Developmental assessment of the technology-dependent infant and young child.

Appropriate developmental intervention for the technology-dependent infant or young child has its basis in a carefully designed and thorough assessment. The role of the nurse is central in this process. This article guides the nurse through an analysis of developmentally relevant medical considerations, an examination of tolerance and endurance, the determination of developmental level, an approach to working with families, and the process of translating assessment data into intervention plans.     

Macrocephaly, increased intracranial pressure, and hydrocephalus in the infant and young child

Macrocephaly, increased intracranial pressure, and hydrocephalus are common related conditions that lead to cross-sectional imaging of the infant and young child. Imaging plays a central role in establishing the diagnosis and guiding disposition and treatment of these patients. In this review, a general overview is provided, and the more common causes of hydrocephalus are presented, including posthemorrhage, postinfection, developmental malformations, and masses. Imaging guidelines are also outlined for initial evaluation and follow-up, along with a discussion of the imaging features of shunt malfunction.     

An assessment of the mental health of physicians specializing in the field of child neurology

We assessed physicians working in the field of child neurology with the aim of improving the physicians' mental health. Our questionnaire included a burnout inventory and a general health questionnaire. We analyzed 29 responses from physicians in a variety of countries obtained through the Internet. According to their responses, 8 (27.5%) of the respondents had attained a burnout status, and 27 respondents (93.1%) had neurotic conditions. We found a greater percentage of physicians in poor mental health than we had found previously in assessments made in Japan. However, the respondents in the present survey had more positive styles for coping with stress. The length of time working as a physician affected respondents in Japan and internationally, whereas nationality or working environment (workplace, night shifts, and so on) did not. Consultants or mentors on work and assertive stress coping would be effective.     

互动模式在家长参与肺炎婴幼儿排痰护理中的应用

目的探讨护士在引导家长参与肺炎婴幼儿排痰护理中应用互动模式的护理效果。方法对符合研究条件的肺炎婴幼儿按入院顺序编号,根据随机数字表分成观察组和对照组各63例,观察组实施双向性的互动护理模式,而对照组实施传统单向性的护理模式。结果观察组患儿肺部哕音消失时间5．129±1．584（d）,与对照组比较t=7．631,P〈0．01;观察组止咳天数5．651土1．536（d）,两组比较t=8．600,P〈0．01;家长心理压力观察组26．087±2．639（分）,两组比较P〈0．01;家长对护理工作的满意度观察组97±1．02％,两组比较P〈0．01;家长参与护理的程度比较X^2=114．692,P〈0．01。结论本研究中护士应用互动模式比传统的单向性护理模式能更有效地达到护理目标。     

成都市金牛区婴幼儿喂养情况及其母亲的喂养知识调查

目的了解成都市金牛区婴幼儿喂养情况及其母亲的喂养知识水平,为合理喂养提供科学依据。方法以随机整群抽样的方法,抽取成都市金牛区400名婴幼儿的母亲进行问卷调查。结果 4个月母乳喂养率为67.35%,6个月母乳喂养率为57.80%,辅食添加时间为（4.61±1.13）月龄;6～12月龄鱼、肉和禽类添加率较低,仅为62.11%。不同年龄段低体重、生长迟缓、肥胖和超重发生率等方面比较差异无统计学意义（P〉0.05）;母亲的喂养知识水平与年龄、职业无显著相关性（P〉0.05）,与文化程度有关（r=0.132,P〈0.05）,母乳喂养者的喂养知识水平较高（χ2=7.055,P〈0.05）。结论婴幼儿喂养主要问题是母乳喂养率较低,婴儿辅食添加存在较早现象,婴儿动物性食物家长喂养知识水平较低,应积极宣传和普及科学喂养知识。     

Use of abbreviated mental status examination in the initial assessment of overdose patients.

Application of formal mental status testing in the emergency department (ED) to assess cognitive function has been hampered by the lack of a rapidly applied instrument. An Abbreviated Mental Status Examination (AMSE) with 10 test items that can be administered within five minutes by nursing personnel is described. Evaluation of the instrument on 296 ambulatory ED patients with grossly normal neurologic function showed that 93% of patients had a total score of seven or more correct answers and 83% of patients had eight or more correct answers. Application of the AMSE to 375 acute drug overdose patients at the same hospital showed a significant correlation with Glasgow Coma Scale (GCS) score. An AMSE score of seven or less was found to be more sensitive than a GCS score of 13 or less for admission to the intensive care unit (ICU) and complications in the ICU (P less than 0.001). The AMSE score may serve as a useful tool for stratifying cognitive function in acute drug overdose patients and for identifying patients at increased risk for an adverse outcome from their overdose.     

Immune dysfunction in the critically ill infant and child

Factors contributing to the high prevalence of immunodeficiency in the PICU population include conditions that lead to frequent requirement of intensive care, suppression of immunity secondary to an acute insult, and iatrogenic measures. The immunodeficiency observed in the critically ill correlates well with their susceptibility to infection and explains the high prevalence of nosocomial sepsis in the PICU--a major cause of morbidity and mortality in critically ill children. Dysactivation of the immune system during an acute insult, with the subsequent release of humoral mediators from activated immune cells, leads to tissue injury and may be involved in the pathogenesis of ARDS, DIC, capillary leak syndrome, and to the development of multiple organ system failure. Suggested approaches to correct the immunodeficiency in the critically ill include reconstitutional immunotherapy, mediator-inhibiting drugs, and mediator removal by plasma exchange. Intensivists should be aware of the phenomenon of immunodeficiency in the critically ill, be accordingly aggressive in diagnosing and treating infections, and avoid, as much as possible, measures that further suppress immunity.