General Pediatric Outpatient Clinic Research Articles

Epilepsy in a children's hospital: an out-patient survey

Epilepsy, a common childhood condition, is largely managed by general paediatricians. To assess whether recent management guidelines are being met, we undertook a prospective questionnaire-based survey of children with epilepsy, attending the general paediatric out-patient clinic, at the Royal Liverpool Children's Hospital, Alder Hey. Ninety-one children were identified over seven months-giving a prevalence of epilepsy in this out-patient population of 13.7/1000. Fifty-four per cent were diagnosed as having tonic-clonic, 16% partial and 5% typical absence seizures. Forty-two per cent received carbamazepine and 33% sodium valproate, as monotherapy, and 7% were treated with multiple antiepileptic drugs (AEDs). Correlation between AED and seizure type was often inappropriate as was the routine measurement of blood level of AEDs. Correlation between seizure frequency and clinic visits was generally acceptable with those children experiencing frequent seizures attending most often. Specialist paediatric neurologist advice was sought in only 14% of children; 19 of the 28 children with the most poorly controlled seizures were not referred for a specialist opinion. This study has demonstrated a poor understanding of seizure/syndrome classification; the frequent inappropriate use of AEDs and their blood level measurement and inadequate referral for specialist advice. Recognized guidelines are not being followed, nor are standards being met by many general paediatricians. There is a clear indication for more extensive education and the need to provide clear recommendations for the management of epilepsy in children.

Paediatric psychotherapy: a service in a general outpatient clinic.

The service of paediatric psychotherapy to a general paediatric outpatient clinic is described. Using techniques developed to suit paediatric patients a median of nine patients each clinic were treated. Referral symptoms resolved in a median time of four months after a median of seven sessions. This model for the management of paediatric patients with emotional and behavioural difficulties may allow an effective and efficient use of psychotherapy time.

Paediatric psychotherapy: The development of a technique for a service in a general paediatric outpatient clinic

Paediatric psychotherapy: The development of a technique for a service in a general paediatric outpatient clinic

Adult psychiatric disorders in psychiatrically ill young adolescents.

Adolescents aged 12-15 years, randomly selected from a psychiatric outpatient clinic, psychiatric consultation service, and general pediatric outpatient clinic, were given a complete psychiatric evaluation and structured diagnostic interview. Of 121 subjects studied, 100 satisfied Rutter and associates' criteria for a childhood psychiatric disorder. When these subjects were rediagnosed according to Feighner and associates' research diagnostic criteria (similar to DSM-III criteria), 52 fulfilled the criteria for an adult disorder. Diagnoses included antisocial personality, hysteria, schizophrenia, depression, mental retardation, anxiety neurosis, and undiagnosed psychiatric illness. There was a correlation between diagnosis according to Rutter and associates' criteria and adult diagnosis.

502 NOSOCOMIAL SCABIES INFECTIONS: EPIDEMIOLOGY IN THE OUTPATIENT CLINIC

Scabies infestation appears to be increasing over the past few years. Nosocomial spread of this disease has been rarely reported. In October of 1978, 2 nurses and a medical student developed pruritic, papular eruptions on wrists, shoulders, neck and axillary areas. Scabies was diagnosed in each case by clinical and microscopic findings. Since all 3 of these individuals were assigned to the general pediatric outpatient clinic, an epidemiologic investigation was initiated. Both nurses and the medical student remembered prolonged close contact (during lumbar puncture procedure) with a 6-year-old child with aseptic meningitis and scabies. This index child had been diagnosed infested with scabies 24 hours previously, but had not received the prescribed treatment. A total of 41 persons who had both direct and indirect contact with the scabietic child were identified and examined. Scabies was diagnosed in 12 cases: 6 family members of the index child, 5 family members of the nurses, and a single child visiting one of the infested children. Topical application of 1% gamma benzene hexachloride was initiated for all diagnosed individuals and persons sharing living facilities were simultaneously treated to avoid reinfection. A re-education of staff, stressing the importance of proper handling of infected and suspected patients was initiated. Proper gowning and careful hand-washing between patients may have prevented this outbreak.

Lost to follow up: a study of nonattendance at a general paediatric outpatient clinic.

50 children defined as persistent outpatient nonattenders were compared with 50 children who regularly attended the same clinics. Several factors were often found in the group of nonattenders: (a) initial referral via casualty without a letter from the family doctor, (b) hospital admission before the first outpatient appointment, (c) recognition of multiple medical problems, and (d) evidence of diffuse social problems affecting the family. 34 of the nonattenders had at least 2 of these factors, compared with only 9 children in the other group. Many of these problems can be identified at the initial consultation, and perhaps other methods of continuing health care should be provided for these children.