Diagnosis, management, and containment of smallpox infections.

The US public health system and primary health care providers must be prepared to address varied biologic agents, including pathogens that are rarely seen in the United States. The increased frequency of international travel, combined with the current national concerns regarding bioterrorism, create an imperative for health practitioners to be more knowledgeable about specific biologic agents. Smallpox poses a serious bioterrorist threat to the US population at this time. Thus, if an outbreak occurred, prompt recognition and the implementation of control measures would be important.     

Overview of the evaluation, diagnosis, and management of urinary tract infections in infants and children

Urinary tract infection (UTI) is the most common serious bacterial infection in infants and children. UTI is an infection of the lower urinary tract, the upper urinary tract, or both. The diagnosis is dependent on the collection and analysis of an uncontaminated urine specimen. It is the combination of bacterial virulence, and host factors that are closely interrelated, which lead to the development of a UTI. Management of UTI in infants and children requires prompt diagnosis, treatment, and resolution of symptoms followed by appropriate radiologic evaluation. The ultimate goal is the preservation of kidney function.     

Current diagnosis and management of urinary tract infections in infants and children

The diagnosis and management of urinary tract infections (UTIs) in infants and children poses a unique set of problems, including sterile urine collection in non-toilet-trained children, and recognizing the subtle signs and symptoms of UTIs in infants. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unaproved, or investigative products or devices.     

Ultrasound in the diagnosis of hydronephrosis in infants and children

A series of 91 infants and children ranging in age from one day to 15 years and presenting a variety of urologic symptoms was examined by intravenous pyelography and ultrasonic scanning of the kidneys. Ultrasonic examinations were performed without knowledge of the indication for and results of pyelography, in order not to prejudice the interpretation of the results. Pyelography demonstrated hydronephrosis in 20 cases of 181 kidneys examined. The ultrasonic scanning demonstrated hydronephrosis in 19 of these 20 kidneys, the negative result being a case of minimal hydronephrosis. Six kidneys with radiographically dilated pelves were ultrasonically diagnosed as hydronephrosis in three, suspicion of hydronephrosis in one, pelvic dilatation in one and one kidney as normal. In eight kidneys with normal pyelography the ultrasonic scanning suggested hydronephrosis in five and pelvic dilatation in three cases. The criteria used were the demonstration of the dilated renal pelvis and to some extent separation of the calyceal echoes. The results indicate that ultrasonic examination can become a reliable screening procedure in infants and children with urologic symptoms.     

Hirschsprung's disease: diagnosis and management in children

Hirschsprung's disease is a congenital abnormality of the bowel that results in loss of peristalsis, and is one of the main reasons why an infant may require a stoma soon after birth. Various stages of surgery may be required to resect the affected part of the bowel, including formation and closure of the stoma. Following surgery, the perception of many families is that their child is now "normal" and that all previous problems of managing their child are now resolved. However, there are a variety of postoperative complications and issues relating to bowel control which can affect the child in the long term. This article looks at how potential postoperative long-term problems can be identified early, and thus minimized, by healthcare staff being aware of possible problems, taking a proactive approach to management and advising families about the issues involved.     

Safeguarding and promoting the well-being of children,families and communities

The Political Psyche Andrew Samuels London, Routledge, 1993 380 pp., Pb £14.99, Hb £40.00

Balancing Dreams and Discipline: the Manager in Practice Sally Irvine London, RCGP, 1992 137 pp., £13.50

Brief Counselling. A Practical Guide for Beginning Practitioners Windy Dryden &; Colin Feltham Buckingham, Open University Press, 1992 219 pp., Pb £11.99

Out of Bounds: Sexual Exploitation in Counselling and Therapy Janice Russell London, Sage Publications, 1993 176 pp., Pb £10.95, Hb £30.00

Death, Dying and Bereavement D. Dickenson &; M. Johnson London, Sage Publications, 1993 336 pp., Pb £12.95, Hb £35.00

Making the Right Decision: Ethics for Managers William D. Hall Chichester, John Wiley, 1993 248 pp., £10.95

Models for Mental Disorder: Conceptual Models in Psychiatry, 2nd edition Peter Tyrer &; Derek Steinberg John Wiley &; Sons, Chichester, 1993 142 pp., £9.95     

Safeguarding children: audit of staff knowledge

Following the publication in 2006 of 'Working together to safeguard children' (HM Government 2006), an audit was undertaken to assess the working knowledge of children's services staff about safeguarding. The aims of the audit were to: identify knowledge of key legal issues required when caring for children and young people; highlight gaps in knowledge; identify training needs. Staff in acute children's services in two district general hospitals and in the child and adolescent mental health service were interviewed using a structured questionnaire. The results of the audit showed that professional's knowledge about the sharing of information was good. This may have been due to a recent introduction of a policy on sharing information and also mandatory training on safeguarding children, which includes issues regarding sharing information. However, the audit identified a lack of understanding about parental responsibility with only 41 per cent of staff able to provide an acceptable response. Other gaps in staff knowledge were identified concerning legal orders, particularly emergency protection orders and police protection powers.     

Safeguarding children: the benefits of a peer-review process

Nurses in hospitals and in the community are increasingly taking a leading role in safeguarding children. NHS London established a Safeguarding Improvement Team (SIT) in 2009. The SIT project was designed as a one-off activity to raise performance related to safeguarding children in London. This article presents a peer-review process that was established by NHS London and implemented across the 31 PCTs across London. This article presents the peer-review process methodology and a summary of the findings from the SIT visits. Feedback was requested from participants about participants' perceptions of the peer-review process immediately after the SIT visits and again, several months after the completion of all SIT visits. Findings show that the peer-review process was of value, both organisationally and professionally, and the process itself led to identification of good practice as well as gaps in existing practices. The non-threatening nature of the peer-review process was particularly valued, as was the feedback offered by the review teams.     

Meeting the challenge of immunizing the nation's children.

Achieving fully immunized status in the nation's pediatric population remains an elusive goal. A new campaign is underway to improve immunization coverage, and the nation's schools are logical sites to implement these projects.     

Differential diagnosis of abuse injuries in infants and young children

A complete differential diagnosis is essential when assessing potential child abuse injuries. The differential diagnosis provides clinicians with the opportunity to compare injuries that might mimic abuse with actual abuse-related injuries. The differential diagnosis should delineate the injury type, injury site, instruments used, patterns, and the appearance of old or repeated injuries. This article discusses differential diagnoses that should be considered when evaluating injuries in infants and young children.     

Scalded skin syndrome: Diagnosis, differential diagnosis, and management of 42 children.

The bacteriologic, epidemiologic, clinical, and diagnostic findings and management of the scalded skin syndrome (SSS) in 42 children are reported SSS may present in one of three ways: (1) Ritter's disease in infants, characterized by an acute, generalized bullous dermatitis simulating the appearance of scalded skin, followed by exfoliation; (2) Lyell's disease, or toxic epidermal necrolysis (TEN), in children or adults, with scalded skin and bullae followed by extensive exfoliation; or (3) a nonstreptococcal scarlatiniform eruption, or staphylococcal scarlet fever, manifested by a generalized scarlatiniform erythema ans subsequent minimal to moderate fine desquamation. Staphylococcus aureus was isolated and implicated as the causative agent in 32 of the 42 children; nine of the other ten children had received a drug or vaccine preceding their rash. SSS in children has increased in frequency recently, is usually due to S aureus infection with potential epidemic aspects, can be recognized easily by its unusual clinical features, and has an excellent prognosis with appropriate management.