Use of a seminar as an aid in helping interns care for dying children and their families

An annual seminar held by the University of Colorado, Department of Pediatrics, is designed to assist interns to cope more effectively with the emotional strains of caring for dying patients and their families. In the seminar, interns are randomly divided into four small groups consisting of six interns, a chief resident, two pediatric faculty members, and a nurse or social worker from an intensive care unit. This paper reviews the resident evaluations of the seminar, as well as the results of a questionnaire which explored attitude formation toward death. Interns felt that the opportunity to discuss death and dying early in their training program helped them gain an understanding of their own feelings about death, which enabled them to cope better with the stress involved in caring for dying children. Additional benefits from the seminar included more effective interpersonal communication, the establishment of deeper and more meaningful friendships, and a stronger esprit de corps.     

Formula feed preparation: helping reduce the risks; a systematic review.

AIMS: To assess what is known about the risks associated with errors in reconstituting the present generation of infant formula feeds, and to examine which methods are likely to be safest. METHODS: Systematic review, and examination of the range of infant formula products currently on sale in the UK. Studies from developed countries conducted after 1977 were included. All studies investigating the reconstitution of formula feeds for full term, healthy babies were eligible. Parameters studied were: measures of accuracy of feed reconstitution including fat, protein, total solids, energy content, and osmolality of feed; weight of powder in scoop; and reported method of preparing feed and measuring powder. Formula products were collected from one large UK supermarket in 2002. Number of different types of infant formula preparations available for sale were determined, together with scoop sizes for powdered preparations. RESULTS: Only five studies were identified, none of adequate quality or size. All found errors in reconstitution, with a tendency to over-concentrate feeds; under-concentration also occurred. Thirty one different formula preparations were available for sale in one UK supermarket, with a range of scoop sizes. Some preparations had never been tested. CONCLUSIONS: There is a paucity of evidence available to inform the proper use of breast milk substitutes, and a large array of different preparations for sale. Given the impact incorrect reconstitution of formula feeds can have on the health of large numbers of babies, there is an important and urgent need to examine ways of minimising the risks of feed preparation.     

Congenital hypothyroidism: increased incidence in Asian families.

Screening in the North West health region of England showed a significantly higher incidence of congenital hypothyroidism in Asian families--1/918 compared with 1/3391 in non-Asians. This could only in part be explained by consanguinity. No differences were found in birth order, season of birth, gestational age, or birth weight between normal infants and those with congenital hypothyroidism. There was a significantly higher incidence of additional congenital abnormalities (9%) and a significantly increased mortality (5%) in infants with congenital hypothyroidism compared with unaffected infants.     

Adenovirus infection in families.

Eighteen families were followed up for four to six weeks after one member of each family was diagnosed as having an adenovirus infection. In 17 of 18 index cases the diagnosis was based on the rapid detection of adenovirus hexon antigen in the nasopharyngeal mucus specimens and in one case (the only adult index case) on isolation of the virus. All index cases had high temperatures associated most commonly with tonsillitis, acute otitis media, gastroenteritis, or febrile convulsions. In 14 of the 16 families with symptomatic contacts the index case was the first symptomatic case, or one of the first symptomatic cases, in that family. Fifteen (94%) of the siblings and 20 (56%) of the parents had signs and symptoms of acute infection during the follow up period. In 10 (63%) and eight (20%) of these cases, respectively, adenovirus was confirmed. The mean (SD) incubation period of confirmed adenovirus infections was 10 (3) days. The observations show that adenovirus infection spreads actively to other siblings in the family. Rapid diagnosis permits parents to be informed prospectively about the expected spread and clinical picture of the illness in the family.     

Familial nesidioblastosis: severe neonatal hypoglycemia in two families.

Severe neonatal hypoglycemia with pathologic findings of diffuse nesidoblastosis of the pancreas is described in five children of both sexes from two families with unaffected parents. This appears to represent an autosomal recessive disorder of pancreatic development. Despite extensive testing, the diagnosis of hyperinsulinism was difficult in the index case of each family and delayed definitive treatment. Medical therapy with steroids and diazoxide was unsuccessful; pancreatectomy was required to treat persistent hypoglycemia. An abnormality of circulating glucagon found in one child with this disorder suggested that hyperinsulinism may not be the sole hormonal imbalance present, but rather that this disease is one of generalized disturbance of islet cell function. The history of severe, persistent neonatal hypoglycemia in an older sibling should lead the physician to investigate subsequent children for the presence of asymptomatic hypoglycemia.     

Familial arthropathy with camptodactyly: reports of two families.

Familial association of congenital camptodactyly and arthropathy without evidence of concurrent inflammation has an autosomal recessive pattern of inheritance. We describe four children born to consanguineous parents in two families with congenital camptodactyly and polyarthropathy which were misdiagnosed and treated as juvenile rheumatoid arthritis (JRA) for some time. The siblings in the second family also had fibrosing pleuritis. Histopathological examination of the synovial tissues of the children in the first family revealed synovial hypertrophy and presence of multinucleated giant cells with minimal inflammation and vasculitis. On the other hand, prominent fibrosis with no inflammation was present in the synovial tissue of the elder boy in the second family. Thus, while the children in the first family had the phenotypic characteristics of congenital familial hypertrophic synovitis, the latter siblings probably represent a form of the familial fibrosing serositis.     

Adoptive families. Needs for counseling.

Adoption is an on-going process which affects each member of the adoptive family during each phase of the adoptee's maturation. Specific factors, such as insecurities of the adoptive parents, the child's awareness of his adoption in relation to his age and fantasies, and recently, the introduction of the possibility that the adoptee may arrange to meet his birth-parents later in life tend to add more perplexities to problems existing in these families. The normally turbulent age of adolescence increases anxieties in these vulnerable families. The pediatrician must understand the various factors uniquely inherent in adoption so that he can more effectively provide counsel to these patients.     

Prone positioning can be safely performed in critically ill infants and children.

OBJECTIVE: To describe the effects of prone positioning on airway management, mechanical ventilation, enteral nutrition, pain and sedation management, and staff utilization in infants and children with acute lung injury. DESIGN: Secondary analysis of data collected in a multiple-center, randomized, controlled clinical trial of supine vs. prone positioning. SETTING: Seven pediatric intensive care units located in the United States. PATIENTS: One hundred and two pediatric patients (51 prone and 51 supine) with acute lung injury. INTERVENTIONS: Patients randomized to the supine group remained supine. Patients randomized to the prone group were positioned prone per protocol during the acute phase of their illness for a maximum of 7 days. Both groups were managed using ventilator and sedation protocols and nutrition and skin care guidelines. MEASUREMENTS AND MAIN RESULTS: Airway management and mechanical ventilatory variables before and after repositioning, enteral nutrition management, pain and sedation management, staff utilization, and adverse event data were collected for up to 28 days after enrollment. There were a total of 202 supine-prone-supine cycles. There were no differences in the incidence of endotracheal tube leak between the two groups (p = .30). Per protocol, 95% of patients remained connected to the ventilator during repositioning. The inadvertent extubation rate was 0.85 for the prone group and 1.03 for the supine group per 100 ventilator days (p = 1.00). There were no significant differences in the initiation of trophic (p = .24), advancing (p = .82), or full enteral feeds (p = .80) between the prone and supine groups; in the average pain (p = .81) and sedation (p = .18) scores during the acute phase; and in the amount of comfort medications received between the two groups (p = .91). There were no critical events during a turn procedure. While prone, two patients experienced an obstructed endotracheal tube. One patient, supported on high-frequency oscillatory ventilation, experienced persistent hypercapnea when prone and was withdrawn from the study. The occurrence of pressure ulcers was similar between the two groups (p = .71). Compared with the supine group, more staff (p 相似文献   

Cultural brokers: helping Latino children on pathways toward success

Latino children in elementary and middle school not only experience developmental changes and confront the risks and adventures held by neighborhoods, they must also juggle the values and expectations of two cultures as they navigate their own pathways toward success. Integrating the results of a series of studies focused on the children of Mexican-American immigrants in California, this article discusses ways that teachers, parents, siblings, and program staff can help young Latino students succeed in U.S. schools and live according to their parents' values.