Michael B. Aldous

Tachypnea is a useful predictor of pneumonia in children with acute respiratory infection

(2000) Arch Dis Child 82, 41. Palafox M, Guiscafre H, Reyes H, et al. . Diagnostic value of tachypnoea in pneumonia defined radiologically. . Jan; . : . –5 . [OpenUrl][1][Abstract/FREE Full Text][2] 
 QUESTIONS: In children with acute respiratory infection, is tachypnea accurate for detecting pneumonia? Does disease duration, age of the child, or presence of malnutrition influence sensitivity and specificity? Blinded comparison of respiratory rate with findings on chest radiography. A state referral hospital in Tlaxcala, Mexico. 110 children who were 3 days to 5 years of age (55% were ≥1 y of age) and had acute respiratory infection. Children who were clinically diagnosed with pneumonia were matched to control children with acute respiratory infection. 30% of children were underweight. Exclusion criteria were chronic diseases, genetic abnormalities, neurological diseases, bronchial asthma, or septicaemia. A paediatrician measured the respiratory rate by observing the childs chest movements for 1 minute while the child rested with no crying or fever. Tachypnea was defined as a respiratory rate >60 breaths/minute in children 50 breaths/minute in children 2 to 12 months of age, and >40 breaths/minute in children ≥1 year of age. The diagnostic standard was chest radiography (not clinical diagnosis). Sensitivity and specificity for detecting pneumonia. 59 children (54%) had a … [1]: {openurl}?query=rft.jtitle%253DArchives%2Bof%2BDisease%2Bin%2BChildhood%26rft.stitle%253DArch.%2BDis.%2BChild.%26rft.issn%253D0003-9888%26rft.aulast%253DPalafox%26rft.auinit1%253DM.%26rft.volume%253D82%26rft.issue%253D1%26rft.spage%253D41%26rft.epage%253D45%26rft.atitle%253DDiagnostic%2Bvalue%2Bof%2Btachypnoea%2Bin%2Bpneumonia%2Bdefined%2Bradiologically%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fadc.82.1.41%26rft_id%253Dinfo%253Apmid%252F10630911%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=archdischild&resid=82/1/41&atom=%2Febmed%2F5%2F5%2F152.atom

Office laboratory procedures, office economics, patient and parent education, and urinary tract infection

This section updates the reader on four important areas of office practice: office laboratory procedures, office economics, patient and parent education, and urinary tract infections. Dr. Michael Aldous reviews the recent literature about office laboratory procedures, including the continued impact of the Clinical Laboratory Improvement Ammendments, what is new in the diagnosis of streptococcal pharyngitis, urinalysis improvements, the diagnosis of anemia, and which patients should undergo cholesterol screening. Dr. Rickey Williams discusses the literature on office economics, including new technology for billing and charting, whether pediatricians should bill for telephone calls, and the latest information on health care policy and the changes offices are facing with the growing managed care market. Dr. Burris Duncan reviews patient and parent education, including new apporaches to infant colic, sleep positioning for the prevention of sudden infant death, the need for the hepatitis B vaccine (which has been slowly implemented), and finally ways that pediatricians can help with parenting. Dr. John Ey discusses the recent literature on urinary tract infections in children, including better ways of making the diagnosis, whether there are any new treatment approaches for urinary tract infections, useful investigational studies for evaluating the urinary system, and how best to follow up children with infected urinary tracts. We hope that this review will help the practicing pediatrician to better care for patients and provide each of you with a greater satisfaction in delivering health care in an office setting.

Office laboratory procedures, economics of practice, patient and parent education, and urinary tract infection.

This review highlights recent advances in four major areas that are relevant to office practice: office laboratory procedures, economics of practice, adolescent risk-taking behavior in terms of sexually transmitted diseases, and urinary tract infections. Who should be screened for diseases and where these screening tests should be done are addressed, keeping the practicing pediatrician in mind. Next we review current office economics, including whether professional courtesy should be continued, how our practices are going to be increasingly influenced by guidelines developed by the American Academy of Pediatrics, the Clinical Laboratory Improvement Amendments, and the new Clinton Health Plan if it survives Congress, and finally how all of these issues will affect our expected income in the years ahead. As pediatricians strive to retain adolescent patients in their practices, they will need to find appropriate ways of counseling these patients concerning risk behaviors that could result in sexually transmitted diseases or HIV infections. Should we leave the comfortable confines of our offices to participate in these counseling programs for adolescents, and are there lessons from existing successful International Health Programs that we can use? Finally, urinary tract infections (UTIs) continue to be a common cause of childhood infections with possible serious long-term sequelae. Can we do a better job of diagnosing UTIs, has improved treatment become available, and is prevention of recurrences possible? Once the diagnosis has been made, how can we best evaluate these children with UTIs for underlying urologic abnormalities? It is our hope that the practicing pediatrician will be better prepared to face these issues having read this review.

Immediate antibiotics were beneficial in children with acute otitis media who had fever and vomiting

Main results In children with fever (temperature > 37.5°C) or vomiting at initial diagnosis, immediate antibiotics reduced distress and night disturbance by day 3 (table) and reduced days of crying (1.58 v 2.82 d, p < 0.001) more than did delayed antibiotics. In children without fever or vomiting, immediate antibiotics did not differ from delayed antibiotics for distress or night disturbance (table), or days of crying (1.53 v 1.93 d, p=0.47). Conclusions In children with acute otitis media and fever or vomiting, immediate antibiotic treatment was more beneficial than delayed antibiotic treatment for reducing distress, night disturbance, and crying. Among those without fever or vomiting, immediate and delayed antibiotic treatment did not differ.

Ventilation tubes did not improve quality of life in persistent otitis media with effusion

Source Citation Rovers MM, Krabbe PF, Straatman H, et al. Randomised controlled trial of the effect of ventilation tubes (grommets) on quality of life at age 1-2 years. Arch Dis Child. 2001 Jan;84:...

A respiratory rate of ≥ 60 breaths per minute had high sensitivity for detecting hypoxia in infants

Source Citation Rajesh VT, Singhi S, Kataria S. Tachypnoea is a good predictor of hypoxia in acutely ill infants under 2 months. Arch Dis Child. 2000 Jan;82:46-9. 10630912

Office pediatrics: Office laboratory procedures, Office economics, Patient and parent education, and Urinary tract infection

&NA; This section updates the reader on four important areas of office practice: office laboratory procedures, office economics, patient and parent education, and urinary tract infections. Dr. Micheal Aldous reviews the recent literature about office laboratory procedures, including the continued impact of the Clinical Laboratory Improvement Ammendments, what is new in the diagnosis of streptococcal pharyngitis, urinalysis improvements, the diagnosis of anemia, and which patients should undergo cholesterol screening. Dr. Rickey Williams discusses the literature on office economics, including new technology for billing and charting, whether pediatricians should bill for telephone calls, and the latest information on health care policy and the changes offices are facing with the growing managed care market. Dr. Burris Duncan reviews patient and parent education, including new apporaches to infant colic, sleep positioning for the prevention of sudden infant death, the need for the hepatitis B vaccine (which has been slowly implemented), and finally ways that pediatricians can help with parenting. Dr. John Ey discusses the recent literature on urinary tract infections in children, including better ways of making the diagnosis, whether there are any new treatment approaches for urinary tract infections, useful investigational studies for evaluating the urinary system, and how best to follow up children with infected urinary tracts. We hope that this review will help the practicing pediatrician to better care for patients and provide each of you with a greater satisfaction in delivering health care in an office setting.