Head injury - how community paediatricians can help

Article Abstract:

Closed head injuries account for five percent of hospital admissions of children each year, and five percent of these cases are severe. Half of the children with severe head injuries will have some degree of motor and cognitive or mental impairment. These children require early and appropriate rehabilitation to prevent the development of secondary damage. However, a recent review showed that children with severe head injury are not managed in a consistent manner. Neurological and neurosurgical expertise should be offered during follow-up of the child. However, children admitted to neurosurgical units are often returned to pediatric wards when the child no longer requires surgical treatment, and the pediatrician becomes responsible for the early rehabilitation and follow-up of the child. Community pediatricians with neurodevelopmental training have the expertise to supervise the process of rehabilitation from hospital admission to reintegration into the local community. A rehabilitation service should offer in the early stages of rehabilitation of severe head injury: (1) evaluation of development before the injury, based on education and health records; (2) a thorough neurological examination; (3) an assessment program that includes detailed psychometric testing of mental, visual, and memory functions; assessment of speech and language; behavior in the educational setting; and housing, mobility, and self-help skills; (4) supervision of a multidisciplinary plan of rehabilitation; and (5) counseling, support, and information. Children seen by a physician at a later stage should undergo thorough assessment to determine the contribution of the head injury to their current developmental, behavioral, or learning problems. Children with minor head injuries may suffer specific cognitive abnormalities that interfere with their learning, life adjustment, and behavior. Pediatricians should provide parents and other persons who come into contact with the child with information about potential problems, outcome, and services available to children with head injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Head injuries, Developmental disabilities

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Attitudes of paediatricians to HIV and hepatitis B virus infection

Article Abstract:

The frequency of accidental exposure to hepatitis B and human immunodeficiency virus (HIV, the cause of AIDS), both viral infections transmitted through contact with blood, is increasing among physicians. Surgeons and anesthesiologists are the two groups considered most at risk for the infections, while pediatricians have been thought to be at low risk. Although techniques for venipuncture (blood sampling) have improved, the risks for pediatricians may be increasing due to increased incidence of HIV among heterosexuals and the difficulty of using gloves when examining infants. The knowledge of pediatricians in one region concerning risks from hepatitis B and HIV were surveyed. To judge by the answers to the questionnaire, knowledge was generally poor. Pediatricians were generally ignorant about the prevalence of HIV and hepatitis B infection, although 93 percent were aware that hepatitis B was more infective than HIV. Only 10 percent of doctors who had suffered needlestick injuries had reported them. About one third used gloves, mostly when in contact with older children or in emergency or obstetrical delivery units. Few had been educated about or were aware of appropriate venipuncture techniques. On the bright side, 71 percent had been immunized against hepatitis B, although only 64 percent of these had the effectiveness of the immunization checked with a subsequent blood test. Perception of being at high risk for the blood-borne infections did not affect how pediatricians handled risk behaviors. Better education about risks for the viruses and appropriate behaviors in medical practice are needed if the high rate of infection among pediatricians is to be reduced. A sample of the survey and a commentary follow the report. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, HIV (Viruses), HIV, Beliefs, opinions and attitudes, Blood-borne diseases, Bloodborne diseases, Hepatitis B virus

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How can the work of junior paediatricians be reduced?

Article Abstract:

The workload of pediatricians has increased over the past 30 years, due primarily to a rise in admissions of children to accident and emergency departments and to improved survival of premature infants. This has resulted in an increased number of infants treated and greater complexity of treatment. Junior physicians in pediatrics were found to work longer hours than those in other specialties, they were the busiest doctors in the hospital at night, and received the most frequent calls while on duty. Methods to reduce the workload of junior pediatricians, such as delaying certain tasks until the morning or assigning tasks to other medical staff, have been assessed. The workload of pediatricians may be reduced by increasing the number of neonatologists (physicians specialized in caring for newborns), delegating technical duties to nurses who have undergone advanced training, making the attendance by a pediatrician at deliveries optional, and decreasing tasks involving the recording of minor activities in diaries. However, many junior pediatricians were doubtful about these recommendations, particularly those concerning the need for an attending pediatrician at a delivery involving the use of forceps, or of an infant with possible birth defects. However, measures to reduce the heavy clinical workload in pediatrics should be implemented, because this problem has caused difficulty in recruiting junior staff and may adversely affect the educational goals of pediatric training programs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Supply and demand, Practice, Pediatrics, Neonatologists

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