Discharge Of Children Research Articles

Focal spike discharges in children not suffering from clinical epilepsy.

Focal spike discharges in children not suffering from clinical epilepsy.

Hospital Use Patterns for Children in the United States, 1983 and 1984

The hospital discharge rate of children less than 15 years of age in the United States declined 12% from 1983 to 1984. This was the first time in the 20-year history of the National Hospital Discharge Survey that there was a statistically significant decrease in children's hospital discharge rates in a 1-year period. The change occurred during a period when prospective hospital payment systems were introduced and when prepaid group health plans and alternative systems of providing health care were expanding. The unprecedented decrease in children's hospital use was evaluated using data from the National Hospital Discharge Survey. This is a continuous survey in which data from a national sample of medical records of discharged patients are collected. Children's hospital use rates were reviewed by age, sex, region, and expected principal source of payment. Significant decreases in discharge rates were found for the age group 1 to 4 years and for all children with private insurance. The patterns and changes in hospital use by diagnostic category were also investigated. The major finding was a 19% decrease in children's discharge rate for diseases of the respiratory system. Mortality statistics and data from the National Health Interview Survey were evaluated for indications of changes in children's health status or use of physician services accompanying the decline in hospital use. Although there were fewer deaths due to respiratory diseases for children less than 5 years of age in 1984 than in 1983, most measures of health status were unchanged. The only significant change in physician use was a decrease in the percentage of acute conditions that were medically attended, also among children less than 5 years of age. It is important to continue monitoring children's hospital use patterns, as well as their health status and use of alternative health services, to further assess the impact of changes in the organization and financing of health services.

Parental visiting of children in foster care: Current knowledge and research agenda

This article reviews research on the relationship between patterns of parental visiting of children in foster care, child-parent attachment, and the child's well-being and discharge from care. Caseworker practice concerning visitation is also examined. Gaps in knowledge are identified and suggestions for future research are offered.

The Neglected Discharge Instruction

We as pediatricians are taught to give careful instructions to parents at the time of a child's discharge from the hospital. These instructions include necessary information about drugs, resumption of the child's activities, and return visits. What is rarely discussed is the possibility that the child may resort to maladaptive behavior as a result of his hospitalization and what the parents should do about it. Before a child goes home from the hospital, parents should be alerted to the fact that difficult behavior patterns often are seen after a child's hospitalization for a serious illness. At the same time, they should be reassured that their child has recovered and does not require special protective treatment.

Humanizing paediatric care

This paper deals with the development of a paediatric team approach to the care of children in the 70 bed paediatric unit in the Royal Hobart Hospital in Tasmania, Australia, and describes the measures used to help children and their parents adapt to life in hospital with a limited budget. The staff includes paediatricians and Pediatric surgeon, resident staff, nurses, teachers, social worker, physiotherapist and pharmacist. There are no visiting hours but the wards are open to parents and relatives at any time. Parents are encouraged to stay in hospital and their accommodation is either in flats at the end of wards or in single or double bed wards using foldup beds. Each young child has a personal details form completed and placed on the end of the cot allowing a nurse to discover likes, dislikes, methods of feeding and sleeping, etc. Parents are asked to complete questionnaires at the time of the child's discharge, asking for their assessment of the standards of care their child received. Playleaders are rostered for evenings and weekends and they work with, and direct Red Cross volunteer ladies. Two full-time teachers cooperate with the child's school in maintaining the child's educational progress. Volunteer visitors entertain children whose relatives are unable to visit or stay in hospital. The methods used to raise the standards of paediatric nursing are also described. Community groups, particularly kindergarten and primary school children, are encouraged to visit the paediatric unit and each group is usually given a brief health education talk by a member of staff.

Louisiana's statewide interdisciplinary approach to diagnostic, protective and treatment services to abused and neglected children and their families

The provision of the most comprehensive funded statewide delivery of diagnostic, protective and treatment services to abused and neglected children and their families in the country has been made possible by the State of Louisiana and its concerned citizenry. The importance of obtaining a legislative mandate establishing and funding the statewide child protection concept by the Louisiana legislature was illustrated. We described how the medical and protective services components cooperate and coordinate at the state and local levels to provide the abused and neglected child and his family with the best possible services available. Throughout our presentation the use of the interdisciplinary team concept was emphasized as the best system known to enhance the reporting, investigation and diagnosis of child abuse and/or neglect cases as well as providing protective and treatment services to the child and his family. The Child Protection Center is the community agency serving as the “core” for the interdisciplinary approach to be successful. The role of each discipline employed by the center was reviewed and how interagency coordination is accomplished through their efforts. The interdisciplinary dispositional conference prior to a child's discharge from the hospital was considered as an excellent method to insure that several disciplines share in the definitive protective and treatment plans for the abused child. Several treatment modalities and their success rates for the child and his family were discussed. The accomplishments of the center were listed. Finally, a review of how the citizenry from the Baton Rouge Community responded overwhelmly by their involvement and commitments in an all out effort to combat a serious social symptom and disease — child abuse and neglect.

Crisis precipitation as observed in pediatric--child psychiatric liaison.

This paper describes the development of crisis situations in the parents of three pediatric inpatients. The cases illustrate that psychiatric techniques, when applied to the evaluation of family and social environments, might result in the uncovering of complicated psychopathology. Precipitating factors may include: a stressful initial interview; biases of the referring physician; exaggerated parental treatment expectations; the sudden release of repressed material; and the disadvantages of rooming-in. Resolution was influenced in several ways, including the further crisis presented by the improvement in the child's illness to the point of discharge and the necessary reconsideration of this because of the parent's urgent emotional needs. The child's discharge was governed by the management of the mother's illness. Close coordination between liaison psychiatrist and pediatrician was essential to the treatment plan.

Vulvovaginal Irritation and Discharge in Children

Vulvovaginal Irritation and Discharge in Children

Psychological considerations in a group of children with poliomyelitis

Summary<ul><li>1.A group of fifty-two children with poliomyelitis were followed by regular interviews and psychological examinations for three years.</li><li>2.Those patients who made a complete recovery from the motor effects of the disease were likely to be emotionally fragile and often showed psychological symptoms suggesting cerebral involvement. These difficulties combined with the emotional upheaval created by the illness resulted in many problems.</li><li>3.Those patients who developed sufficient motor disability to require prolonged hospitalization and orthopedic care showed certain characteristic disturbances:<li>a.Those in the age-group one to five years were found to have an irregular mental development. During the first years of hospitalization, a lag in speech development was particularly noted. Difficulty in comprehension of object relationships was noted. Unsatisfactory emotional adjustment was observed, which improved gradually after the child's discharge to the home, but in most cases left some marks upon the patient's personality development.</li><li>b.Those in the age group five years and over showed varying symptoms, ranging from short attention spans, difficulty in concentration and resulting learning difficulties to more specific disturbances in functions of abstraction suggesting nervous system involvement. General emotional fragility was also quite evident. All these signs were prominent during the first year. After this, they tended to recede, though traces were still discernible for several years.</li><li>4.This study suggests that poliomyelitis, first as a specific infection of the central nervous system and second, as a crippling disease leading to prolonged hospitalization and immobilization, tends to produce interference with normal mental and emotional development.</li><li>5.On the basis of this study, it is recommended that greater attention be paid to psychological factors in the care of these children as follows:<li>a.Careful psychological appraisal of children recovering from poliomyelitis will be useful in order to protect the recovering child from undue mental strain.</li><li>b.Supportive technique during the period of readjustment of the child to the home may help relieve parents' anxieties and children's emotional problems in the convalescent period.</li><li>c.Special programs devised to compensate the hospitalized and immobilized child for restricted experiences will be useful in mitigating problems in emotional, mental, and social development.</li></li></li></ul>

Vaginal Discharge in Children; Study of 255 Selected Cases, with Special Reference to the Question of the Diagnostic and Specific Value of Smear Examinations

Original Article from The New England Journal of Medicine — Vaginal Discharge in Children; Study of 255 Selected Cases, with Special Reference to the Question of the Diagnostic and Specific Value of Smear Examinations