Articles: pediatrics.
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Randomized Controlled Trial Clinical Trial
Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit.
High incidence, rising admission rates, and relatively ineffective therapies make the management of bronchiolitis controversial. Since 1980, the rate of hospitalization for children with bronchiolitis has increased by nearly 250%, whereas mortality rates for the disease have remained constant. It has been speculated that the increasing use of pulse oximetry has lowered the threshold for admission and may have contributed to the rise in bronchiolitis-related admissions. The objective of this study was to describe pediatric emergency medicine physicians' management preferences regarding infants with moderately severe bronchiolitis and to assess the influence of specific differences in oxygen saturation as measured by pulse oximetry (SpO2) and respiratory rate (RR) on the decision to admit. ⋯ When treating infants with moderately severe bronchiolitis, pediatricians who work in emergency departments frequently use bronchodilators and nasal suction, 2 practices for which supporting data are either conflicting (bronchodilators) or nonexistent (nasal suction). In addition, their decisions to admit differ markedly on the basis of only a 2% difference in SpO2. It is possible that increased reliance on pulse oximetry has contributed to the increase in bronchiolitis hospitalization rates seen during the past 2 decades.
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Pediatr Crit Care Me · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialInterpretation of digital radiographs by pediatric critical care physicians using Web-based bedside personal computers versus diagnostic workstations.
To determine whether the interpretations of digital radiographs by pediatric critical care physicians displayed on the bedside personal computer differ from the interpretations of images displayed on the diagnostic workstation. ⋯ With the exception of diffuse chest abnormalities, pediatric critical care physicians can use the Web-based bedside personal computer for clinical decision-making with the confidence that the decisions will be similar to those made on the diagnostic workstation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Caller satisfaction with after-hours telephone advice: nurse advice service versus on-call pediatricians.
To compare caller satisfaction with after-hours medical advice provided by a for-profit nurse advice service with advice provided by on-call pediatricians. ⋯ Callers were less satisfied with medical advice provided by a nurse advice service compared with the traditional on-call pediatrician. The lower satisfaction was associated with somewhat poorer compliance with recommended triage dispositions and more frequent repeat calls for medical advice.
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Randomized Controlled Trial Clinical Trial
Watch needle, watch TV: Audiovisual distraction in preschool immunization.
To evaluate the effectiveness of audiovisual distraction compared with a blank TV screen in the reduction of pain associated with intramuscular immunization. ⋯ Watching cartoons did not distract children during needle injection nor reduce their pain. Looking at the TV screen was related to lower behavioral pain scores in the total sample.
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Arch Pediat Adol Med · Jan 2002
Randomized Controlled Trial Clinical TrialEffects of improved access to safety counseling, products, and home visits on parents' safety practices: results of a randomized trial.
To present the results of an intervention trial to enhance parents' home-safety practices through pediatric safety counseling, home visits, and an on-site children's safety center where parents receive personalized education and can purchase reduced-cost products. ⋯ Home visiting was not effective in improving parents' safety practices. Counseling coupled with convenient access to reduced-cost products appears to be an effective strategy for promoting children's home safety.