Abstract:
Objective: To determine relationship between length-based resuscitation tape (LBT)-based color-coded zones and actual weight-based color-coded zones.

Methods: Data were retrospectively abstracted from 839 patients in Rochester, Minnesota, at birth, 4 to 6, and 10 to 12 years. Height was plotted on LBT to determine estimated weight and corresponding color zone. Patient’s weight-based color zone was obtained by plotting measured weight on LBT. Degrees of discrepancy between length-based and actual weight-based color zones were assessed.

Results: Total of 544, 520, and 143 subjects were analyzed at birth, 4 to 6, and 10 to 12 years, respectively, with a subset of 103 subjects measured longitudinally at more than 1 age strata. Among infants, all LBT color zones were the same as actual weight-based color zones. In children aged 4 to 6 years, 70% (n = 361) of LBT-estimated color zones were the same as actual weight-based color zones; LBT underestimated 19% (n = 99) by 1 color zone, 0.5% (n = 3) were underestimated by 2 color zones, 0.5% (n = 3) exceeded weight limit on LBT, and 10% (n = 54) were overestimated by 1 color zone. In adolescents aged 10 to 12 years, 40.6% (n = 58) of LBT-estimated color zones were the same as actual weight-based color zones; LBT underestimated 3.5% (n = 5) by 1 color zone, 44.1% (n = 63) exceeded weight limit on LBT, 11.2% (n = 16) were overestimated by 1 color zone, and 0.6% (n = 1) were overestimated by 2 color zones.

Conclusions: Overall, LBT reasonably estimates appropriate color zones for drug dosing. However, LBT tends to underestimate color zones among younger obese children and adolescents. Potential implications of the rising trend of overweight children on resuscitation practice and drug administration must be considered.

Abstract:
Objective: Although supraventricular tachycardia (SVT) can be identified from any lead of the bedside monitor, the mechanism of tachycardia is not always obvious. We analyzed the 12-lead electrocardiogram (ECG) in SVT of pediatric patients with different mechanisms of SVT to determine if there is a consistent optimal lead for rhythm identification.

Methods: Twelve-lead ECGs during SVT were available for retrospective analysis in 54 patients. The tachycardia mechanism was determined either by intracardiac or transesophageal recording, or after cardioversion analysis of atrial flutter or fibrillation. Blinded analysis of each separate lead of the 12-lead ECG was done to determine the best lead to diagnose the mechanism of tachycardia. For statistical analysis, [chi]2 or Fisher exact test was used.

Results: From analysis of the surface ECG, the mechanism of SVT could be identified in 49 (91%) of 54 patients. Lead V1 was the most useful lead to determine the tachycardia mechanism. V1 identified the mechanism in 39 (80%) of 49 patients compared with 29 (59%) of 49 in lead III (P < 0.05), 22 (51%) of 49 in lead II (P < 0.01), and 12 (24%) of 49 in V6 (P < 0.001). Lead V1 identified accessory pathway-mediated tachycardia in 15 (68%) of 22 patients, atrial flutter in 12 (87%) of 14 patients, atrial fibrillation in 7 (70%) of 10, and atrioventricular nodal reentrant tachycardia in 5 (62%) of 8 patients. The mechanism of tachycardia was more readily diagnosed using a combination of V1 and lead III (47/49 patients, 96%) compared with V1 alone (P < 0.05).

Conclusions: A right precordial lead (V1) is the best single lead to diagnose the mechanism of SVT. Furthermore, a combination of V1 and lead III increases the number of patients in whom the mechanism could be identified. Therefore, we recommend that V1 should be combined with an inferior limb lead during cardiac monitoring for optimal identification of the mechanism of SVT in children.

Abstract:
Objectives: To determine the frequency, prescriber, and type of prescribing errors in written in-house orders and ambulatory prescriptions in a pediatric emergency department (PED).

Methods: A 17-day retrospective chart review and a 6-month retrospective ambulatory prescription review in a PED for medications with weight-based dosing. Orders and prescriptions were checked for prescriber identification number, route, weight-based target dose in milligrams per kilogram, frequency, correct dosing, and drug allergies. Narcotics were excluded from the prescription analysis.

Results: Forty-seven (12.5%) of 377 in-house orders and 37 (19.4%) of 191 individual charts contained at least 1 error: 4 (1.1%) orders contained an incorrect dose, 41 (10.8%) were written incorrectly, and 2 (0.5%) contained an incorrect dose and were written incorrectly. Thirty (4.3%) of 696 ambulatory prescriptions contained 1 error: 14 (2.0%) contained an incorrect dose, and 16 (2.3%) were written incorrectly. Pediatric postgraduate year-3 residents had the highest in-house order incorrect dose error rate (1 of 29 orders or 3.5%), and ED pediatric postgraduate year-2 residents had the highest ambulatory prescription incorrect dose error rate (6 of 66 prescriptions or 9.1%). Pediatric ED attending physicians had the highest error rates for writing orders and prescriptions incorrectly, 25% (3 of 12) and 9.7% (3 of 31), respectively. Antibiotics, analgesics, and narcotics were most often involved in errors.

Conclusions: Prescribing errors are common in both written in-house orders and ambulatory prescriptions in a PED. Targeting safety interventions toward groups with less practice in prescribing pediatric doses and reeducating groups on safe medication writing techniques could decrease this error rate.

Abstract:
Background: The incidence of reported cases of pertussis is increasing, despite high rates of vaccination among infants and children. The burden of disease, and rates of complication and death are highest among infants. The limited availability of a timely reliable confirmatory test for pertussis hinders early identification of infected infants.

Objective: Our objective is to identify clinical and laboratory predictors for pertussis among infants.

Methods: Demographic, clinical, and laboratory data were collected from the medical records of all infants aged 12 months or younger who underwent confirmatory testing (culture, direct fluorescent assay, or polymerase chain reaction) for Bordetella pertussis from January 1, 2001, to July 31, 2005. The association of 15 variables with a positive pertussis test was analyzed using univariate and multivariate analysis, and when appropriate, using receiver operating characteristics.

Results: We reviewed the medical records of 141 infants who were tested for pertussis. The mean age was 88 days, and the most common chief complaints were cough and breathing difficulty. Eighteen patients (13%) had a positive pertussis test, and 123 (87%) had a negative test. Bronchiolitis and upper respiratory tract infection were the most common discharge diagnoses among infants with a negative test. The 2 groups were similar with respect to sex, history of cough, vomiting, fever, symptoms of apparent life-threatening event, presence of fever, or hypoxia, and heart rate. Infants who were younger (55 days vs 93 days, P = 0.02), evaluated between July and October (23% vs 9%, P = 0.02), less tachypneic (39 breaths/min vs 47 breaths/min, P = 0.02), had higher white blood cell counts (20,000/[mu]L vs 15000/[mu]L, P = 0.02), higher percentage of lymphocytes (72 vs 55, P = 0.00), and higher absolute lymphocyte counts ([ALC] 14,536/[mu]L vs 8357/[mu]L, P = 0.00) were more likely to have a positive test. Receiver operating characteristics for ALC demonstrated an area under the curve of 0.81, with a 95% confidence interval of 0.72 to 0.90. An ALC cutoff point of 9400 was determined to maximize sensitivity (89%) and specificity (75%). The negative predictive value of this cutoff point was 97%, and the positive likelihood ratio was 3.6, with a 95% confidence interval of 2.3 to 5.4.

Conclusions: Among infants who underwent confirmatory testing for pertussis, those who are younger, evaluated between July and October, less tachypneic, have higher white blood cell counts, higher percentage of lymphocytes, and higher ALCs are more likely to have a positive test. The ALC was the best predictor of pertussis, and an ALC of less than 9400/[mu]L excluded almost all infants without pertussis.

AP (2/13) reports that “[f]ewer American doctors are focusing on primary care, but the decline is being covered by physicians from other countries,” according to the General Accountability Office (GAO). Data from the GAO indicate that “as of 2006 there were 22,146 American doctors in residency programs in the United States specializing in primary care,” compared to “23,801 in 1995.” Sen. Bernie Sanders (I-Vt.) said of this trend, “It is troubling to me that the number of Americans pursuing a career in primary care has declined.” Sanders also noted that the U.S. is “increasingly dependent on international medical school graduates to meet [its] needs.” The GAO reported that “the number of international medical graduates training in primary care had grown from 13,025 in 1995 to 15,565 in 2006.” In contrast, “the number of Americans in training [for specialties] went from 45,300 in 1995 to 47,575 in 2006, and over the same period, international specialists grew from 11,957 to 12,611.” clips free spanking movieporn movies asianmovies lesbian pornmovie reviews adultporn movies long freecumfiesta moviesmovie blowjob britney spearsspears britney sex moviefree lesbian sex moviesfree long xxx movieslg 1400 ringtone7250 blackberry ringtoneass nextel bad ringtone for americanpolyphonic ringtone 3585 nokiacents 50 candy shop ringtone1.00 ringtone330 ringtone philips50 candy ringtone cent shop Map

The Tennessean (2/12, Pinto) reported that with the aid of a Tennessee Department of Health grant, “Vanderbilt University Medical Center’s” ED “will begin performing free HIV testing on adult patients this week, unless they opt out of the procedure.” 

Jeanece Seals, the state’s director of HIV/AIDS programs, said that “17 states are conducting similar programs,” but “Vanderbilt is the only Tennessee” ED “administering the test, unless patients, who will be told about the test, check a box on their paperwork opting out.”  Seals added, “We are interested in making HIV testing a routine part of medical care.”

LA Times (2/13, Engel) reports, “The honeymoon between the Los Angeles County Board of Supervisors and its health services director finally foundered Tuesday amid fears that a second county hospital could close.”

Dr. Bruce Chernof, head of the nation’s second-largest public health system, “told the supervisors last week that the federal government would be citing Harbor-UCLA Medical Center for placing its emergency patients in ‘immediate jeopardy’ because of overcrowding and long waits.” Supervisor Gloria Molina said, “I’m very concerned that we’re entering a spiral here very similar to what happened at” Martin Luther King Jr.-Harbor Hospital in Willowbrook, which closed last year.

According to a report prepared by Dr. Chernof, “Harbor-UCLA saw 82,300 emergency patients in the last year. The average wait was 12.2 hours, and 16.6 percent left without” receiving treatment. However, the “supervisors were clearly frustrated when Chernof could not tell them how waiting times at UCLA-Harbor had changed since King-Harbor closed.” The Times notes that “Harbor-UCLA is the third hospital owned by Los Angeles County to undergo federal scrutiny in recent months for” ED fatalities.

Wall St. Journal, 2/13/08:  Johnson & Johnson is voluntarily recalling a version of its blockbuster pain patch Duragesic because of manufacturing issues that could lead to accidental overdoses.

Duragesic, for patients experiencing moderate to severe chronic pain, contains fentanyl, an opioid that could lead to problems such as respiratory depression and fatal overdose.

The recall includes all 25-microgram-per-hour patches that are sold in the U.S. by J&J’s PriCara unit and Sandoz; they are made by another J&J unit, Alza Corp.

In all, about 32 million patches will be recalled. PriCara estimates that two per million — 64 total — have the defect.

The Food and Drug Administration issued an alert about fentanyl patches in July 2005.

The issue involves a sliced edge in the pouch that contains the fentanyl gel, which could result in the gel leaking. That could result in an overdose, or leave insufficient medicine.

A handful of product returns alerted PriCara to a possible problem in January, and the company “acted immediately,” says PriCara spokesman Greg Panico. No fatalities were reported, the company said.

An FDA spokeswoman says, “The FDA continues to engage with the company in its voluntary recall, and is investigating the situation.”

Recalls in 2004 were limited to some batches of the 75-microgram patch. The more-widely used 25-microgram patch is prescribe mainly for lower-weight patients, children and patients just starting on the medicine.

Duragesic lost U.S. patent protection in 2005. Nonetheless, the patch still brought in $1.16 billion in 2007, largely because international sales remain strong. J&J’s follow-up pain medicine, called Ionsys, has been delayed coming to market in the U.S. because of manufacturing difficulties.

In its most recent public filing with the Securities and Exchange Commission, J&J said 72 people have sued the company alleging injury from Duragesic. A case this past summer yielded a $5.5 million verdict.

The recall may boost the hopes of plaintiffs’ attorneys who are claiming that the product is responsible for dozens of deaths.

“Perhaps it is time for the FDA to consider removing the Duragesic patch from the American marketplace, because there are safer alternatives,” says Alex H. MacDonald of MacDonald Rothweiler & Eisenberg LLP, which has filed four wrongful-death suits related to Duragesic.

“We’re acting responsibly by recalling the defective lot,” says the PriCara spokesman, Mr. Panico, adding that the company can’t comment on pending lawsuits. “Despite the defect, there’s much unaffected product on the market and we think overall the patients have been served by this therapeutic option.”

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San Jose Mercury News, 2/13/08: Facing a torrent of criticism Tuesday, Blue Cross of California abruptly halted its practice of asking physicians in a letter to look for medical conditions that could be used to cancel patients’ insurance coverage.

In a statement issued about 6 p.m., the state’s largest for-profit insurer said, “Today we reached out to our provider partners and California regulators and determined this letter is no longer necessary and, in fact, was creating a misimpression and causing some members and providers undue concern.

“As a result, we are discontinuing the dissemination of this letter going forward.”

The announcement came after blistering rebukes Tuesday by physicians, patients, privacy experts and officials including Gov. Arnold Schwarzenegger and Sen. Hillary Rodham Clinton, D-N.Y., after the Los Angeles Times disclosed the practice.

The letters sent to holders of individual policies in the state came just months after Blue Cross was fined $1 million by the state for unfairly revoking coverage to scores of its policy holders.

“For a company that has gotten a real black eye over the issue of rescinding coverage over the past year – to actually be more aggressive rather than less is simply stunning,” said Anthony Wright, executive director of HealthAccess California, a health care advocacy organization.

“It certainly is not a position physicians want to be put in,” said Dr. Dean Didech, chief medical officer of the San Jose Medical Group, a group of 70 local physicians. “It really is a problem between the doctor-patient relationship.”

In a letter to physicians last week, Blue Cross asked the doctors to “identify members who have failed to disclose medical conditions on their applications that may be considered pre-existing.”

It went on to say that “Blue Cross has the right to cancel a member’s policy back to its effective date for failure to disclose material medical history.”

In a statement earlier Tuesday, Blue Cross defended the letter, saying that it “highly values the trust of its members and understands the personal relationship members have with their physicians and medical groups.” But it also has a responsibility to make sure its records are accurate.

This letter could never have been written, Wright said, if legislation that stalled in the California Legislature earlier this month had been enacted into law. Among other things, the legislation would have meant that insurance companies couldn’t deny coverage based on health status.

Didech put it this way: Medical insurance companies should be forced to provide policies to everyone, “just like a driver’s license.”

Some 19 million Californians receive their health insurance through their employers – and because of the market power of group coverage, insurance companies accept all of a company’s workforce. Another 10 million Californians are covered through such public programs as Medi-Cal or Medicare. It’s the remaining 2 million or so who buy coverage as individuals who were targeted by the Blue Cross letter.

Those people tend to be freelancers and independent consultants, the jobless, early retirees, employees of small businesses without insurance, or entrepreneurs starting new businesses.

The California Medical Association, a group of 35,000 doctors in the state, had called on the state Department of Managed Health Care that regulates the health insurance industry to order Blue Cross to rescind the letter and stop these “deeply disturbing, unlawful” practices.

“As long as no charges are filed and they’re collecting premiums, it’s OK. But when the bill comes, then they investigate the background,” complained Dr. Anmol S. Majal, a gastroenterologist in Fremont and past president of the California Medical Association.60 s porn galleries60s porn60s pornographyporn site 60s-80smovies 69 porn freegay 69 porn69 porn moviesporn videos 69 Map