Medical equipment use in children with disabilities: A descriptive survey.

OBJECTIVE: To investigate the use of medical equipment by children with disabilities, the reasons for use, and prescribers of equipment. METHODS: A convenience sample. SETTING: Referral clinic for children with developmental conditions. PARTICIPANTS: Caregivers of children with motor disabilities completed an interview survey for children 0-21 years. RESULTS: 108 parents/caregivers reported 467 (mean=4.3 per patient) pieces of owned equipment. The mean age of children was 7.1 years (± 5.0), and 49% were female. The most common diagnoses were cerebral palsy (45%), 'Other' diagnoses including intellectual disability (19%), genetic abnormality (13%), spina bifida (13%), and neuromuscular diseases (7%). Survey participants described use of the following types of equipment: orthotics (82%), bath chair (37%), seating device (34%), stander (19%), augmentative communication devices (17%), walker (14%), and gait trainer (10%). Reasons for "non-use" of equipment included: outgrown (19%), not useful (14%), and child refusal (15%). Physicians were the sole prescriber for 15% of families, whereas physical or occupational therapists most commonly recommended new equipment (76%). CONCLUSION: Based on parental report, children with neuromuscular disabilities use most equipment that is medically recommended. The majority of equipment needs are identified by therapists. Pediatricians can benefit from additional expertise in the provision of medical equipment for children.

Ghrelin levels in young children with Prader-Willi syndrome.

OBJECTIVE: To explore the hypothesis that high ghrelin levels contribute to obesity in Prader-Willi syndrome (PWS), we assessed whether the increased levels observed in older persons with PWS exist in very young children, before the onset of hyperphagia. STUDY DESIGN: We measured ghrelin levels in nine children with PWS (17-60 months of age) and eight healthy control subjects of equivalent body mass index (BMI), age, and sex. RESULTS: PWS and control groups had equivalent BMI (16.8 +/- 1.4 vs 16.1 +/- 0.9 kg/m(2), respectively; P = .24), age (37.8 +/- 15.4 vs 50.3 +/- 17.7 months; P = .14), and sex. PWS and control groups also had equivalent fasting levels of total ghrelin (787 +/- 242 vs 716 +/- 135 pg/mL, respectively; P = .24), bioactive ghrelin (102 +/- 35 vs 91 +/- 23 pg/mL; P = .45), insulin, and glucose. Ghrelin correlated negatively with BMI among controls (r = -0.760, P = .029) but not PWS (r = 0.015, P = .97). CONCLUSIONS: Children <5 years of age with PWS, who had not yet developed hyperphagia or excessive obesity, had normal ghrelin levels, in contrast with the hyperghrelinemia of older, hyperphagic people with PWS. It is possible that ghrelin levels increase suddenly before hyperphagia develops.

Mentoring for the New Millennium.

The challenges and benefits of a formal mentoring program are considered within the context of learning organizations: specifically, graduate medical education and professional development. While no single definition addresses every aspect of mentoring, this process is a distinct one with established traditions and expectations. The core requirements of attraction, action and affect remain and are essential for this adult developmental process to be successful. This paper's review of the literature supports the belief that mentoring has value, even into the next millennium, with some conceptual evolution. We are encouraging a paradigm shift from the traditional dyad model of mentoring to a triad model: organization, mentor, and protégé. The future development of outcome measures will be a necessary goal to demonstrate that both personal and organizational goals can coexist.