Parental permission, information, and consent

Article Abstract:

Agreement concerning medical testing and treatment is a significant part of the relationship between patients and their doctors. Patient consent involves informing the patient about the reason for tests or treatment and granting of consent for any medical action to be taken. Written consent is obtained in surgical practice, while procedures in medical practice are not as clear. To better understand current medical practices, 150 parents of children who were admitted to hospitals through emergency rooms were interviewed. Of 106 parents whose children had blood tests, 60 were not asked for permission and 10 thought they should have been asked. Urine tests or X-rays were taken without asking, in 65 of 104 and 47 out of 81 children, respectively, and eight and nine parents, respectively, thought they should have been asked. Information about reasons for blood tests, urine tests, and X-rays was not provided to 59, 65, and 30 parents, respectively. Of 120 parents whose children were given drugs, 107 were not asked for permission and 29 thought this should have been done. Information about the drugs was not provided to 52 parents, 45 of whom though they should have been informed. Parents were informed about the reason for 166 of 240 drug treatments. Parents felt that permission for tests was implied by children being inpatients in 111 of 142 cases where tests were done and in 104 of 120 cases where drug treatment was started. The study suggests that although most parents wish to be informed about reasons for medical testing and treatment of their children, one third or more are not given this information. This low rate of patient education may harm compliance with medical treatment and suggests that an active doctor-passive patient relationship still exists in most medical practices. An appendix showing a sample survey follows the report. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Surveys, Patient education, Informed consent (Medical law), Informed consent, Parental consent

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Routine measurement of blood pressure in schoolchildren

Article Abstract:

The measurement of blood pressure is a part of routine clinical examination and helps to identify disease conditions such as hypertension (high blood pressure). In children, routine measurement of blood pressure may not be as helpful because their blood pressure readings tend to be highly variable. Blood pressure should be measured in children under certain circumstances: if there is a family history of hypertension, during illness, and in the presence of kidney or cardiovascular disease, abnormalities of the urinary tract, diabetes, meningomyelocele (a swelling of the spinal cord due to a defect in the vertebrae), and neurofibromatosis (the development of tumors on the nerves in the extremities). Children with symptoms of headache, vision problems, paralysis of the face, neurological disease, increased blood calcium levels, lead poisoning, and reduced blood volume should also have their blood pressures measured. Routine monitoring should accompany treatment with certain drugs, such as steroids, birth control pills, drugs that mimic activation of the sympathetic nervous system (which affects many involuntary functions, such as heart rate), and intravenous administration of fluids and blood products. Blood pressure should be taken under circumstances that produce the least anxiety in a child, in ambient temperature, and after the child has been sitting quietly for a few minutes. The common device for measuring blood pressure, the sphygmomanometer, should be fitted with an appropriate sized cuff for the child being examined. The procedure for using the sphygmomanometer to measure blood pressure is discussed. Blood pressure measurements can be checked against reference charts, which relate blood pressure to age. Other reference charts that relate blood pressure to weight and height are also available. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical examination, Children, Blood pressure, Blood pressure measurement

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Rapid anticonvulsant monitoring in an epilepsy clinic

Article Abstract:

Drug monitoring, particularly of anticonvulsant drugs, is essential for appropriate clinical management of pediatric epilepsy. Current procedures usually require a lapse of hours or days before drug levels are known. The availability of rapid anticonvulsant drug monitoring could be valuable to the physician in determining dosage schedules, especially when treatments require multiple drugs. Such monitoring can also assist in rapid assessment of toxic reactions, can evaluate untoward drug reactions, and can be used to measure patient compliance. A study to measure the effects of rapid monitoring was conducted with a total of 144 patients using 481 drug assays over a five-year period beginning in 1982. All of the different forms of epilepsy were represented the study group. Both a physician and a pediatric pharmacologist evaluated the treatment dosage and patient response. Drugs most frequently assayed were carbamazepine, sodium valproate, phenytoin, ethosuximide, and phenobarbitone. The pediatrician and pharmacologist showed considerable differences in their approaches to drug schedules and dosages. Knowledge of anticonvulsant plasma concentrations had little effects on the physicians' treatment decisions. The rapid monitoring procedures are substantially more expensive than the usual procedures, and the additional cost is questionable. Except for phenytoin assays, many of the assays conducted did not have any measurable clinical value. The advantages for patient management, if any, to be derived from these procedures depend on more discriminant use of the assay, their selections and the numbers of tests conducted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Drug therapy, Anticonvulsants, Epilepsy in children, Pediatric epilepsy

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