Preparing for pediatric emergencies: drugs to consider

This clinical report provides current recommendations regarding the selection and use of drugs in preparation for pediatric emergencies. It is not intended to be a comprehensive list of all medications that may be used in all emergencies. When possible, dosage recommendations are consistent with those used in current emergency references such as the Advanced Pediatric Life Support and Pediatric Advanced Life Support textbooks and the recently revised American Heart Association resuscitation guidelines.     

Preparing children for travel to tropical and developing regions

Visiting a grandparent for a first time, exploring the ruins of an ancient civilization in a distant country, or river rafting through a tropical jungle are all moments that are never forgotten. Illness, visits to the doctor, and disability should not be a part of these experiences. Diseases such as malaria, yellow fever, travelers' diarrhea, and hepatitis A are preventable. Through the use of vaccines, prophylactic medications, and disease-prevention education, clinicians may help ensure their pediatric patients have enjoyable and rewarding travel experiences.     

Preparing families to care for ventilated infants at home

Advances in neonatal care have led to increased survival of infants with complex medical needs and technology dependence. Transition of the ventilator-dependent infant from hospital to home is a complex process that requires extensive coordination between the medical team and family. Home caregivers must be prepared to provide routine care for the ventilator-dependent child and respond to life-threatening emergencies. Families should be counseled on the need for home nursing, medical equipment and an adequate home environment to ensure a safe transition to home. Throughout the process, the family may require financial, social and psychological support. A structured education and transition process that is clearly communicated to parents is necessary to have an effective partnership with families.     

Preparing for a consultant interview: advice from a regional advisor

Applying for your first consultant's post can be a very stressful experience and therefore it is advisable to start your preparation in your final year of training. If you have been granted a CCST, your clinical abilities will not be in dispute and it is often the other aspects involved in the preparation for your application, which generate most anxiety. It is important to read widely on managerial and medico-political issues and to attend a formal management course. Your CV should be updated regularly to incorporate all the non-clinical skills that you will acquire in the year prior to your CCST and then, once a post has been advertised, adapted to include all the requirements in the person specification. Your pre-interview visits should be carefully planned and will provide you with some valuable insight about the Trust, the department and the job itself (not to mention possible questions that you might be asked!). Practice your interview technique and have some prepared answers ready for the more predictable questions you are likely to be asked.     

Preparing for avian influenza

PURPOSE OF REVIEW: Pandemic influenza is inevitable, will have significant impact on the population and will challenge healthcare delivery. Planning for an influenza pandemic will improve the ability of healthcare facilities to respond successfully. RECENT FINDINGS: Planning activities involve determining the role of the facility during an influenza pandemic, estimating resources necessary to fulfil this role and developing the infrastructure, material and human resources surge capacity necessary to meet the estimated needs. Plans to perform surveillance for potentially contagious individuals, handle clinical specimens, increase social distancing during a pandemic and the development of personal preparedness plans may be beneficial. SUMMARY: The goal of this review is to provide a framework for healthcare facility pandemic influenza planning.     

Chest pain in children referred to a cardiology clinic

One hundred consecutive patients (54 girls, 46 boys) referred to a pediatric cardiology department with the primary complaint of chest pain were evaluated. The age distribution was 2.5–16.0 years (mean 11.3 years for girls and 9.9 years for boys). The history showed 17% of patients with chest pain, 22% with heart disease, and 19% with recent death in the family. The time course of the pain was longer than 1 week in 92 patients. Localization was on the left precordium in 60 patients, and there was no radiation from the original site in 66 cases. Ninety-two percent of cases were idiopathic in origin. Of the 74 patients who had a psychiatric interview, 55 (74%) had psychiatric symptoms and 5 required psychiatric care. Anxiety, conversion disorder, and depression were the main psychiatric symptoms.     

Preparing residents to counsel about smoking

The objective of this study was to evaluate the effects of an innovative, multicomponent, theory-based educational intervention for pediatric residents on prevention of tobacco use counseling for cessation. Before and 3 months after intervention residents in a large urban midwestern pediatric residency program completed a self-assessment of measures of their attitudes and counseling behaviors. The intervention was a 3-hour multicomponent program including presentations, case discussions, role-plays and support material based on concepts from Motivational Interviewing (MI). Participants reported increased confidence in their ability to counsel, as well as greater frequency of counseling (standardized effect size (d) = 0.57). Residents also reported an increased use of principal components of MI, assessing how important quitting is to patients (d = .66), and how confident patients are in their ability to quit (d = .78). This brief educational intervention taught theory-based counseling techniques to pediatric residents. After the study, participants reported significant increases in their frequency of counseling as well as greater use of the MI principles.     

Preparing adolescent patients for college

Adolescents making the transition to college should have a thorough medical evaluation during the year prior to matriculation. In addition to required and recommended immunizations and tests, a comprehensive history and physical examination is important. Screening for substance abuse, sexual activity, depression, and suicidality is needed with appropriate anticipatory guidance, examinations, and treatment, if indicated. The teen should also be counseled on stress, sleep, and self-care, with information on when to seek medical care. The adolescent should be encouraged to continue communications with the primary care clinician during college. While respecting the adolescent's confidentiality, it is important that the physician communicate all significant medical and psychiatric health information to the college health center before the adolescent arrives on campus.