Pediatrics
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Clinical Trial
Treatment of urinary tract infections among febrile young children with daily intravenous antibiotic therapy at a day treatment center.
Urinary tract infections (UTIs) are common among infants and toddlers. Children can be treated effectively with short courses (2-4 days) of intravenous (IV) therapy followed by oral therapy. If IV therapy is chosen, use of once-daily dosing may allow outpatient management instead of hospital admission. However, no description of ambulatory treatment with IV antibiotics of UTI among febrile children has been reported to date. We aimed to describe the feasibility and complications of outpatient management with IV antibiotics of UTI among febrile children, at the day treatment center (DTC) of a tertiary-care pediatric hospital. ⋯ Our data show that ambulatory treatment with IV antibiotics, at a DTC, may be used for at least three-fourths of UTIs among febrile children 3 months to 5 years of age. It is safe and feasible and appears very satisfactory to parents. Although ambulatory treatment with IV antibiotics is more invasive than oral therapy during the initiation of UTI treatment, it ensures almost full compliance, allows close medical supervision, and facilitates investigations related to the UTI. It is an interesting alternative to hospitalization.
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Key worker programs for families of children with disabilities, to promote information provision, emotional support, and liaisons among different agencies, have long been advocated but not extensively implemented. We report the impact on the experiences of parents and the practices of health care professionals of a novel, hospital-based, key worker service (Community Link Team [CLT]), implemented in the pediatric ophthalmology department of Great Ormond Street Hospital (London, United Kingdom). ⋯ Research on the needs of families of visually impaired children has been limited but indicates that, as with other childhood disabilities, the greatest needs during the critical period around diagnosis are for information, especially about educational and social services, and emotional support from professionals, informal and formal social networks, and support groups. Although not widely implemented or studied, key worker programs for families of visually impaired children, particularly in the context of multidisciplinary visual impairment teams, have been advocated, on the basis of their potential to facilitate coordination of health, educational, and social services. The model of such provision evaluated in this study reflects the fact that it was established as an outpatient service in a tertiary referral center for pediatric ophthalmology in the United Kingdom, with the specific structure and specialized roles for health care professionals that this requires. Different models might be more suitable in other settings in the United Kingdom or elsewhere. However, the important general lessons learned should guide implementation of such services for families of children with other disabilities. The recently launched National Service Framework for Children provides a new context and standards for meeting the needs of disabled children and their families in the United Kingdom and may also guide initiatives elsewhere. The findings of this study support implementation of programs for information provision, support, and liaison by key workers in all specialized centers for the assessment and diagnosis of children with serious visual problems. Implementation of similar services for families with children with other disabilities is likely to be equally valuable.
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Comparative Study
Equivalent lengths of stay of pediatric patients hospitalized in rural and nonrural hospitals.
Many children receive their care at local hospitals outside of a large urban area. There may be differences in the length of stay (LOS) between children hospitalized in rural versus urban hospitals. This study compared the differences in LOS, conditional LOS (CLOS), odds of prolonged stay, and 21-day readmission rates for children with 19 medical conditions and 9 surgical procedures admitted to rural, community, and large urban hospitals. ⋯ In their treatment of pediatric hospitalized patients, rural hospitals were not significantly different from hospitals in all geographic regions other than large urban areas. Rural hospitals appear to deliver similar care, compared with nonrural hospitals, for many of the common pediatric conditions included in this study. Additional research is needed to apply these results to other regions or states with different geographic distributions of hospitals and children, in order to determine the overall impact on the regionalization of pediatric care.
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Young smokers commonly identify themselves as "social smokers," a pattern of smoking behavior that is poorly understood. We assessed the prevalence and correlates of social smoking among US college students. ⋯ Social smoking is a distinct pattern of tobacco use that is common among college students and may represent a stage in the uptake of smoking.
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The practice of pediatric critical care medicine has matured dramatically during the past decade. These guidelines are presented to update the existing guidelines published in 1993. Pediatric critical care services are provided in level I and level II units. Within these guidelines, the scope of pediatric critical care services is discussed, including organizational and administrative structure, hospital facilities and services, personnel, drugs and equipment, quality monitoring, and training and continuing education.