ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Pediatric training programs have recently witnessed a renewed emphasis on community-based experiences. This change can be attributed partly to the need for a more appropriate foundation for careers in general pediatrics and partly to a call for more generalist physicians as a result of health care reform. Community experiences provide optimal sites for residents to learn community-based primary care, practice management, collaboration with patient care teams, and advocacy on behalf of children's issues. The literature of the past year has focused on the theoretical issues, curricular components, and practical demands of implementing such experiences.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A reduced hospital length of stay for normal newborns has become common, largely in an attempt to reduce hospital costs. Although evidence in the literature suggests that this is a safe practice, the overall quality of the studies is weak, and controversy exists regarding the advisability of this practice. A review of the rather modest literature and experience with shortened hospital stays lead us to conclude that early discharge of newborns is safe if it is but one component of a larger program designed to transfer portions of care traditionally provided in the hospital to pre- and postnatal care provided outside the hospital. The early discharge program developed at the Harvard Community Health Plan is presented as an example of such a program, with the hope that this model will provide a useful framework to those who are involved with shortened hospital maternity lengths of stay.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

As the number of children affected by the HIV epidemic increases, the primary care physician can have an important role in ensuring that these children receive comprehensive health care. Clinical aspects of pediatric HIV disease are reviewed, including the recently revised Centers for Disease Control and Prevention classification system. Important advances include the development and application of techniques for establishing in early infancy whether or not a child is infected. The implications for the use of these techniques are discussed, and recommendations are made for a system of coordinated care between the primary care physician and specialty clinic. Specific treatment approaches, such as the early introduction ofPneumocystis cariniipneumonia prophylaxis, antiretroviral medications, and the use of intravenous immunoglobulin, are discussed.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This article reviews recent publications related to the epidemiology, pathogenesis, diagnosis, and management of otitis media. Otitis media is a continuum of conditions that includes acute otitis media, otitis media with residual or persistent effusion, unresponsive otitis media, recurrent otitis media, otitis media with complications, and chronic suppurative otitis media. The pathogenic mechanisms of otitis media involve interactions among host characteristics, virulence factors of viral and bacterial pathogens, and environmental factors. Recent studies document the emergence and rapid spread of drug-resistant Streptococcus pneumoniae in acute and unresponsive otitis as well as persistent effusions and chronic suppurative otitis. Few issues in clinical medicine are as controversial as the efficacy and risks associated with antibiotic treatment of otitis media. It is best to avoid the antibiotic treatment dilemma as much as possible by not overdiagnosing otitis media.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Emergently ill or injured children may access care through their primary care provider, through prehospital emergency medical services, or directly in a hospital emergency unit. Primary health care providers and emergency care providers need to have the skills, proper equipment, and medications available to care for these children. This paper reviews recent articles on the prevention, evaluation, treatment, and outcomes of illness and injury in children, which should be of interest to primary and emergency care givers. Areas of recent research include the epidemiology, prevention, and evaluation of childhood injuries and the evaluation of infants and children with fever. Other areas reviewed are respiratory disease and the treatment of gastroenteritis. Also reviewed are articles on the role of the primary care physician in emergency medical services for children.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Portal hypertension is an uncommon but serious complication in children. The etiology may be intrahepatic or from an extrahepatic vascular occlusion. The pathophysiology is unknown, but the development of increased vascular resistance and portal flow are believed to be the primary changes. Increased portal flow is created by a decrease in systemic vascular resistance regionalized to the splanchnic vascular bed. Abnormally reduced response to vasoactive substances may be responsible. Advances in ultrasonography and endoscopy may improve our ability to evaluate portal hypertensive vascular changes. However, pharmacologic management is still limited to controlling the hemodynamic disturbances after they have occurred. Nonsurgical shunt management is increasingly being used in children, limiting the need for surgical shunt placement. Liver transplantation is now a viable option for managing end-stage disease. Future management depends on understanding the role of vasoactive substances controling portal flow velocity, subsequent development of targeted pharmacologic therapy, and application of nonsurgical shunt technology in children. Transjugular intrahepatic portosystemic shunt placement is the next technologic advance moving from the adult into the pediatric realm.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Autoimmune hepatitis is an inflammatory disease of the liver of unknown etiology that progresses toward cirrhosis and liver failure and is generally responsive to immunosuppressive treatment. The presence of anti-smooth muscle antibodies with anti-actin specificity and of anti-liver kidney microsomal antibodies defines two distinct subgroups of the disease. An autoantibody against liver cytosolic antigens has recently been described. Management of autoimmune hepatitis relies on immunosuppressive therapy with steroids alone or combined with azathioprine. When the disease is poorly controlled, despite good patient compliance to therapy, cyclosporin should be recommended. Progressive liver disease in chronic hepatitis B in adults has been associated with the presence of precore mutants of hepatitis B virus. In children, the presence of precore mutants seems not to affect the rate of seroconversion to anti-hepatitis B e antigen. However, high viremic levels of precore mutants are associated with persistent viral replication and liver disease. Interferon alfa seems to be less effective in children than in adults in the treatment of chronic hepatitis B; however, it hastens the seroconversion rate to anti-hepatitis B e antigen, accelerating the spontaneous clearance of the virus in children with already low levels of viral replication. Blood transfusions, especially those received in the perinatal period, are the single most important source of infection with hepatitis C in childhood. HIV coinfection is a major risk factor for vertical transmission of hepatitis C virus in pregnant women. Chronic hepatitis C in children is usually an asymptomatic disease associated with mild to moderate fluctuation of aminotransferase activities and histologic features of mildly active hepatitis. Severe active hepatitis and cirrhosis are infrequent during childhood and adolescence. Interferon may have a place in the treatment of chronic hepatitis C in children.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Inflammatory bowel disease remains a serious chronic illness in children. Recent developments in the care of these patients involves both basic science research into the pathophysiology of ulcerative colitis and Crohn's disease and the development of refinements in the surgical techniques and medical therapies available as treatment options. In Crohn's disease, a new steroid analogue (budesonide) shows some promise as a possible medical treatment that would limit the devastating side effects of steroids in children. In addition, the bowel-sparing technique of strictureplasty has now been reported in children with good results. In ulcerative colitis, the surgical technique of endorectal pull-through continues to evolve with reports of the efficacy of specific pouch designs and surgical techniques. An understanding of pouchitis, the most common complication of endorectal pull-through, has focused on documenting specific alterations in the microbiology and physiology of the pouch, as well as investigating a possible link between autoantibodies and susceptibility to this complication.

ISSN:1040-8703    

出版商:OVID    

年代:1995

数据来源: OVID