Showing papers by "Atlantic Health System published in 2007"

Use of decubitus radiographs in the diagnosis of foreign body aspiration in young children.

Abstract: Background:Lateral decubitus radiographs are often obtained in young children with suspected foreign body aspiration. Their usefulness has not been well studied.Objectives:To assess the value of decubitus radiographs in detecting foreign body aspiration in young children and compare their value to h

Hypertension in Childhood

Abstract: 1. Leonard G. Feld, MD, PhD* 2. Howard Corey, MD† 1. *Editorial Board 2. †Director, Pediatric Nephrology, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ After completing this article, readers should be able to: 1. Describe the practical approach to confirming the diagnosis of hypertension. 2. Delineate the differential diagnosis and diagnostic approach for a child who has significant hypertension. 3. Discuss the role of the pediatrician in advising the parents and child/adolescent on the nonpharmacologic approach to treating hypertension. 4. List the primary classes of antihypertensive medications to treat hypertension in childhood. David is a 10-year-old boy who complains of frequent headaches. He generally is healthy, but he is overweight and has an anxiety disorder. There is a strong family history of hypertension. On physical examination, the seated blood pressure (BP) using a child-size cuff and an automated noninvasive blood pressure monitor is 140/85 mm Hg. Suspecting hypertension as the cause of the headache, his physician refers David to a pediatric nephrologist for additional investigation . On the initial physical examination, the seated BP reading using an adult-size cuff and a manual aneroid manometer is 135/80 mm Hg. A second reading, taken 15 minutes later, is 122/72 mm Hg. His body mass index (BMI) exceeds the 95th percentile for age. The remainder of the physical examination findings are unremarkable . Subsequently, a 24-hour ambulatory blood pressure monitor (ABPM) reveals that 35% of the daytime readings exceed the 95th percentile for age, sex, and height, confirming the diagnosis of hypertension. Echocardiography reveals mild left ventricular hypertrophy (LVH), but otherwise shows normal results, as do blood chemistries, urinalysis, plasma renin activity, catecholamine measurement, and renal ultrasonography. However, the plasma uric acid concentration is mildly elevated at 6.6 mg/dL (0.39 mmol/L) . In the 3 decades since the first Report of the Task Force on Blood Pressure Control in Children , the guidelines for pediatric hypertension have been clarified, diagnostic evaluation has been refined, and therapeutic options have been expanded. Increasing …

School Nurse Knowledge and Perceptions of Recurrent Abdominal Pain: Opportunity for Therapeutic Alliance?

Abstract: Recurrent abdominal pain of childhood affects up to 15% of school-age children, who face significant psychosocial consequences, including school absence. Because assessment of recurrent abdominal pain is frequently made at the school nurse level, a questionnaire was sent to 425 school nurses to evaluate perceptions about recurrent abdominal pain. Among the responses, 47.1% believed children were faking or seeking attention; 3.6% considered it a serious disease, 77.9% stated that affected children should see a physician, 51.5% believed they should relax, and 25.0% believed they needed medicine. Results indicated that school nurses were unclear on epidemiologic and etiologic features of recurrent abdominal pain and had negative views that may inadvertently contribute to the anxiety felt by affected children. Education of school nurses and communication from physicians may advance strategies designed to reduce the fiscal and social costs associated with this common childhood condition.

Uma visão evidente da prática baseada em evidências na medicina perinatal: ausência de evidência não é evidência de ausência

Abstract: OBJECTIVE: To provide valuable elements and some humor in this so-called era of "evidence-based practice" with the aim of helping clinicians make better choices in the care they deliver based on evidence, not simply or exclusively based on a randomized clinical trial (RCT) or meta-analysis (which may not be evidence). SOURCES: Books and peer-reviewed articles are quoted and listed in the bibliography. Evidence of life, learning from our own mistakes and many other evident facts that support this review are not quoted. SUMMARY OF THE FINDINGS: 1) "Absence of evidence is not evidence of absence" and "lack of evidence of effect does not mean evidence of no effect". 2) RCTs with "negative" results and those with "positive" results, but without outcomes that matter, often cannot conclude what they conclude. 3) Non-randomized clinical trials and practical trials may be important. 4) Research to prove is different than research to improve. 5) Clinical choice must assess effects on outcomes that matter to patients and their parents. 6) Quantifying adverse outcomes, number needed to damage and to treat is not that simple. CONCLUSIONS: Significant challenges inherent to health service research must be correlated to possible clinical applications using tools to have a more "evident view of evidence-based practice" in perinatal medicine, recalling that absence of evidence is not evidence of absence.

Two cases illustrating a potential difference between transobturator and retropubic slings

Abstract: The transobturator sling procedure is a relatively new technique as compared to the retropubic version. The functional differences between these two procedures are largely unknown. Two cases of failed transobturator slings are reported. In both cases, the procedure was done under local anesthesia and a cough stress test was performed to adjust the tape. The transobturator slings were unable to stop the leakage and we replaced them with the retropubic versions, which were successful. Even when pulled very tightly, some transobturator slings will fail to stop stress incontinence that is amenable to cure from a typically placed "tension-free" retropubic sling. The cough stress test can identify such cases.