Pediatric clinical decision units: Observations past, present, and future

Pediatric clinical decision units are a relatively new form of care that are being increasingly provided by pediatric emegency departments. Current evidence suggests that a significant number of children with common emergency department diseases, such as asthma, dehydration, and croup, may be cared for in clinical decision units. This report looks at the development of pediatric clinical decision units from a personal historical perspective, provides a discussion of the utility of clinical decision units, and identifies future directions for this unique form of health care delivery based on research needs and current public policy.     

Pediatric hospital medicine: historical perspectives, inspired future

Pediatric hospital medicine (PHM) is in an accelerated growth phase. Multiple elements have combined to affect the current state of the field. PHM is similar to other geographic specialties such as pediatric emergency medicine and pediatric critical care that deliver general, comprehensive care to patients based on hospital site. Pediatric hospitalists have been molded by changes in medicine, consumer expectations, and training program modifications. The history of PHM dates back for more than 3 decades, when unwitting pediatricians began to focus on delivering care for the hospitalized child. The ensuing years allowed for natural responses to external pressures that resulted in much of the field's initial development. In more recent years, however, pediatric hospitalists have been catalysts for change and driving forces for health care systems' improvements. Simultaneous with this has been the nearly exponential surge of energy focused on targeted initiatives, which have further defined the field and brought attention on a national level. PHM is at a critical but brilliant juncture in development. Further decisions regarding scope and demonstration of competencies are important to make with clarity of purpose. Pediatric hospitalists are advancing child health in the inpatient setting through evidence-based care, research, education, clinical excellence, advocacy, and health care business acumen. With a strong community sense and leadership evident, PHM has a bright future.     

Pediatric heart transplantation: The past,the present,and the future

Heart transplantation (HTx) has a storied past, with origins dating back to the early twentieth century and the first pediatric orthotopic heart transplant performed in 1967 on a neonate with Ebstein abnormality. Today, approximately 500 pediatric HTx are performed annually, with survival times now measured in decades rather than days or weeks. In large part, advances in immunosuppression, critical care, dedicated transplant teams and mechanical circulatory support have paved the way for improvements in waitlist mortality and post-transplant survival, with future directions including the development of intracorporeal ventricular assist devices (VADs) for small children, expanding/standardizing donor criteria, and xenotransplantation.     

Paediatric palliative medicine in the UK: past, present, future

Like any new specialty, paediatric palliative medicine is facing challenges as it establishes itself. While many of the required core skills have their roots in adult palliative medicine, its practitioners come from a range of paediatric backgrounds that include oncology, community paediatrics, neurodisability and acute pain. Such heterogeneity has been invaluable in bringing together the diverse set of skills and competencies needed by children and families facing life-limiting illness. At the same time, it brings its own challenges in establishing consistent standards of clinical expertise, education and research--essential if children are to have access to the same degree of medical expertise in palliative care already available to most adults. This article traces the origins of palliative care in children, examines its current strengths and challenges, and considers how those might shape its future.     

Intussusception: past,present and future

Intussusception is a common etiology of acute abdominal pain in children. Over the last 70 years, there have been significant changes in how we diagnose and treat intussusception, with a more recent focus on the role of ultrasound. In this article we discuss historical and current approaches to intussusception, with an emphasis on ultrasound as a diagnostic and therapeutic modality.     

SIDS: past, present and future

Despite the large reduction in SIDS mortality, which occurred in the early 1990s following the 'Back to Sleep' campaigns, SIDS remains the leading cause of death in the postneonatal age group. This paper describes the position in the 1980s, the contribution of the New Zealand Cot Death Study, what should be recommended and the current research priorities.
Conclusion:  SIDS is preventable. Application of what we currently know could eliminate SIDS. The challenge is to find ways of implementing our knowledge.     

Clitoroplasty: past,present and future

This paper reviews the history of clitoral surgery throughout the twentieth century. The changing operations, from amputation through to attempts to produce a normal clitoris mirror the changing attitudes and available knowledge. It also examines the current issues that arise out of available data on long-term outcomes of clitoroplasty.     

The Internet: past, present and future

Although the Worldwide Web has just blossomed this past decade, the origins of the Internet date to the late 1950s and Cold War concerns. The technological underpinning of the Internet rests with the concept of packet switching of data over dispersed routes of electronic intercommunication. Grounded in applications for the national defense, and nurtured in the domains of science within academia, the Internet of the masses has exploded with the addition of strong commercial interest and potential. Electronic mail is still the predominant application of the Internet, and the ease of widespread and near simultaneous dissemination of such communication has led to the genesis of listservers, especially appropriate as well as predominant in Medicine. One such list for pediatric surgeons is Pedsurg-L. There is an impressive evolving etiquette for those contributing to such lists. Initiatives are already well developed with public and private partnerships for the future of the Internet.     

America's schoolchildren: past, present, and future

To provide a context for the articles in this journal issue, which focus on programs for children in elementary and middle school, this article depicts the cohort of children who were between 5 and 14 years old in the 1990s and compares them with their counterparts earlier in the century. It reports their numbers, overall and by racial and ethnic heritage; the makeup, employment, and economic status of their parents; and the time they spend in school. The article examines changes in these demographics and characteristics of school-age children with an eye to the effect that these trends may have on public attitudes toward children and youths, and on support for government funding to keep young people safe and to promote their development.