Required procedural training in family medicine residency: a consensus statement.

Background And Objectives: Specific procedural training standards for US family medicine residencies do not exist. As a result, family physicians graduate with highly variable procedural skills, and the scope of procedural practice for family physicians remains poorly defined. Our objective was to develop a standard list of required procedures for family medicine residencies.

Administration of steroids in pediatric cardiac surgery: impact on clinical outcome and systemic inflammatory response.

Cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response. Pre-bypass steroid administration may modulate the inflammatory response, resulting in improved postoperative recovery. We performed a prospective study in the departments of cardiovascular surgery and pediatric intensive care medicine of two university hospitals that included 50 infants who underwent heart surgery.

Clinical outcomes for newborn intensive care in Alaska.

Recent clinical outcomes for the Newborn Intensive Care Unit (NICU) at Providence Alaska Medical Center based on Alaska Neonatology's Clinical Outcomes Database are presented. There has been a decrease in overall mortality, with much of the improvement occurring in babies from 22 to 25 weeks gestation in the years 1998--2002. There has also been a decrease in the incidence of severe intraventricular hemorrhage / periventricular leukomalacia.

Plasma levels of interleukin-8 and expression of interleukin-8 receptors on circulating neutrophils and monocytes after cardiopulmonary bypass in children.

Objective: Cardiopulmonary bypass induces a systemic inflammatory response that causes substantial clinical morbidity. This study sought to determine cellular and humoral variables of inflammation. We hypothesized that chemokines are a major source of stimulation of neutrophils and monocytes in pediatric cardiac surgery.

Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study.

Background: Multiple organ dysfunction syndrome is more frequent than death in paediatric intensive care units. Estimation of the severity of this syndrome could be a useful additional outcome measure in clinical trials in such units. We aimed to validate the paediatric logistic organ dysfunction (PELOD) score and estimate its validity when recorded daily (dPELOD).

Respiratory distress syndrome in near-term babies after caesarean section.

Objective: Severe respiratory distress syndrome (RDS) caused by surfactant deficiency is described not only in preterm infants but also in (near-) term babies after caesarean section (CS), especially when carried out before the onset of labour. The aim of the present study was to document the severity of this theoretically avoidable entity in order to improve obstetric and perinatal care.

Patients: All neonates admitted to the paediatric intensive care unit of the University Hospital of Bern between 1988 and 2000 with RDS on the basis of hyaline membrane disease (HMD) needing mechanical ventilation (MV) after CS and with a birthweight > or = 2500 g were analysed.

Early postoperative arrhythmias after open-heart procedures in children with congenital heart disease.

OBJECTIVE: Evaluation of occurrence, clinical course, necessity of treatment, and outcome of early postoperative cardiac arrhythmias after open-heart surgery. DESIGN: Prospective study. SETTING: Tertiary pediatric intensive care and pediatric cardiology unit.

Reproducibility of the blood flow index as noninvasive, bedside estimation of cerebral blood flow.

Objective: To investigate the feasibility and reproducibility of the blood flow index (BFI) method for measuring cerebral blood flow.

Design And Setting: Prospective functional study in pediatric intensive care.

Patients And Participants: 14 consecutive patients with median age of 2 months (range 1 days-11 years) requiring artificial ventilation, invasive arterial blood pressure monitoring, and central venous access.

Inflammatory response of neutrophil granulocytes and monocytes after cardiopulmonary bypass in pediatric cardiac surgery.

Objective: To determine whether the activation state of polymorphonuclear neutrophils (PMNs) and monocytes contributes to the inflammatory response after cardiopulmonary bypass (CPB) in pediatric cardiac surgery.

Design: Observational prospective clinical study.

Setting: Pediatric intensive care unit of a university hospital.

Dynamic cerebral autoregulatory response to blood pressure rise measured by near-infrared spectroscopy and intracranial pressure.

Objectives: Noninvasive near-infrared spectroscopy (NIRS) continuously monitors changes in cerebral hemoglobin saturation (Hb(Diff) ) and content (Hb(Total)). It may allow visualization of the dynamic cerebral autoregulatory response to rapid blood pressure increases without relevant contamination of the NIRS signal from extracerebral hemoglobin.

Design: Prospective cohort study.

Severe traumatic brain injury in children--are the results improving?

Questions Under Study: Traumatic brain injury (TBI) remains an important cause of mortality and morbidity in children. Medical management is constantly being refined, and thus results should improve. The aim of the present study was to analyse our data of recent years and to compare them with previous series (1978-83 and 1988-92).

Procedural factors associated with early postoperative arrhythmias after repair of congenital heart defects.

Objectives: Early postoperative arrhythmias frequently are a relevant problem in the early postoperative management after surgical intervention for congenital heart disease. Few data are available indicating risk factors for their occurrence. The hypothesis was tested that factors closely related to the surgical procedure itself were associated with a higher incidence of arrhythmias early in the postoperative course after repair of congenital heart disease.

Common anorectal conditions.

Patients with a wide variety of anorectal lesions present to family physicians. Most can be successfully managed in the office setting. A high index of suspicion for cancer should be maintained and all patients should be questioned about relevant family history or other indications for cancer screening.

Common anorectal conditions: Part II. Lesions.

Patients with a wide variety of anorectal lesions present to family physicians. Most can be successfully managed in the office setting. A high index of suspicion for cancer should be maintained and all patients should be questioned about relevant family history or other indications for cancer screening.

Survivors with bad outcome after hypoxic-ischaemic encephalopathy: full-term neonates compare unfavourably with children.

Unlabelled: Hypoxic-ischaemic encephalopathy (HIE) is of major importance in neonatal and paediatric intensive care with regard to mortality and long-term morbidity. Our aim was to analyse our data in full-term neonates and children with special regard to withdrawal of life support and bad outcome.

Patients: All patients with HIE admitted to our unit from 1992-96 were analysed.

Racial differences in newborn intensive care morbidity in Alaska.

Birthweight-specific neonatal mortality for Alaska Natives is higher than for non-natives for the years 1987-1996. We investigated the reasons for this based on Level III Neonatal Intensive Care Unit information available from 1991-1996. We also investigated whether differences in mortality extended to measures of morbidity.

Common anorectal conditions: Part I. Symptoms and complaints.

Anorectal symptoms and complaints are common and may be caused by a wide spectrum of conditions. Although most conditions are benign and may be successfully treated by primary care practitioners, a high index of suspicion for colorectal cancer should be maintained, and all patients should be appropriately investigated. Inspection, palpation and anoscopic examination using an Ive's slotted anoscope provide adequate initial assessment.

Lobar pulmonary interstitial emphysema in a premature infant on continuous positive airway pressure using nasal prongs.

Unilobar pulmonary interstitial emphysema may emerge in extremely low birth weight infants without mechanical ventilation but on continuous positive airway pressure using nasal prongs.

Bronchodilator responsiveness in a ventilator-dependent infant with severe tracheobronchomalacia.

A neonatal case of severe, ventilator-dependent tracheobronchomalacia (TBM) is described. The extent of the malacic segment was determined by endoscopy and tracheobronchography. Additionally, relevant and ever increasing reversible peripheral airway obstruction was documented by measuring the mechanical properties of the respiratory system before and after salbutamol.