Children's Healthcare

pediatric asthma; a real challenge in management

Asthma is the most common chronic disease of childhood. Continuing on a theme we started yesterday, talking about children with chronic disease, I was very interested to read an  article by Kevin Dubrowski and colleagues from this month's edition of Pediatrics about one way to follow children with this disease, called spirometry.

I have asked my colleague, Dr. Andre Muelenaer, head of the Carilion Clinic Children's Hospital section of pediatric pulmonology and allergy, to comment on this article. Here is what he has to say:

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more complex children in our hospitals

Those of us who provide inpatient care for children have been saying this over and over for the last decade or so: "children in our hospital are more complex to care for than ever before." However, most of the time, we were saying this based solely on our feeling, and the nature of the children we were seeing in the institutions in which we worked. 

This month's issue of the journal Pediatrics, published by the American Academy of Pediatrics presents two articles and a  commentary that address the issue of what types of children are being admitted to our hospitals.

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optimal care for children in the emergency department

Did you know that of the approximately 119 million visits to an emergency department (ED) each year, nearly 20% are made by children? That means that nearly 24 million children are seen in EDs each year. There are nearly 4000 EDs in the US, and only a minority of those are in children's hospitals, or hospitals with pediatric training programs, or clearly identified pediatric ED's. Emergency care for children was identified by the institute of medicine (IOM) in 2003 as woefully in need of improvement. The IOM found that EDs often lack the expertise and equipment needed to provide appropriate care for childre during emergencies.

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working on the weekend

OK, I might as well warn you. I am about to stand up on a soap box and make a lot of noise. It is the weekend. I have been "on call" for the inpatient service since Friday afternoon, and will continue until 8 am on Monday morning. It has been a beautiful weekend, and of course I have had some thoughts such as "wish I didn't have to spend such beautiful weather working." As weekends go, this one has been pretty quiet so far, and there is no way that I can claim that I have been overworked.

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another word on flu vaccine

We have seen some questions and comments on the issues of getting vaccinated or having children vaccinated.

The original post, comments and replies can be accessed here

But I would also like to provide another link from the Centers for Disease Control and Prevention that has information about the  intranasal spray form of the vaccine known as flu mist

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what do you expect from your physician?

On Monday night I watched the latest episode of the medical series "House" on Fox. I watch this program for amusement, and to some extent because it annoys my twenty-somethng daughter to hear me discount many of the thought processes the "team" is supposedly engaging in to demonstrate how smart they are. This week, for example they tried to "rule out lead poisoning" by sending someone out to the patient's home to look for something she might have been exposed to. I know this is good TV, but it is VERY BAD medicine.

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confessions of call night accountability

I did something last night I cannot remember doing in all of my 30 plus years of taking phone calls from referring physicians requesting hospital admission of a patient. Instead of following my usual policy of "just say yes" to a request for transport and admission of a young child, I spent ten minutes on the phone reviewing the case, and then explaining to the physician in a rural Southwest Virginia emergency department why the patient would not benefit from the admission.

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a family member is not a visitor

On Friday I wrote about issues in patient safety, and I will continue in that vein today

. One big focus of the Children's hospital over the last two years, has been the introduction and development of patient and family centered care (PFCC). There are many aspects to health care that make it patient and family centered. One major aspect is acknowledging the role that families play in the lives  of patients, and recognizing that respect for families is an important part of how we care for patients.

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our healthcare system is like an autumnal mountainside

This morning as I awoke with the sun coming up over the mountain, I was struck with the similarity of the autumnal changes of the mountain, and the changes we are now seeing in our health care system.

If you look at the side of a mountain as a whole, the change appears to be gradual. Slowly the variegated green of summer turns into a quilt of reds, organges, yellows and browns. But have you noticed that some of the trees actually turned bright red weeks ago? And after all the leaves have turned color and eventually fallen to the forest floor, there will be some patches of green left on that mountainside, created by those trees whose colors will never change.

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