Martin I. Lorin

Treatment of tuberculosis in children.

This article discusses and gives rational guidelines for the treatment and control of pulmonary and extrapulmonary tuberculosis in children, giving special consideration to questions of antibiotic resistance. Also featured is a discussion of the special problems of managing a tuberculous mother and her infant.

Bacteremia in children afebrile at presentation to an emergency room.

Charts of 182 outpatient children with bacteremia caused by Streptococcus pneumoniae, Haemophilus influenza type b or Neisseria meningitidis were reviwed. Twenty-four patients (13%) were afebrile (temperature < 37.8°C) at presentation. Five afebrile patients had no history of fever. Four of the five had localizing signs of infection and one appeared toxic. Afebrile patients were not strikingly different from febrile bacteremic patients by any assessments. Bacteremia in children cannot be excluded on the basis of absence of fever by history and examination. Blood cultures should be performed on afebrile children who either have localizing signs of serious bacterial infections or appear toxic.

What is a clinical pearl and what is its role in medical education

Background: Despite the advent of evidence-based medicine, clinical pearls, verbal and published, remain a popular and important part of medical education. Aims: The purpose of this study was to establish a definition of a clinical pearl and to determine criteria for an educationally sound clinical pearl. Methods: The authors searched the Medline database for material dealing with clinical pearls, examined and discussed the information found, and formulated a consensus opinion regarding the definition and criteria. Results: Clinical pearls are best defined as small bits of free standing, clinically relevant information based on experience or observation. They are part of the vast domain of experience-based medicine, and can be helpful in dealing with clinical problems for which controlled data do not exist. Conclusions: While there are no universally accepted criteria for preparing or evaluating a clinical pearl, we propose some rational guidelines for both.

Extreme leukocytosis in patients presenting to a pediatric emergency department

We determined the frequency and clinical significance of white blood cell (WBC) counts ≥25,000/µl in children presenting to an emergency department (ED) and defined a degree of leukocytosis which might be considered extreme in this setting. Records of all patients seen in the ED between February 1985 and December 1986 with WBC counts ≥25,000/µl were identified. Each patient was paired with the chronologically nearest patient with a WBC count between 15,000 and 25,000/µl. Of the total WBCs obtained, 5.8% were ≥25,000/µl; only 1% were ≥35,000/µl. Eighteen percent of patients with counts ≥25,000/µl had a serious disease, and 6% had bacteremia. Twenty-six percent of patients with counts ≥35,000/µl had a serious disease, and 10% had bacteremia. On the basis of infrequency and severity of illness, we suggest that, in children presenting to a pediatric emergency department, WBC counts ≥35,000/µl be considered extreme leukocytosis.

Transforming teaching into scholarship

Background:  Traditionally, scholarship has been defined very narrowly as the number of one’s publications and grant awards. Recently this definition has broadened to include dissemination of knowledge, experience or a tangible product shared with the educational community.

Value Placed on Formal Training in Education by Pediatric Department Chairs and Residency Program Directors

BACKGROUND While much is known about how educational leaders at the medical school level (eg, deans) view the importance of formal training in education for medical school teachers, little is known about how leaders at the clinical level (eg, department chairs) view such training. We sought to determine how pediatric department chairs and residency program directors view the value of formal training in education, such as that at a Master of Education (MEd) level, and to estimate the number of clinical pediatric faculty with or pursuing such training. METHODS A survey designed to assess the value placed on formal training in education and to estimate the number of clinical faculty with or pursuing such training was mailed to pediatric department chair persons and residency program directors at all 131 allopathic medical schools in the United States and Puerto Rico. RESULTS Eighty department chairs (61%) responded, and most indicated that when hiring new faculty, they view an applicant with an MEd as having an advantage. Both chairs and residency directors considered an MEd to be advantageous for a residency director by a ranking of 4.5 and 4.2, respectively, on a scale of 1 to 5 (P  =  .008). Of the 80 chairs who responded, 58.8% of respondents reported one or more faculty in their department had or was pursuing an MEd. Of the 72 responding residency directors (55%), 11 respondents (15.3%) indicated that they had an MEd. CONCLUSION More than half the medical school pediatric chairs responding to the survey had one or more clinical faculty with or pursuing an MEd in their departments. Survey results indicated that such training is valued by both department chairs and residency directors. Given the time and expense involved in obtaining an MEd, awareness of these data 5 be helpful to those considering pursuing, offering, or requiring such training.

Similarity in white blood cell counts between white and black children with bacteremia

The charts of 104 white and 52 black children with bacteremia caused by Streptococcus pneumoniae or Haemophilus influenzae type b were reviewed to determine each patients white blood cell (WBC) and absolute polymorphonu-clear cell (PMN) counts at the time of presentation to the emergency room. Mean WBC and PMN counts were virtually identical for the racial groups, 18 300 vs. 18 700/μl and 12 900 vs. 13 000/μl, respectively. Examination of subgroups of white and black children with or without meningitis or other focal infection also revealed no significant differences between races, although significantly lower mean WBC and PMN counts were found in children with, compared to those without, meningitis regardless of race. As an aid to the identification of children at high risk for S. pneumoniae or H. influenzae type b bacteremia, it appears that WBC and PMN counts may be interpreted without regard to race.