ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1987.tb02182.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1987.tb02183.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1987.tb02184.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractSurveillance of clinical research involving child subjects, or tissues taken from them, continues to become more formalized and sophisticated. Many doctors and most paediatricians can be expected to be offered the opportunity to serve on paediatric Institutional Ethics Committees (IEC) at some stage of their professional lives. Fearless and independent Ethics Committees have considerable influence on both the design and implementation of clinical research, and on the topics of allowable research in which infants and children will be involved. The composition of lECs generally is designed to give a balance of sexes, professional backgrounds, and institutional and non‐institutional affiliations. In addition to these now well established compositional guidelines, lECs adjudicating on paediatric research have a pragmatic requirement for three extra specific roles: those ofin loco parentis, in loco infanti, and the special role of nursing staff. These roles and the ethical basis for them are defined. Further, thein locoparentis role is ethically complex, and an IEC considering this role should be clear about its implications. Paediatric research projects involve not only specific risks inherent to the project in question, but also more general risks inherent in any clinical research intervention endeavour itself. Paediatric lECs should act in a mode of encouragement, rather than purely as ‘doctor watchers’, and should insistab initioon the publication of results as a condition of permission to undertake the research in question. One particularly effective form of ethical audit is the national and international peer review that follows such publication of paediatric research. This report discusses these special themes in the evolving context of greater surveillance of paediatric res

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1987.tb02185.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractSurvival and disability rates of extremely low birthweight infants have significantly improved. Since it is impossible to give an accurate prognosis at the time of birth, all such live births should be resuscitated and curative treatment, including the use of life support measures when appropriate, promptly initiated. In the event that medical facts indicate curative efforts are futile or lack compensating benefit, they should be discontinued and palliative treatment, which provides symptomatic relief and comfort, should be introduced. The attending neonatologist has the primary role as advocate for the infant and medical advisor to the parents, while the parents act as surrogates for their infant. The shift in emphasis from curative to palliative treatment requires medical consensus among all those involved in the care of the infant and consent from the parents closely involved in this widely shared decision. The role of infant bioethics committees is one of advisor and consultant to this decision‐making process. Legislation needs to uphold the primary prejudice in favour of life white conceding that discontinuation of curative treatment, which is no longer effective, and the provision of palliative treatment, are appropriate medical decisions in exceptional case

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1987.tb02186.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractAn attempt was made to review the diagnostic or problem‐solving skills of a group of four students as they interviewed children and their parents, who presented with common paediatric problems. The students were instructed to complete a pro forma stating the most likely diagnosis with their reasons; their answers to be given as the interview proceeded and after completion of the patient encounter. The students entertained up to six diagnoses and despite considering the correct diagnosis early in the interview, often arrived at an incorrect final diagnosis. Some improvement was noted in the students' performance when the exercise was repeated at the end of their 10 week paediatric term. The students tended to follow a disengaged enquiry, in part related to an inadequate knowledge base. By way of comparison, four consultants were put through the same exercise and arrived at the correct diagnosis after considering only one or two diagnoses.The students were also asked how they considered they had acquired those skills. As part of their answers, all included “formal learning”. The majority also suggested the observation of a suitable clinical model. When the consultants were asked the same questions all included “independent learning”. All subjects came from traditional medical schools.The relevance of these findings is discussed in terms of patient management and the teaching of problem‐solving skills to undergraduate and postgradua

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1987.tb02187.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractA method of clinical audit was devised to document paediatric morbidity patterns at the Prince of Wales Hospital, a new 1428 bed general hospital serving the eastern part of the Hong Kong New Territories (with a current population of about 750 000). The applicability of the method is illustrated by considering morbidity in 1654 children aged from 1 month to 12 years admitted to the hospital over a 13 month period in 1984–8

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1987.tb02188.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractTwo children with leukaemia are described who successfully underwent oversewing of perforated duodenal ulcers which probably were secondary to immunosuppression and steroid therapy. This is only the second report of ulceration in childhood leukaemia. Stress ulceration in children responds favourably to conservative surgery and removal of the insult. Ulcer prophylaxis with antacids or Cimetidine Should be initiated in patients being subjected to combined immunosuppression and high‐dose steroids, particularly during bone marrow transplantatio

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1987.tb02189.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractOne hundred and eleven children with recurrent abdominal pain were studied to determine the clinical features in a group of unselected children presenting in a general paediatric practice. Organic disease was found in four children and was easy to recognize. There were characteristic clinical features in children with no apparent organic cause for pain which suggest that detailed investigations are inappropriate. A simple psychosomatic approach showed an immediate and sustained improvement in symptoms in 70% of children studied.

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1987.tb02190.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

AbstractThe study investigated the prevalence of emotional and behavioural problems in children with recurrent abdominal pain (RAP), the sensitivity of RAP children to a painful stimulus, and the attitudes shown by RAP mothers to issues of health and illness. Three groups of children were compared including two groups with RAP, one in which an organic cause for the pain was found, and one where no organic cause was identified. The third group consisted of pain‐free children from the general community. No consistent patterns of differences was identified between the groups on the measures used. Possible reasons for the findings are discussed and recommendations made for further research in this are

ISSN:1034-4810    

DOI:10.1111/j.1440-1754.1987.tb02191.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY