Pediatrics
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Training for pediatric residents who intend to pursue fellowship differs little from training for residents who intend to practice general pediatrics. It is unknown how well residents who intend to pursue subspecialty training believe that residency prepares them for subspecialty fellowships or future careers. To characterize the strengths and weaknesses of residency training and the factors influencing subspecialty choice from the perspective of subspecialty fellows, we conducted a survey of current fellows on these issues. ⋯ The finding that a large proportion of fellows would opt for shortened subspecialty training should prompt discussion and debate within the profession regarding the skills necessary for a pediatric subspecialist. Patient safety, physician-parent communication, and care coordination are emphasized primarily through informal training during residency. Although most clinicians believe themselves to be adequately prepared, research has identified gaps in clinician skills and understanding of these issues of great importance to patients and their families.
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To review the use of inhaled corticosteroids on asthma control in children by using the new therapeutic paradigm outlined in the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. ⋯ Treatment with inhaled corticosteroids improves the asthma-control domains of impairment and risk in children. Differences in study protocols make detailed comparisons difficult. Specific needs for additional trials include (1) more studies using appropriate indicators for impairment (eg, rescue-medication use; symptoms scores; asthma/episode-free days) and risk (eg, forced expiratory volume in 1 second in children who can perform spirometry; exacerbations requiring oral corticosteroids; urgent care usage) and (2) more studies evaluating adolescents; the majority of the data reported were for children up to the age of 12 years, and data for adolescents are often lost (either grouped with adults [eg, studies in patients > or =12 years old] or not included [eg, studies of school-aged children < or =12 years old]). Attention should be given to standardizing variables that will permit comparison of outcomes between trials.
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Randomized Controlled Trial Multicenter Study Comparative Study
A pilot randomized, controlled trial of later treatment with a peptide-containing, synthetic surfactant for the prevention of bronchopulmonary dysplasia.
Oxidant injury and lung inflammation in extremely premature infants are associated with the development of bronchopulmonary dysplasia. Surfactant dysfunction resulting from these events may contribute to the pathogenesis of bronchopulmonary dysplasia. Treatment with exogenous surfactant may decrease the incidence or severity of bronchopulmonary dysplasia. We conducted a masked, multicenter, multinational, randomized, controlled, pilot study to estimate the effects of treating infants at high risk for developing bronchopulmonary dysplasia with lucinactant, a synthetic, peptide-containing surfactant, on safety during dosing and the incidence of death or bronchopulmonary dysplasia. ⋯ There were trends toward lower oxygen requirements and toward a lower incidence of mortality or bronchopulmonary dysplasia at 36 weeks' postmenstrual age in infants who received the higher dose of lucinactant, and this warrants further investigation.