Lawrence F. Nazarian

Normal pulmonary function measurements and airway reactivity in childhood after mild bronchiolitis

Concern about the long-term sequelae of bronchiolitis has been raised through studies of children hospitalized for bronchiolitis, but the long-term sequelae of mild bronchiolitis have not been studied. We assessed the hypothesis that 25 children with mild bronchiolitis (index subjects) were at greater risk for abnormalities of pulmonary function or airway reactivity to cold air between the ages of 8 and 12 years than were randomly selected, matched controls. There were no consistent differences in pulmonary function or airway reactivity between index and control groups. Airway hyperreactivity was found in five control subjects and three index subjects, and all children with symptomatic asthma were identified by cold air challenge. Our data suggest that children with a history of mild bronchiolitis are not at increased risk between ages 8 and 12 years for airway hyperreactivity or for abnormalities in pulmonary function.

Pediatrics in Review: A Reflection of Our Profession

1. Lawrence F. Nazarian, MD, Editor-in-Chief As I look back on 27 years of affiliation with Pediatrics in Review ( PIR ), it strikes me that much of what has evolved in the growth and development of the Journal mirrors what has been happening in the general realm of pediatrics. The complexion of our profession is different from what it was in 1985, when I first joined the editorial board, and that metamorphosis is paralleled by changes that have taken place in PIR . A much stronger emphasis on backing up our practice with evidence has swept through all of medicine. I like to think that we had always based our actions on solid findings; however, the intensity of this effort has increased mightily. Although the Journal is known for its practical philosophy, we have encouraged authors to give the readers the underlying evidence for their recommendations and to indicate the strength of that evidence. Articles have been written specifically on the topic of evaluating the literature and making intelligent judgments from studies. We have published a series on research and statistics, educating our readers about the specific procedures that determine validity and applicability of research data. Our series on complementary and holistic pediatrics presents in an objective fashion the studies that have been done of these alternative therapies, focusing on the evidence for efficacy and safety and putting each treatment into a proper perspective. All of society has been …

Friend to All PediatriciansA Privilege to Know Him

1. Joseph A. Zenel, MD 1. Editor-in-Chief, Pediatrics in Review 2. Sanford Childrens Hospital, The Sanford School of Medicine, University of South Dakota, Sioux Falls, SD “Emphasis on the first syllable. Rhymes with kennel.” This is my well-seasoned response when asked how to pronounce my last name. At the start of each school year when our children were growing up, our children would annually complain at the dinner table about how badly our last name was pronounced by the new teacher. Invariably our children would follow with, “Yeah, we know Dad! Emphasis on the first syllable. Rhymes with kennel.” My last name used to be longer and significantly more nuanced in pronunciation. Family legend has it that my paternal grandfather, fleeing from World War I, emigrated from Poland at age 14 years and …

More than just a friend.

1. Lawrence F. Nazarian, MD, Editor-in-Chief Let me introduce you to some of my friends. My most vivid recollection of Benjamin takes me back to his 5-year-old visit, just before he started kindergarten. He was sitting on the examining table wearing only two things: underpants, on which were emblazoned various superheroes, and a backpack, which proudly displayed the same defenders of the universe. He removed his backpack and said, with a grin, “Wanna see my stuff?” At that moment, the contents of his backpack defined the most important aspect of his world, perhaps his very identity. It made me yearn for a time when things were that simple. Nevaeh was only 2 weeks old when I …

Change is in the Air

Although the primary goal of Pediatrics in Review ( PIR ) is to keep the pediatrician up to date across the broad spectrum of pediatric knowledge, the journal serves other purposes. One function is to allow the reader to earn continuing medical education (CME) credits. Reading the journal and taking the quizzes, learners can earn up to 36 credits per year; taking the companion PREP Self-Assessment in learning mode can add up to 43 additional credits. Many physicians can fulfill all of their CME requirements by using these two learning tools. As most readers are aware, specific criteria must be met before accrediting educational organizations will grant CME credit. For instance, the Accreditation Council for Continuing Medical Education (ACCME) in 2011 awarded the American Academy of …

The pediatrician as teacher.

1. Lawrence F. Nazarian, MD, Editor-in-Chief The word “doctor” means “teacher,” and like all physicians, pediatricians function as teachers in many contexts. Every time a patient is cared for, some teaching is accomplished, even in a brief visit. When performing health maintenance or managing chronic illness, teaching becomes a major component of care. Patients, parents, and caregivers are the students (although the complete physician will be learning constantly from those folks as well). In a pediatric office, physician partners teach and learn from each other, and that type of interchange extends to the entire health-care team. I acknowledge with gratitude the invaluable lessons I have learned from nurses and nurse practitioners, and I hope I have repaid in kind. Secretaries, receptionists, business personnel – we can teach all of them, and their contribution to our education is critical. Many in our profession have devoted their careers to teaching, and those of us in practice who have learned so much from academic physicians, both in our training …

Expanding Our Horizons

1. Lawrence F. Nazarian, MD, Editor-in-Chief As I interview candidates for admission to medical school, I marvel at the experiences they have had compared with my generation. International travel, volunteer experiences of kaleidoscopic diversity, exposure to research from the bench to the clinic, excursions into disciplines far removed from medicine—these young people roam far beyond the traditional track that I and most of my classmates followed. Similarly, the perspectives of medicine and of pediatrics have broadened constantly. Although good physicians always have realized that any aspect of the human condition is relevant to the patients welfare, we now formally study areas that were not part of the curriculum decades ago. One example is cultural effectiveness, which has had more than one name but in essence connotes sensitivity to and knowledge of the elements of …

A Flood of Information

1. Lawrence F. Nazarian, MD, Editor-in-Chief Many elements in our lives can overwhelm us and overload our circuits, including responsibilities, worries, and conflicting appointments. Even some treats we enjoy can get to be too much, such as tomatoes in the garden at the peak of the season, photographs waiting to be organized, and exceptional books crying out to be read. Another flood that threatens to engulf us is information. Even if we ignore the obviously misleading or irrelevant rivers of data flowing toward our minds, there is enough worthwhile, relevant, desirable information coming our way to sweep us over the falls. Restricting our focus to medical knowledge, and even further to an understanding of pediatric medicine, we still find that sector of the information ocean stretching out to the horizon and getting bigger every year. There used to be lectures, seminars, workshops, textbooks, and journals. All of these sources have multiplied, and we have added continuing medical education courses, teleconferences, CDs and DVDs, and that infinite highway to knowledge about everything under the sun and beyond, the Internet. No wonder many practitioners feel they are lost at sea and going down for the …

Improving the Health of Children Through You

1. Lawrence F. Nazarian, MD, Editor-in-Chief In 2005, Pediatrics in Review ( PIR ) concentrated on its dual missions of keeping clinicians current across the broad spectrum of pediatric medicine while preparing those who will be maintaining their certification. We consider PIR not just a journal but also a critical component of a systematic program of lifelong learning. Basing our coverage on the content specifications of the American Board of Pediatrics, the foundation for their cognitive recertification examination, has been a key factor in achieving those goals. The PREP Self-Assessment, our sibling in continuing medical education, shares coverage of the content specifications and allows those seeking maintenance of certification to fulfill the requirement for self-evaluation. At the same time, we recognize the need to present material that goes beyond those content specifications, and we want …

Alexis's picture: a perspective on a different perspective.

1. Lawrence F. Nazarian 1. Rochester, NY The coloring on this school work sheet was done by Alexis Barboza of New Bedford, Mass. Alexis is 6 years old …