摘要:

Pneumonia is a common serious illness in children with acute episodes of fever and in children with more prolonged episodes of fever, termed fevers of unknown origin. Recent studies have demonstrated that the clinical evaluation, including observation, history, and the physical examination, is highly sensitive in identifying children with acute episodes of fever who have pneumonia. The sensitivity of the clinical evaluation for pneumonia has been demonstrated for febrile infants younger than 90 days of age as well as older children. In children with fever of unknown origin, the chest roentgenogram is considered part of the diagnostic evaluation, but further research may define specific indications for its use based on observation, history, and physical examination.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Guidelines at an increasingly prominent part of the practice of pediatrics. Ai' ing from studies of variability in care, they are widely used as a mechanism to assess and improve quality. Rigorous methods of guideline development differentiate current guidelines from past consensus efforts. The American Academy of Pediatrics has been active in developing and publishing guidelines for common problems, including asthma, hyperbilirubinemia, febrile seizures, gastroenteritis, and, together with the Agency for Health Care Policy and Research and others, otitis media with effusion. Although strategies for how to use guidelines to improve care are increasingly well designed, whether these guidelines will indeed change practice or improve outcomes has yet to be determined.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

There is an increasing focus on the recognition, assessment, and management of pain in children. Children undergo many painful procedures in different clinical environments and are frequently undertreated for their pain. The pediatrician should be familiar with general concepts about the perception of pain in children. Many pain-assessment tools have been developed and restructured to provide the clinician with valid and reliable scales to assess pain in children and assess the effect of interventions. New pharmacologic agents for conscious sedation are being used with increasing frequency in the pediatric outpatient setting for reducing pain and anxiety. Also there has been increasing use of regional anesthetic techniques for procedures once requiring general anesthesia. There has been an increase in the development of topical anesthetics as well as modifying injectable local anesthetic to decrease the pain of local infiltration. Nonpharmacologic methods of pain management are being tested, developed, and used alone or as adjuncts to pharmacologic therapy for children undergoing painful procedures. It is imperative that clinicians keep themselves informed about new advances pertaining to pain treatment and incorporate them into their practices.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Adolescents continue to engage in sexual behaviors that place them at risk for sexually transmitted diseases, including HIV, and pregnancy. Recent advances in the prevention and management of sexually transmitted diseases and pregnancy may eventually lead to fewer negative consequences associated with adolescent sexual behavior. This paper discusses scientific and technologic advances in the management of adolescent sexual behavior such as the use of DNA amplification tests to detect genital chlamydial infection and the new female-controlled contraceptives.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Now that there is widespread acceptance of glucocorticoids for inpatient treatment of croup, the focus of research has shifted to the effectiveness of glucocorticoids for outpatients with croup. Recent evidence from randomized controlled trials has shown that nebulized budesonide causes an acute improvement in croup symptoms, shortens stay in the emergency department, and significantly reduces admission rate. Intramuscular or oral dexamethasone also result in acute clinical improvement in patients with croup, and oral dexamethasone reduces the length of stay in an emergency department observation unit. There is accumulating evidence that patients receiving epinephrine do not necessarily require hospitalization but when treated simultaneously with dexamethasone may be safely discharged to home after a 3-hour observation period. Future trials in outpatients with croup need to determine the optimal dosing of oral dexamethasone, the utility of epinephrine therapy alone or in combination with glucocorticoids, and the optimal glucocorticoid regimen (budesonide, dexamethasone, or budesonide and dexamethasone).

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Children, particularly adolescents, have unique health care needs and experience frequent barriers to receiving needed medical care. The expansion of school-based health services since the early 1970s is one recent development in the area of health services delivery that is a specific response to facilitate meeting the medical needs of youth. Limited resources, shrinking budgets, demographic and behavioral changes among our nation's youth, and recent trends toward managed care all demand innovative strategies by school-based health services if they are to ensure their viability in providing adequate health care to children and adolescents. This article reviews the recently published literature regarding the role of school-based health centers as sites providing primary care services to children and adolescents. In addition, it addresses recent efforts to develop strategies that school-based health centers may need to consider in order to adapt and survive within the environment of health care reform and managed care.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Parents as well as health care workers continue to ascribe a multitude of gastrointestinal symptoms to increased intestinal gas. Much folklore has developed concerning the causes of intestinal gas, and the pharmaceutical and infant formula industries have attempted to develop products to address a consumer-perceived need for products to reduce gas. This article summarizes the pathophysiology of intestinal gas production and provides an overview of well-accepted clinical manifestations of this volatile problem.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The ingestion of food is frequently associated with specific adverse gastrointestinal symptoms, including emesis, diarrhea, abdominal cramping, and gastrointestinal bleeding. This brief review discusses a variety of food-induced gastrointestinal diseases and will highlight the recent information pertaining to the pathophysiology, clinical presentation, diagnostic approach, and treatment of these disorders. Reactions resulting from immediate hypersensitivity and cell-mediated processes will be reviewed in detail, as well as other proposed pathophysiologic mechanisms. The clinical presentation and diagnostic approach to several food-induced gastrointestinal diseases will be individually examined. In addition, the treatment, especially the proper use of nutritionally balanced restriction diets and hypoallergenic formulas, will be discussed.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Parenteral nutrition is an expensive therapy that is often necessary in certain situations, such as short-bowel syndrome. In many other conditions, its efficacy remains controversial. Providing optimal parenteral nutrition can be particularly challenging in premature infants while managing metabolic and catheter complications. Use of special nutrients, glutamine, and growth hormone may have benefits in the nutritional management of premature infants and trauma patients. Metabolic complications of parenteral nutrition such as cholestasis might be reduced by early enteral feedings, ursodeoxycholic acid, and cholecystokinin-octapeptide. Traceelement deficiencies may still occur, and thus patients must be monitored carefully. Methods that have been used to prevent or reduce catheter occlusion or infection include heparin, oral anticoagulants, antibiotics, and thrombolytic agents such as urokinase and tissue plasminogen activator.

ISSN:1040-8703    

出版商:OVID    

年代:1996

数据来源: OVID