Current problems in pediatric and adolescent health care
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Curr Probl Pediatr Adolesc Health Care · Oct 2013
ReviewEducational strategies for improving clinical reasoning.
Clinical reasoning serves as a crucial skill for all physicians regardless of their area of expertise. Helping trainees develop effective and appropriate clinical reasoning abilities is a central aim of medical education. Teaching clinical reasoning however can be a very difficult challenge for practicing physicians. ⋯ Experimentation with different strategies for improving clinical reasoning can help address learner struggles in each of these domains. In this chapter, various strategies for improving reasoning related to knowledge acquisition, data gathering, data processing, and clinician metacognition will be discussed. Understanding and gaining experience using the different educational strategies will provide practicing physicians with a toolbox of techniques for helping learners improve their reasoning abilities.
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Diagnostic errors are the most common errors in primary care. Diagnostic errors have been found to be the leading cause of malpractice litigation, accounting for twice as many claims and settled cases as medication errors. Diagnostic error is common, harmful, costly, and very critical to the patient-safety issues in health care. ⋯ This may include any failure in timely access to care; elicitation or interpretation of symptoms, signs, or laboratory results, formulation and weighing of differential diagnosis; and timely follow-up and specialty referral or evaluation. The literature reveals that diagnostic errors are often caused by the combination of cognitive errors and system failure. Increased understanding about diagnostic decision making, sources of errors, and applying some existing strategies into clinical practice would help clinicians reduce these types of errors and encourage more optimal diagnostic processes.
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Curr Probl Pediatr Adolesc Health Care · Oct 2013
ReviewSystem-related factors contributing to diagnostic errors.
Several studies in primary care, internal medicine, and emergency departments show that rates of errors in test requests and result interpretations are unacceptably high and translate into missed, delayed, or erroneous diagnoses. Ineffective follow-up of diagnostic test results could lead to patient harm if appropriate therapeutic interventions are not delivered in a timely manner. The frequency of system-related factors that contribute directly to diagnostic errors depends on the types and sources of errors involved. ⋯ Patients can participate in the effort to reduce diagnostic errors. Providers should educate their patients about diagnostic probabilities and uncertainties. The patient-safety strategies focusing on the interface between diagnostic system and therapeutic intervention are strategies that involve both processes to facilitate appropriate follow-up and structural changes, such as the use of electronic tracking systems and patient navigation programs.
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Curr Probl Pediatr Adolesc Health Care · Sep 2012
ReviewNail disorders as signs of pediatric systemic disease.
Herein, we describe some of the more common changes in the nail unit that can be seen in systemic diseases in children. Changes that can be seen are not limited to those discussed in the following pages. ⋯ When evaluating a pediatric patient with a nail disorder, it is important to perform a complete physical examination of the skin and oral mucosa, as other clues to the diagnosis of the nail problem may be found. A comprehensive family history is also important to uncover possible syndromic associations with nail disease or diseases that can manifest with nail changes.
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Curr Probl Pediatr Adolesc Health Care · May 2012
Review Historical ArticlePediatric hospital medicine: historical perspectives, inspired future.
Pediatric hospital medicine (PHM) is in an accelerated growth phase. Multiple elements have combined to affect the current state of the field. PHM is similar to other geographic specialties such as pediatric emergency medicine and pediatric critical care that deliver general, comprehensive care to patients based on hospital site. ⋯ Further decisions regarding scope and demonstration of competencies are important to make with clarity of purpose. Pediatric hospitalists are advancing child health in the inpatient setting through evidence-based care, research, education, clinical excellence, advocacy, and health care business acumen. With a strong community sense and leadership evident, PHM has a bright future.