Pediatric Clinical Skills, 4 th Edition, by renowned author Richard B. Goldbloom, is your ideal guide to mastering necessary, often complex and challenging pediatric clinical skills. Written in a clear, informal tone, this book explains the nuances of the child/family interview and history, pediatric physical exam, crucial interpersonal skills, and important issues such as cultural sensitivity, chronic conditions, and athletic participation. An indispensable learning tool for in-training physicians, this book is also a valuable resource for pediatric and family practice physicians, nurses, physician assistants, and all healthcare personnel who work with children.
goldbloom pediatric clinical skills
In 1944, Richard Goldbloom, the overachieving medical student son of McGill University's professor of pediatrics, met Ruth Schwartz and his destiny, which lay not in Montreal but in New Waterford, Schwartz's home town. In pursuit of her, Goldbloom arranged an elective with the town's medical practice, which provided comprehensive medical care to miners and their families under an insurance scheme known colloquially as the "Check-Off." (1) Goldbloom describes Kristal as his "principal mentor" and the town's "most competent surgeon." (2) Kristal's practice included general surgery (appendectomy, perforated peptic ulcers), orthopedics (closed reduction of fractures and amputations), gynecology (curettage, hysterectomy, cesarean section) and surgical treatments of tuberculosis (pneumothorax) and diphtheria (tracheotomy). Goldbloom recalls the locals calling Kristal the "head cutter," recognizing not only his superior surgical skills, but also his willingness to undertake burr holes to drain epidural hematomas. Anesthesia was provided by another general practitioner (GP) specialist trained on the job, Dr. Joe Roach.
The purpose of this study is to develop a method for estimating patient-specific dose from abdomen-pelvis CT examinations and to investigate dose variation across patients in the same weight group. Our study consisted of seven pediatric patients in the same weight/protocol group, for whom full-body computer models were previously created based on the patients' CT data obtained for clinical indications. Organ and effective dose of these patients from an abdomen-pelvis scan protocol (LightSpeed VCT scanner, 120-kVp, 85-90 mA, 0.4-s gantry rotation period, 1.375-pitch, 40-mm beam collimation, and small body scan field-of-view) was calculated using a Monte Carlo program previously developed and validated for the same CT system. The seven patients had effective dose of 2.4-2.8 mSv, corresponding to normalized effective dose of 6.6-8.3 mSv/100mAs (coefficient of variation: 7.6%). Dose variations across the patients were small for large organs in the scan coverage (mean: 6.6%; range: 4.9%-9.2%), larger for small organs in the scan coverage (mean: 10.3%; range: 1.4%-15.6%), and the largest for organs partially or completely outside the scan coverage (mean: 14.8%; range: 5.7%-27.7%). Normalized effective dose correlated strongly with body weight (correlation coefficient: r = -0.94). Normalized dose to the kidney and the adrenal gland correlated strongly with mid-liver equivalent diameter (kidney: r = -0.97; adrenal glands: r = -0.98). Normalized dose to the small intestine correlated strongly with mid-intestine equivalent diameter (r = -0.97). These strong correlations suggest that patient-specific dose may be estimated for any other child in the same size group who undergoes the abdomen-pelvis scan.
Physical examination of the abdomen is an essential skill. Knowledge of its clinical anatomy and application is vital for making diagnoses. Misinterpretation of anatomy during examination can have serious consequences. This review addresses understanding of the anatomy, methodology, and complications of abdominal physical examination. It includes particular reference to modern technology and investigations. Physical examination is performed for diagnostic purposes. However, the art of physical examination is declining as more and more clinicians rely on newer technology. This can have regrettable consequences: negligence, waste of time and resources, and deterioration of clinical skills. With a sound knowledge of clinical anatomy, and realization of the importance of physical examination of the abdomen, clinician, and patients alike can benefit. Clin. Anat. 30:352-356, 2017. 2017 Wiley Periodicals, Inc. 2017 Wiley Periodicals, Inc.
Computed tomography (CT) is a widely used diagnostic tool in pediatric medicine. However, due to concerns regarding radiation exposure, it is essential to identify patient characteristics associated with higher radiation burden from CT imaging, in order to more effectively target efforts towards dose reduction. Our objective was to identify the effects of various demographic and clinical patient characteristics on radiation exposure from single abdomen/pelvis CT scans in children. CT scans performed at our institution between January 2013 and August 2015 in patients under 16 years of age were processed using a software tool that estimates patient-specific organ and effective doses and merges these estimates with data from the electronic health record and billing record. Quantile regression models at the 50th, 75th, and 90th percentiles were used to estimate the effects of patients' demographic and clinical characteristics on effective dose. 2390 abdomen/pelvis CT scans (median effective dose 1.52mSv) were included. Of all characteristics examined, only older age, female gender, higher BMI, and whether the scan was a multiphase exam or an exam that required repeating for movement were significant predictors of higher effective dose at each quantile examined (all p
Health professionals often manage medical problems in critical situations under time pressure and on the basis of vague information. In recent years, dual process theory has provided a framework of cognitive processes to assist students in developing clinical reasoning skills critical especially in surgery due to the high workload and the elevated stress levels. However, clinical reasoning skills can be observed only indirectly and the corresponding constructs are difficult to measure in order to assess student performance. The script concordance test has been established in this field. A number of studies suggest that the test delivers a valid assessment of clinical reasoning. However, different scoring methods have been suggested. They reflect different interpretations of the underlying construct. In this work we want to shed light on the theoretical framework of script theory and give an idea of script concordance testing. We constructed a script concordance test in the clinical context of "acute abdomen" and compared previously proposed scores with regard to their validity. A test comprising 52 items in 18 clinical scenarios was developed, revised along the guidelines and administered to 56 4(th) and 5(th) year medical students at the end of a blended-learning seminar. We scored the answers using five different scoring methods (distance (2), aggregate (2), single best answer) and compared the scoring keys, the resulting final scores and Cronbach's α after normalization of the raw scores. All scores except the single best answers calculation achieved acceptable reliability scores (>= 0.75), as measured by Cronbach's α. Students were clearly distinguishable from the experts, whose results were set to a mean of 80 and SD of 5 by the normalization process. With the two aggregate scoring methods, the students' means values were between 62.5 (AGGPEN) and 63.9 (AGG) equivalent to about three expert SD below the experts' mean value (Cronbach's α : 0.76 (AGGPEN
Pain abdomen is a common pediatric complaint that brings patient to the hospital in Nepal. Knowledge about its etiology and frequency helps in its evaluation and management. The present study was undertaken to find out the causes and their frequency of pain abdomen in Nepali children. Children with pain abdomen presenting at the emergency room and pediatric outpatient department of Kathmandu Medical College, Kathmandu from January, 2006 to December 2007 were clinically evaluated and investigated to find out the causes and frequency of their pain abdomen. The outcomes were tabulated and analyzed for interpretation. Of 444 patients attended, 356 completed investigations and came for follow up. Cause of pain abdomen was apparent in 117 (32.9%) only. 91.5% were medical causes, comprising predominantly of diarrheal diseases (28.3%), infantile colic (9.4%), urinary tract infection (7.7%) and acid peptic disease (6.8%). 8.5% causes were related to surgical conditions, which needed operative management. Secondary or extra-abdominal causes were found in 20 cases (17.1%). Pneumonia (2), functional (5), vulvovaginitis (2) and infantile colic (11) were predominant causes. Our study showed that the causes of pain abdomen in children were predominantly medical. Gastroenteritis was the most frequent cause. Secondary causes, including functional and emotional causes were infrequent. Small percentage needing surgical management formed a diagnostic challenge.
Acute abdominal pain in children is a common cause for referral to the emergency room and for subsequent hospitalization to pediatric medical or surgical departments. There are rare occasions when the abdominal pain is derived from extra-abdominal organs or systems. The aim of the present study was to establish the most common extra-abdominal causes of acute abdominal pain. The notes of all children (1 month-14 years of age) examined for acute abdominal pain in the Accident and Emergency (A&E) Department of Alexandroupolis District University Hospital in January 2001-December 2005 were analyzed retrospectively. Demographic data, clinical signs and symptoms, and laboratory findings were recorded, as well as the final diagnosis and outcome. Of a total number of 28 124 children who were brought to the A&E department, in 1731 the main complaint was acute abdominal pain. In 51 children their symptoms had an extra-abdominal cause, the most frequent being pneumonia (n = 15), tonsillitis (n = 10), otitis media (n = 9), and acute leukemia (n = 5). Both abdominal and extra-abdominal causes should be considered by a pediatrician who is confronted with a child with acute abdominal pain. 2ff7e9595c
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