Reported practices of pediatric residents in the management of attention-deficit hyperactivity disorder

Article Abstract:

Pediatricians today are dealing with behavioral and developmental problems of children more than previously. There is concern over the adequacy of training of pediatric residents in these areas. One of the most complex behavioral problems a pediatrician may diagnose is attention-deficit hyperactivity disorder (ADHD), a disorder of learning and behavioral disabilities for which there is no known cure. However, the symptoms of ADHD often subside or disappear over time. A survey of 124 pediatric residents in seven residency programs was undertaken. The residents reported on their diagnosis and treatment of children with ADHD. It was found that the pediatric residents used evaluation and treatment approaches similar to the current recommendations. Techniques of diagnosis did not differ among the institutions studied, but referral and treatment patterns did differ. Residents differed from practicing pediatricians in that many of the residents used questionable diagnostic procedures or relied primarily on medication to treat children with ADHD. There is concern over several practices utilized by the residents: the child's response to medication or the child's behavior in the examination room were very often used to make the diagnosis, and these techniques have been questioned recently. Also, the associated features of ADHD, such as learning and social problems, often were not differentiated from the diagnostic signs of ADHD; most residents missed several diagnostic signs. These results, based on self-reports by residents, may not reflect actual practice by the residents. In any case, the findings suggest that pediatric residents are learning more accepted methods for diagnosing and treating children with ADHD. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diagnosis, Training, Study and teaching, Pediatrics, Attention-deficit hyperactivity disorder

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Natural history of hematuria associated with hypercalciuria in children

Article Abstract:

When children with hematuria (blood in the urine) are examined further, many are found to also have hypercalciuria (HCU; excess calcium in the urine). The significance of this finding is not clear, but it is possible that such children are at risk for the formation of urinary stones (urolithiasis). To learn more about the consequences of untreated HCU in children with hematuria, 58 children seen at one medical center in a 5.5-year period were examined annually. Three quarters of the group had family histories of urolithiasis. Nineteen patients had renal HCU (excess levels of urinary calcium in the fasting state), while 24 children had absorptive HCU (excess calcium in the urine after ingesting a predetermined amount of calcium in a test). Ten children developed urolithiasis or calcifications during follow-up. These patients had been older when they were first examined, had persistent hematuria, and had family histories of urolithiasis. Subsequent follow-up on 23 children without stones showed considerable variability in the presence of hematuria and HCU, and in their coexistence. For instance, hematuria did not recur in 11 cases after the first time, although seven of these children continued to have HCU. The results show that children with hematuria and HCU are at risk for developing stones, particularly if the hematuria is extensive and the family history for urolithiasis is positive. The cause of hematuria in children with HCU is not known; possible explanations are discussed. Better understanding is needed of the mechanisms associated with hematuria in such cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Risk factors, Physiological aspects, Development and progression, Hematuria, Calculi, Urinary, Urinary stones, Pediatric urology, Hypercalciuria

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New York regulation of residents' working conditions: 1 year's experience

Article Abstract:

Training provided for resident physicians has been the subject of great controversy, not because of its quality, but rather concerning the extraordinarily demanding hours that are typically required. This schedule frequently exceeds 100 hours per week. To alleviate the stress and fatigue of the residents, and to reduce the possibility of diminished patient care, these hours were reduced at the Children's Hospital of Buffalo (State University of New York). The reduction occurred following the report of a committee appointed by the New York State Department of Health. The committee reviewed working conditions and supervision of residents, as well as the organization and provision of emergency services in hospitals. Specifically, the report recommended that trained and credentialed physicians, and at least one attending physician, be available on duty at all times. It was recommended that residents not be permitted to work more than 12 straight hours in the emergency department. Residents' work schedules should not exceed an average of 80 hours per week over a 4-week period. Also, residents should not work more than 24 hours continuously, and should have at least one 24-hour non-working period weekly. Moonlighting work hours were to be limited as well. At the Children's Hospital of Buffalo, these and other changes were made in an attempt to improve the quality of life for residents and maintain the proper quality of patient care. The work and training schedule is undergoing continual change in an attempt to achieve the maximum benefits for staff and patients alike. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social policy, Hospitalization, Hospitals, Hospital emergency services, New York, Hospital care, New York (State)

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