Risk Factors for Child Maltreatment Fatalities in a National Pediatric Inpatient Database.

Background And Objectives: Child maltreatment (CM) is recognized as a major public health concern, and an important number of children suffer injuries related to abuse and neglect that result in death. We sought to identify risk factors for CM fatalities among hospitalized children that can provide clinicians with information to recognize at-risk children and reduce further death.

Methods: In this study, we included cases from the 2012 Kids' Inpatient Database with diagnosis codes related to CM who were <5 years of age and were not transferred to another facility.

Community Advisory Board Members' Perspectives Regarding Opportunities and Challenges of Research Collaboration.

This case study examines the perspectives of rural community advisory board (CAB) members regarding the opportunities and challenges of partnering with academic investigators on funded research. We used a sequential exploratory design to evaluate the phenomena. Qualitative and quantitative data from CAB members were integrated to gain better understanding.

Coaching for insight. A tool for dealing with disruptive physician behavior.

Discover ways to provide disruptive physicians with a clear picture of themselves so they can better understand how their behaviors affect others.

A modified "cover your cough" campaign prevents exposures of employees to pertussis at a children's hospital.

Background: In the 4th quarter of 2004, there was an increase in patients seeking medical care for pertussis symptoms at the Children's Hospital, Omaha, NE. The Hospital Epidemiology service noted a sharp rise in exposures of Children's Hospital employees to these patients, requiring employee testing, prophylactic antibiotic prescriptions, and relief from duty.

Methods: Initial efforts at employee education failed to prevent the exposures.

Dealing with angry patients.

Understanding what angers patients, how to listen to their concerns and what steps to take to find a resolution sound like relatively easy tasks. But, in reality, they can be one of the toughest challenges physician executives face.

Adolescent sexuality, cultural sensitivity and the teachings of the Catholic Church.

In recent years it has been increasingly recognized that physicians must be sensitive to the cultural beliefs of their patients. This is especially important for physicians who deal with sexuality, especially when dealing with adolescents. Despite this, many mainstream text-books and journal articles ignore the teachings of the largest single religious denomination in the United States, the Roman Catholic Church.

Shaken baby syndrome.

Purpose: To examine the comprehensive ophthalmologic experience with the shaken baby syndrome at one medical center, including clinical findings, autopsy findings, and the outcome of survivors.

Design: Retrospective, noncomparative case series.

Participants: One hundred twenty-three children admitted from January 1987 through December 1998 for subdural hematomas of the brain secondary to abuse were included.

Psychosocial aspects of child abuse for primary care pediatricians.

Childhood is an image that advertisers use to conjure up feelings of care-free innocence. Society frequently calls for protecting our children and creating strong, healthy families. Yet thousands of children experience violence on a regular basis, and their lives are irretrievably altered.

Evaluation for possible physical or sexual abuse.

In summary, child abuse requires a multidisciplinary approach. The clinician's role in obtaining the history and physical examination demands that one be familiar with interview technique, appropriate developmental milestones, normal genital anatomy, and the use of local community resources. Knowing that there are circumstances when the examination should be deferred to a specialized center or done under anesthesia is critical.

The Whiplash Shaken Infant Syndrome: has Caffey's syndrome changed or have we changed his syndrome?

Objective: The aim of this study is to examine the data used by John Caffey in his description of the Whiplash Shaken Infant Syndrome and compare it with recent data in an attempt to determine whether the syndrome that he described has changed, or if we have changed his syndrome into what we now call The Shaken Infant Syndrome.

Method: This study examined recent literature describing the Shaken Infant Syndrome, and compared it to Caffey's descriptions. In addition, a retrospective review of 71 children under the age of 3 years identified as having a subdural hematoma caused by other than accidental means during 54 months was done.

Evaluating child sexual abuse in the emergency department: clinical and behavioral indicators.

Child sexual abuse is an increasingly common problem. This article reviews the current clinical and behavioral indicators that will aid the emergency physician when evaluating and managing this condition. The most common differential diagnoses are described and a general approach to this diagnosis is suggested.

Whatever happened to Mary Ellen?

It is well recognized that the organized response to child abuse in the United States began with the rescue of a little girl named Mary Ellen from the abuse inflicted upon her by her stepmother. It is often forgotten, however, that Mary Ellen was, indeed, a real child who survived her horrendous start in life and went on to have a meaningful and productive life and raise children of her own.

Otitis media and language development.

Otitis media can be a vexing, recurrent problem. An episode is often treated with antibiotics, followed by reevaluation at two weeks. The complete resolution of effusion, however, may never be documented.

Evaluation of system providing feedback to students on videotaped patient encounters.

A technique in which feedback is provided on videotaped performances to teach interview and examination skills in a pediatric clerkship was evaluated with a single-blind, controlled study. At the beginning of the pediatric ambulatory rotation, each of 105 third-year medical students received verbal and written instruction in conducting pediatric patient interviews and examinations. Then an encounter between each student and a patient was videotaped using a stationary camera mounted in an examination room.

Interobserver and method variability in tuberculin skin testing.

Accurate measurement and interpretation of tuberculin skin tests is essential both to avoid unnecessary prophylactic treatment with potentially hepatotoxic drugs and to ensure the proper institution of therapy in tuberculin-positive individuals. Although two methods are currently used for reading tuberculin skin tests, palpation and ballpoint, the optimal technique has not been established. We compared measurements obtained by each method on 101 patients tested with intermediate tuberculin purified protein derivative.

Management of acute epiglottitis.

Airway obstruction secondary to acute epiglottitis is a dramatic, life-threatening emergency. Early diagnosis and provision of an adequate artificial airway are critical in the management of these patients. Tracheostomy has been the traditional method of securing the airway in acute epiglottitis, but more recently, endotracheal intubation has been advocated.

Depressed skull fracture in the neonate. Report of three cases.

The authors describe three cases of neonatal depressed skull fracture that were elevated by means of an obstetrical vacuum extractor. In one case, a transparent breast pump shield replaced the metal vacuum extractor cup, permitting direct observation as the depression was elevated. Neonatal depressed skull fractures not associated with neurological signs may be safely elevated without surgery using the obstetrical vacuum extractor.