice residents; and first- and second-year pediatric residents scored significantly higher on the patient note component than first-year family practice residents. All differences noted were significant at P<.05. There were no significant differences on physical examination between the groups. Reliabilities were 0.69 for history taking, 0.64 for physical examination, 0.76 for interpersonal skills, and 0.81 for the patient note component. On a Likert scale (5 indicates high; 1, low), residents rated the PCSA 3.9 for realism, 4.1 for challenge, 3.1 for enjoyment, and 2.9 for fairness. Child SPs found the experience positive. No negative effects on the children were identified by their real parents or their SP parents. CONCLUSIONS: Our development method gives content validity to our PCSA, and resident scores give indication of PCSA construct validity. Reliabilities are in the acceptable range. Residents found the PCSA challenging and realistic but less than enjoyable and fair. Use of child SPs is feasible. Resident performance scores were low relative to the performance criteria of the PCSA development group. The adequacy of clinical skills teaching and assessment in residency programs needs to be reviewed. Deficits in specific skills and overall performance of residents identified by a PCSA could be used to guide individual remediation and curricular change.

Adolescent↗
PubMed2000

Pediatric resident and faculty knowledge of the Denver II.

OBJECTIVE: To assess knowledge of the Denver II, the revised developmental screening tool recommended by the American Academy of Pediatrics, in residents and faculty, and to evaluate a teaching intervention for incoming postgraduate year 1 (PGY-1) trainees. DESIGN: A cross-sectional test of knowledge for all subjects and pretesting and posttesting of the incoming PGY- 1 trainees. SETTING: University of Texas-Houston Medical School Department of Pediatrics. PARTICIPANTS: Faculty (n = 9) and residents (n = 78), including an intervention group (n = 45), of incoming PGY-1 trainees over 2 years. INTERVENTIONS: Postgraduate year 1 trainees in both 1994 through 1995 and 1995 through 1996 viewed the Denver II training videotape on entry into a continuity clinic. Trainees were encouraged to perform Denver II evaluations on at least 1 appropriate patient at each pediatric clinic session and had access to Denver II support materials. MAIN OUTCOME MEASURES: Scores on the Denver II Proficiency Written Test, self-reported measures of comfort, and number of Denver II evaluations performed. RESULTS: The mean (SD) test scores for incoming, preintervention PGY-1 trainees (n = 45) (41.3 [9.6]) did not differ from scores for outgoing PGY-1 trainees (n = 13) (38.5 [10.4]) who had not received the intervention. Postintervention PGY-1 test results were significantly improved (59.4 [10.6]) (P<.001). Test scores for upper-level residents who had participated in the developmental pediatrics rotation (n = 14) were better (55.3 [9.31), but all scored below passing. Residents who had not yet participated in the developmental pediatrics rotation (n = 19) and members of the general pediatric faculty (n = 9) had scores similar to those of PGY-1 trainees (40.9 [13.4] and 39.0 [15.1], respectively). CONCLUSIONS: Residents had a greater knowledge of the Denver II after completing a developmental pediatrics rotation. Our intervention produced significant improvement in PGY-1 trainees' knowledge, raising it to levels similar to those of upper-level residents exposed to developmental pediatrics. Faculty were not expert in using the Denver II.

Child↗
PubMed2001

Third-year medical student survey of office preceptorships during the pediatric clerkship.

OBJECTIVE: To assess medical students' interest in a career in pediatrics following their categorical pediatric clerkship. DESIGN: Satisfaction questionnaire to 704 third-year clerks in 5 university medical schools following the pediatric clerkship. METHODS: Analysis of the influence of the community office-based experience compared with the inpatient experience, and examination aspects of the office preceptorship most valued by the medical students. MAIN OUTCOME MEASURE: Satisfaction questionnaire addressing office-based experiences. RESULTS: Third-year pediatric clerks report that the private office setting provides a valuable learning experience, particularly when there is exposure to a wide spectrum of disease and when the preceptor had time to teach. Feelings about pediatrics as career choice rose during the clerkship from neutral to positive, and the frequency of strongly positive feelings rose from 9.2% to 28.6%. In deciding about pediatrics as a career, experiences with patients and residents in the inpatient setting still seem to count more than those experiences in the outpatient setting. CONCLUSION: Categorical pediatric clerkships provide learning environments that influence students positively toward pediatrics as a career choice. This choice is enhanced by encouraging community practitioners with students in their office to expose them to a wide variety of issues and devote time to teaching.

Career Choice↗
PubMed2003

Effect of an intervention standardization system on pediatric dosing and equipment size determination: a crossover trial involving simulated resuscitation events.

BACKGROUND: Pediatric medication dosing has been recognized as a high-error activity with the potential to cause serious harm. Few studies assess systems approaches to error reduction in pediatrics. OBJECTIVE: To estimate the decrease in deviation from recommended medication doses associated with use of a pediatric intervention standardization system in the acute setting. DESIGN: Two-period, 2-treatment crossover trial with data collected between December 1, 1999, and February 29, 2000. SETTING: Tertiary, academic medical center. PARTICIPANTS: Convenience sample of 28 resident physicians, representing 69% of pediatrics and 50% of medicine-pediatrics residents. INTERVENTION: Each resident participated in 4 simulated pediatric resuscitations. The Broselow Pediatric Emergency Tape and color-coded materials were available in either the first or second 2 scenarios. Traditional dosing references were available in all scenarios. MAIN OUTCOME MEASURE: Median difference between deviation from recommended dose range (DRDR) in scenarios where color coding was used (intervention) and DRDR in scenarios where color coding was not available (control). RESULTS: Median DRDR in intervention scenarios was 25.4% lower than in control scenarios (95% confidence interval [CI], 19.1%-32.5%; P<.001). In 4 medication prescriptions in intervention scenarios and in 54 prescriptions in control scenarios, DRDRs exceeded 100%. Median deviation from recommended equipment sizes in intervention scenarios was 0.12 size lower than in control scenarios (95% CI, 0.03-0.22 size; P<.001). Deviations in equipment size of 2 or more sizes were noted in 1 size determination in intervention scenarios and in 21 size determinations in control scenarios. CONCLUSIONS: Color coding was associated with a significant reduction in deviation from recommended doses in simulated pediatric emergencies. Numerous potentially clinically significant deviations from recommended doses and equipment sizes were avoided. Future studies should measure impact in the real clinical setting.

Academic Medical Centers↗