Hope and Optimism in Pediatric Deep Brain Stimulation: Key Stakeholder Perspectives.

Introduction: Deep brain stimulation (DBS) is utilized to treat pediatric refractory dystonia and its use in pediatric patients is expected to grow. One important question concerns the impact of hope and unrealistic optimism on decision-making, especially in "last resort" intervention scenarios such as DBS for refractory conditions.

Objective: This study examined stakeholder experiences and perspectives on hope and unrealistic optimism in the context of decision-making about DBS for childhood dystonia and provides insights for clinicians seeking to implement effective communication strategies.

Circumcision practice patterns in the United States.

Objective: To determine 1) the performing of circumcision by medical specialty, gender, and years of practice; 2) the pattern of anesthetic use for this procedure; and 3) the reasons physicians cite for not using anesthesia.

Design: A total of 3066 questionnaires were received from a mailing to a representative sampling of physicians stratified by specialty and geographic location.

Results: Fifty-eight percent (1768) of the questionnaires were returned and interpretable from the following specialists: pediatricians (PEDs), 73% (n = 691); family practitioners (FPs), 52% (n = 464); and obstetricians (OBs), 51% (n = 623).

Beyond dorsal penile nerve block: a more humane circumcision.

Objective: To explore techniques that can be utilized in addition to the dorsal penile nerve block (DPNB) to further reduce the neonate's stress and pain from routine circumcision, and thus make the procedure more humane.

Setting: Level 1 nursery at a community hospital.

Subjects: Eighty healthy, term, newborn male infants scheduled for routine neonatal circumcision.

Prospective evaluation of complications of dorsal penile nerve block for neonatal circumcision.

Objective: To evaluate the complications of the dorsal penile nerve block (DPNB) when used for routine neonatal circumcisions.

Methods: All male newborns born in a community hospital between November 1, 1989 and August 31, 1990, and circumcised after DPNB were evaluated. Questionnaires were completed at the time of hospital discharge and at a health supervision visit 2 weeks later.

Duration of positive throat cultures for group A streptococci after initiation of antibiotic therapy.

Objective: To determine if it is appropriate to recommend that patients with group A beta-hemolytic streptococcal pharyngitis, who are clinically well by the morning after starting antibiotic treatment, can return to school or day care, or if they should wait until they have completed 24 hours of antibiotics as recommended by the American Academy of Pediatrics Committee on Infectious Diseases.

Methods: We examined the duration of positivity of the throat culture after antibiotics were begun as a means of assessing the potential risk of transmission to close school contacts. Forty-seven children (4 to 17 years of age) with pharyngitis and a positive throat culture for group A streptococci in an outpatient, staff model health maintenance organization clinic were enrolled and were randomly selected to receive therapy with either oral penicillin V, intramuscular benzathine penicillin G, or oral erythromycin estolate.

Local anesthesia for neonatal circumcision. Effects on distress and cortisol response.

A controlled, double-blind investigation was conducted to determine whether the dorsal penile nerve block using lidocaine hydrochloride without epinephrine would effectively reduce behavioral distress and adrenocortical responses to routine neonatal circumcision. The subjects were healthy male newborns whose parents had requested circumcision. Equal numbers (n = 20) were randomly assigned to circumcision with lidocaine, saline, or no injection.

Breast and testicular self-examination in primary care.

Among a random sample of Michigan family physicians, attitudes about encouraging patients to perform breast and testicular self-examination were very positive. The physicians' self-reported incorporation of such encouragement into their practices was much lower for testicular than breast self-examination. Two hundred seventy-eight randomly selected family physicians in Michigan were surveyed about their beliefs about and professional practices regarding encouraging patients to perform breast self-examination (BSE) and testicular self-examination (TSE).

Preventive medicine: physician practices, beliefs, and perceived barriers for implementation.

Despite increasing recognition of the need for physicians to practice preventive medicine, there is much evidence that performance is well below the ideal recommended by experts. The purpose of this study was to determine what preventive medicine activities physicians practice, whether their personal health practices and beliefs about preventive medicine correlate with professional practices of preventive medicine, and what barriers to practicing preventive medicine physicians identify. Results from a questionnaire mailed to a random sample of 430 family physicians indicated physicians practice health promotion for themselves more than revealed in earlier studies and that physicians frequently incorporate many preventive medicine activities into their professional practices.

Interferences in collaboration between child psychiatrists and pediatricians: a fundamental difference in attitude toward childhood.

The relationship between pediatrics and child psychiatry has been discussed at length. Opportunities seem to exist for cooperation between the two specialties, and yet difficulties exist. This study compared attitudes toward childhood held by pediatricians and child psychiatrists, as well as by residents at the beginning and end of training in pediatrics, psychiatry, and child psychiatry.