Intravenous Ketamine Infusion for Complex Regional Pain Syndrome: Survey, Consensus, and a Reference Protocol.

Objective: To find and reach a consensus on the usage of ketamine in the treatment of complex regional pain syndrome and to determine a reference protocol for future studies.

Design: Three hundred fifty-one medical professionals participated in our survey on practice procedures, with 104 respondents providing information on their usage of ketamine for treating the pain associated with complex regional pain syndrome. Respondents answered questions about inpatient treatment, outpatient treatment, children vs adults, safety, and basic demographic information.

Analysis of studies to evaluate immune response to combination vaccines.

The development and evaluation of new combination vaccines is an important public health endeavor. Trials to evaluate these vaccines are customarily designed and analyzed as noninferiority studies. We explain the concept of noninferiority and highlight important issues that can be challenging in the statistical evaluation of these vaccines.

Teaching telephone management skills to pediatric residents in a pilot program using a standardized patient.

Background: Pediatricians spend a significant amount of time on the telephone but receive little formal training in telephone management skills. We found only two previous reports in the literature using a randomized controlled trial (RCT) that documented the effectiveness of a telephone management program for residents.

Methods: The goals of this pilot study were (1) to provide second year pediatric residents (PL-2s) an experimental telephone management educational program, using a standardized patient (SP); (2) to assess the PL-2s' affective skills and ability to address relevant content on a series of simulated telephone calls; and (3) to determine whether feedback to the experimental group would improve their telephone management skills.

Effect of HIV counseling and testing on sexually transmitted diseases and condom use in an urban adolescent population.

Objective: To determine whether human immunodeficiency virus (HIV) counseling and testing has an effect on reducing subsequent risk behaviors in those tested, to evaluate stability in condom use over time, and to determine whether self-reported frequency of condom use relates to the incidence of sexually transmitted diseases (STDs).

Design: Cohort study with 2-year follow-up.

Setting: An urban adolescent-medicine clinic.

Perilymphatic fistula: a Washington, DC, experience.

One hundred ninety-seven patients who underwent surgical repair for a presumed unilateral perilymphatic fistula were reviewed. Of those patients, 87% with vestibular symptoms reported complete or near-complete relief of their symptoms. Forty percent of the patients with sudden hearing loss had an improvement in their hearing levels.

Are adolescents accurate in self-report of frequencies of sexually transmitted diseases and pregnancies?

Purpose: Many surveys of adolescent behavior are dependent on self-reported data. We sought to assess the accuracy of adolescent self-report of sexually transmitted diseases (STDs) and pregnancies.

Methods: We randomly selected 149 (118 females, 31 males) adolescents to participate in this accuracy study.

Extracorporeal membrane oxygenation exposes infants to the plasticizer, di(2-ethylhexyl)phthalate.

Objectives: To determine the exposure to, and evaluate the potential toxicity from, the plasticizer, di(2-ethylhexyl)phthalate (DEHP) during extracorporeal membrane oxygenation (ECMO) therapy.

Design: Protocol 1 consisted of a prospective comparison of three ECMO circuit designs in vitro. Protocol 2 consisted of a prospective, comparative clinical study evaluating DEHP plasma concentrations in ECMO vs.

Assessing student performance on a pediatric clerkship.

Objective: To determine whether any of 4 parameters used as evaluation methods in the pediatric clerkship at Children's National Medical Center, Washington, DC, could predict a student's performance, as measured by the final grade.

Design: A retrospective study in which the following data were collected: (1) a record of the diagnoses and total number of patients seen during the rotation, (2) clinical performance grade, (3) the National Board of Medical Examiners (NBME) pediatric shelf test score, (4) case presentation grade, and (5) the final clerkship grade for overall performance.

Setting: Third-year pediatric clerkship in the 1987-1988 academic year at Children's National Medical Center, the George Washington University School of Medicine.

Obstetrical brachial plexus palsy (OBPP) outcome with conservative management.

Resurgence of neurosurgical intervention of obstetrical brachial plexus palsy prompted our review of 186 patients evaluated between 1981 and 1993, correlating clinical examination, electrodiagnosis, and functional outcome with conservative management. Eighty-eight percent had upper brachial plexus palsies, and 63% were mild. Forty-two infants required no long-term follow-up because they rated 1 or 2 on initial physical examination.

Neurodevelopmental status at age five years of neonates treated with extracorporeal membrane oxygenation.

Objective: To determine the neurodevelopmental status at age 5 years among children who received extracorporeal membrane oxygenation (ECMO) in the newborn period as a treatment for severe cardiorespiratory failure.

Methods: We conducted a prospective cohort study of 103 five-year-old ECMO-treated children born between June 1984 and July 1988, and treated at our institution. Thirty-seven healthy control children were recruited locally.

Physician burnout in pediatric critical care medicine.

Objectives: To determine the prevalence of, and factors associated with, burnout among pediatric intensivists across a variety of practice settings.

Design: A population-based survey, using a mailed questionnaire that included a previously validated Burnout Scale.

Setting: Private and academic pediatric critical care practices.

Survivors of medulloblastoma: implications for program planning.

A growing literature documents the deleterious effects of radiation therapy in children treated for malignant brain tumors. However, the clinical relevance of previous research has been limited by reliance on global IQ and achievement test scores. The present study of a sample of long-term survivors of medulloblastoma examined their cognitive and socioemotional functioning in depth with standardized psychologic measures.

Impact of quality-of-care factors on pediatric intensive care unit mortality.

Objective: To determine the importance of the following care factors previously associated with hospital quality on survival from pediatric intensive care: size of the intensive care unit (ICU), medical school teaching status of the hospital housing the ICU, specialist status (pediatric intensivist), and unit coordination.

Design: After a national survey, consecutive case series were collected at 16 sites randomly selected to represent unique combinations of quality-of-care factors.

Setting: Pediatric ICUs.

Quality of long-term survival in young children with medulloblastoma.

The reported success of treatment for children with medulloblastoma must be balanced against the effect that treatment has on the quality of life of long-term survivors. The outcome of long-term survivors reported in previous studies has been conflicting. The authors evaluate the mental and behavioral skills of a group of medulloblastoma survivors from their institution, all of whom had survived for more than 5 years postdiagnosis.

Urinary N-acetyl-beta-glucosaminidase and beta-2-microglobulin in the diagnosis of urinary tract infection in febrile infants.

Urinary N-acetyl-beta-glucosaminidase (NAG) and beta-2-microglobulin (B2M) concentrations were measured in 24 pediatric patients with febrile urinary tract infection (UTI) and compared with the technetium-99m-labeled dimercaptosuccinic acid (DMSA) renal scan results, in order to evaluate a noninvasive means to localize the site of UTI. Increased urinary B2M and NAG were not associated with renal inflammation (pyelonephritis), as defined by positive dimercaptosuccinic acid scan. Median NAG concentrations were 114.

Attitudes, knowledge, and behavior regarding condom use in urban black adolescent males.

This study was conducted to determine male adolescent behavior, attitudes, and knowledge concerning the use of condoms. Subjects were 241 sexually active black adolescent males attending an inner-city adolescent medicine clinic who were surveyed using a structured interview technique. Factors associated with condom use included higher grade level, > or = 2 sexual partners in the past six months, communication about contraception with sexual partner(s), desire for sexually transmitted disease (STD) prevention when contracepting, and parental suggestion to use condoms.

Medical students' experiences with and perceptions of chronic illness prior to medical school.

Concerns have been expressed about the failure of the medical curriculum to address the health-care needs of the chronically ill. It has been shown in the literature that medical students develop cynicism and negative feelings towards chronic illness as they progress through their training, perhaps as a result of the attitudes and frustrations of their teachers. What has been inadequately addressed are the experiences with and perceptions about chronic illness that medical students have before entering medical school.

Pediatric intensive care units: results of a national survey.

Objective: To describe the structure and organization of pediatric intensive care units (ICUs) in the United States.

Survey Methods: We directed a mail survey to pediatric ICU medical and nursing directors and hospital quality assurance officers. A total of 201 of 301 hospitals with pediatric ICUs initially responded.

Prevention of postischemic canine neurological injury through potentiation of brain energy metabolism by acetyl-L-carnitine.

Background And Purpose: Mechanisms of ischemia/reperfusion brain injury include altered patterns of energy metabolism that may be amenable to pharmacological manipulation. The purpose of this study was to test the effectiveness of postischemic acetyl-L-carnitine administration on potentiation of metabolic recovery and prevention of neurological morbidity in a clinically relevant model of complete, global cerebral ischemia and reperfusion.

Methods: Neurological deficit scoring as well as spectrophotometric and fluorescent assays of frontal cortex lactate and pyruvate levels were used in a canine model employing 10 minutes of cardiac arrest followed by restoration of spontaneous circulation for 2 or 24 hours.

Escherichia coli virulence factors and 99mTc-dimercaptosuccinic acid renal scan in children with febrile urinary tract infection.

Correlation of virulence factors of Escherichia coli with renal inflammation documented by 99mTc-dimercaptosuccinic acid renal scan was undertaken in 59 children with febrile urinary tract infections to identify more accurately the role of bacterial virulence factors in the development of pyelonephritis. P fimbriae were present in 63% of isolates from the positive scan group and 83% of those from the negative scan group (P = 0.126).

Use of a radioreceptor assay in the assessment of cushingoid features in patients with juvenile rheumatic diseases.

A marked variation has been observed in severity of cushingoid appearance in patients with rheumatic diseases (RD) following steroid administration. We studied ten children with RD to determine if a relationship exists between cushingoid features and an individual's steroid activity as measured by prednisolone equivalents using a radioreceptor assay. Cushingoid features were clinically assessed by a "cushing score" according to the method of Bergrem.