Preventing Home Medication Administration Errors.

Medication administration errors that take place in the home are common, especially when liquid preparations are used and complex medication schedules with multiple medications are involved; children with chronic conditions are disproportionately affected. Parents and other caregivers with low health literacy and/or limited English proficiency are at higher risk for making errors in administering medications to children in their care. Recommended strategies to reduce home medication errors relate to provider prescribing practices; health literacy-informed verbal counseling strategies (eg, teachback and showback) and written patient education materials (eg, pictographic information) for patients and/or caregivers across settings (inpatient, outpatient, emergency care, pharmacy); dosing-tool provision for liquid medication measurement; review of medication lists with patients and/or caregivers (medication reconciliation) that includes prescription and over-the-counter medications, as well as vitamins and supplements; leveraging the medical home; engaging adolescents and their adult caregivers; training of providers; safe disposal of medications; regulations related to medication dosing tools, labeling, packaging, and informational materials; use of electronic health records and other technologies; and research to identify novel ways to support safe home medication administration.

Children's low-level pesticide exposure and associations with autism and ADHD: a review.

Pesticides are chemicals that are designed specifically for the purpose of killing or suppressing another living organism. Human toxicity is possible with any pesticide, and a growing body of literature has investigated possible associations with neurodevelopmental disorders. Attention deficit disorder with or without hyperactivity (ADHD) and autism spectrum disorder (ASD) are two of these specific disorders that have garnered particular interest.

Resource utilization and cost of inserting peripheral intravenous catheters in hospitalized children.

Objective: The goal of this study was to measure the costs and difficulty in placing peripheral intravenous (IV) catheters in hospitalized children; measures of resource utilization. We measured the costs and difficulty in placing peripheral intravenous (IV) catheters in hospitalized children. This common procedure has implications for the utilization of hospital resources.

Are children still at risk for lead poisoning?

Background: The prevalence of elevated blood lead levels (EBLLs) has decreased nationally, creating challenges in identifying children at risk.

Methods: In a community known to have lead hazards, we screened children with a field-administered capillary blood lead test and asked parents to complete a questionnaire about lead risk factors.

Results: Of the 77 child-parent pairs screened with a blood lead test and a parental questionnaire, 4 had finger stick blood lead levels of ≥10 µg/dL.

Peripheral intravenous access in pediatric inpatients.

Background: Peripheral intravenous (PIV) line placement is a time-consuming procedure performed on the majority of general pediatric inpatients, with significant discomfort to patients.

Objective: To determine parameters of pediatric PIV placement, including success rates, time to success, and factors associated with success.

Design: Prospective study involving direct observation of PIV placement by trained research staff.

Acute disseminated encephalomyelitis following infectious mononucleosis.

Two months following an Epstein-Barr virus infection, a 17-year-old white female presented with seizures, intermittent visual changes, and altered mental status. Magnetic resonance imaging showed white matter changes of acute disseminated encephalomyelitis with a predilection for posterior cerebral artery distributions but without radiological evidence of arteritis. Epstein-Barr virus titers and polymerase chain reaction analysis results for the virus were consistent with postinfectious acute disseminated encephalomyelitis.

Does anything beat DEET?

In comparison trials, DEET is more effective than any other insect repellent. Despite some reports of serious adverse events, when comparing the thousands of other reports of exposure and millions of past users, DEET has a good safety record. The appropriate and safest concentration to use on children remains unclear, however.

Environmental pediatrics and its impact on government health policy.

Recent public recognition that children are different from adults in their exposures and susceptibilities to environmental contaminants has its roots in work that began >46 years ago, when the American Academy of Pediatrics (APA) established a standing committee to focus on children's radiation exposures. We summarize the history of that important committee, now the AAP Committee on Environmental Health, including its statements and the 1999 publication of the AAP Handbook of Pediatric Environmental Health, and describe the recent emergence of federal and state legislative and executive actions to evaluate explicitly environmental health risks to children. As a result in large part of these efforts, numerous knowledge gaps about children's health and the environment are currently being addressed.

Preventive services: blood pressure checks at well child visits.

The objective of this study was to determine rates of blood pressure (BP) screening at well-child visits as recommended by the Task Force on Blood Pressure Control in Children. The 1985 and 1996 National Ambulatory Medical Care Surveys were analyzed for changes in proportion of well visits for children aged 3-18 years at which BP was checked. Patient and physician demographics are described.

Inaccuracy in parental reporting of the age of their home for lead-screening purposes.

Objective: To determine the proportion of children living in pre-1950 housing who are correctly identified by parental report as being at risk for lead poisoning.

Design: Cross-sectional survey of parents. Parents' answers about the age of their home were compared with the age of the home found in tax assessor records.

Using geographic information systems to assess risk for elevated blood lead levels in children.

Objectives: Targeted screening for childhood lead poisoning depends on assessment of risk factors including housing age. Using a geographic information system (GIS), we aim to determine high-risk regions in Charleston County, South Carolina, to assist public health officials in developing targeted lead-screening.

Methods: Properties built before 1978 were geocoded (assigned latitude and longitude coordinates) from tax assessor data.

Environmental health education in the medical school curriculum.

Objective: To collect baseline data of environmental history-taking skills and clinical toxicology knowledge and examine the effects of a lecture on environment on students' history-taking skills.

Methods: An anonymous survey was distributed to third-year medical students prior to an asthma lecture that strongly emphasized environmental triggers. Fourteen questions assessed students' practices and attitudes toward environmental history taking.

Pesticides in children.

Children are exposed to a wide range of pesticides, including insecticides, herbicides, fungicides, and rodenticides. They differ from adults in their exposures and responses to exposures. Acute and chronic toxicity are discussed, and important chronic effects, such as carcinogenesis, endocrine disruption, and neurodevelopment effects are reviewed.

Time required for blood lead levels to decline in nonchelated children.

Objective: To determine the time for a decline in blood lead to less than 10 microg/dL in nonchelated children who are enrolled in case management.

Study Design: Retrospective analysis of venous blood lead data of lead-poisoned children followed in a case management program designed to decrease lead exposure. Children were excluded if their blood lead had not yet declined to less than 10 microg/dL, if they received chelation therapy, or if they had not received follow-up for more than 15 months.

When do medical students identify career-influencing physician role models?

Purpose: To identify when medical students gain physician role models relative to when they make their specialty choices.

Method: The 1998 graduating class of one medical school was surveyed about when and where they had made contact with their role models and whether they had made contact before or after making their specialty choices. Students also provided data about their demographics, curriculum pathways (problem-based or traditional), and specialty choices at matriculation and graduation.

Children's health and the environment: a new agenda for prevention research.

Patterns of illness in American children have changed dramatically in this century. The ancient infectious diseases have largely been controlled. The major diseases confronting children now are chronic and disabling conditions termed the "new pediatric morbidity"--asthma mortality has doubled; leukemia and brain cancer have increased in incidence; neurodevelopmental dysfunction is widespread; hypospadias incidence has doubled.

Prenatal care and infant lead exposure.

Objective: The objective of the study was to determine the relation between prenatal care of mothers and blood lead concentrations in their offspring in the first year of life.

Methods: A retrospective survey was conducted of 200 predominantly black infants between the ages of 6 and 22 months (mean age, 13.4 months).