Web sites and pediatric residency training programs in the United States.

The purpose of this study was to describe the use of Web sites by pediatric residency programs in the United States, the information provided on those Web sites, and the degree of user-friendliness in navigating the Web sites. Most residency programs (137/197) listed a Web address; 96% (131) of these sites were accessible and were analyzed. Most programs (98/131) provided information for 11 to 20 content items, 11 programs described less than 10 content items, and the remaining 22 programs listed 21 to 42 content items on their Web sites. Most Web sites (87%) were categorized into the user-friendly level. Extremely user-friendly Web sites also provided information on significantly more content items. Although 95% and 96% of positions were filled through match in programs with user-friendly Web sites and programs with extremely user-friendly Web sites, respectively, these were not statistically different from the programs with less user-friendly Web sites, where only 88% of positions were filled through the match. The majority of pediatric residency training programs have Web sites. Most of these Web sites were user-friendly and provided a variety of information sought by applicants.

Osteomyelitis in adolescents.

Osteomyelitis in adolescents is a serious disease with the potential for lifelong disability. Microbial invasion of the bone typically results from hematogenous seeding. Staphylococcus aureus is the most common cause of acute hematogenous osteomyelitis. The clinical presentation and management of osteomyelitis in children and adolescents is changing with the emergence of invasive community-acquired methicillin-resistant S aureus infections. Antibiotic treatment should target S aureus including community-acquired methicillin-resistant strains. In some cases, surgical debridement is indicated, especially in cases of chronic osteomyelitis or osteomyelitis associated with septic arthritis. Early diagnosis and subsequent appropriate medical and surgical intervention is critical for avoiding chronic bone destruction and, thus, preventing permanent disability. A multidisciplinary approach involving the pediatrician, infectious disease specialist, and orthopedic surgeon is essential for achieving the best outcome for the patient.

Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis.

Group A beta-hemolytic streptococcus (GABHS) is the most common bacterial cause of acute pharyngitis. Clinical criteria alone are not reliable enough to diagnose GABHS pharyngitis. Microbiological-testing is required for correct diagnosis. Although a throat swab culture remains the gold standard for documenting the presence of GABHS, a significant disadvantage of the culture is the delayed time of 1-2 days to obtain results. Most rapid antigen detection tests can provide results in less than 15 min. Rapid identification and treatment of patients with GABHS pharyngitis can reduce the risk of the spread of disease, may shorten the duration of symptoms, decrease the incidence of suppurative complications, decrease the amount of time lost from school/work, decrease the inappropriate use of antibiotics, reduce patient/parent dissatisfaction and alleviate the need for costly follow-up visits. All rapid antigen detection tests involve extraction of the group-specific carbohydrate antigen from the GABHS cell wall and identification of the antigen by an immunological reaction. There are numerous rapid antigen detection testing methods, namely latex agglutination, enzyme immunoassay, optical immunoassay, chemiluminescent DNA probes and PCR methods. Most of the rapid antigen detection tests that are currently in use have an excellent specificity of greater than 95% and a sensitivity of greater than or equal to 90%. Owing to the high specificity of the rapid antigen detection tests, a positive rapid antigen detection test is accepted as adequate for the diagnosis of GABHS pharyngitis. Conversely, confirmation of a negative antigen detection test with a throat culture result is necessary, unless the physician has ascertained in his/her practice that the sensitivity of the rapid antigen test used is comparable with that of a throat culture.

Immunizations for the college student: a campus perspective of an outbreak and national and international considerations.

Although vaccine-preventable diseases have declined to record-low levels in the United States, infectious disease "epidemics" on college campuses continue. A large student body with variable immunization status makes a college campus fertile ground for the spread of communicable diseases. The presence of international students and an increasingly large number of students traveling abroad make it essential that individuals charged with defining and instituting health-related policies for the university have knowledge about health issues occurring in foreign countries as well. Several safe and effective vaccines are available that offer protection to young adults from a variety of infectious diseases in the United States. Because vaccine-preventable diseases can cause both human and economic problems for colleges and universities, administrators should take steps to assure that the students on college campuses benefit from these vaccines.

Student evaluation practices in pediatric clerkships: a survey of the medical schools in the United States and Canada.

Despite the curriculum changes during the past decade, there is paucity of information regarding the structure and evaluation processes in pediatric clerkships. Information regarding the educational components of the pediatric clerkship and student evaluation practices was obtained from the pediatric clerkship directors via a paper/electronic survey. Completed surveys were received from 97 US and Canadian medical schools and were analyzed. The average length of a clerkship was 7 weeks. Most clerkships required a 4-week ward, a 1-week newborn rotation, and a 2-week ambulatory rotation. Students were evaluated on each component of the clerkship in 93.5% of the programs. All programs evaluated student's clinical performance and fund of knowledge; 85.6% evaluated student's written record. Student's clinical performance was evaluated by direct observation in 57% of the programs. Penalties for failing in clinical performance were harsher. In 56% of programs, a student failing in clinical performance failed the entire clerkship in contrast to 21.8% or 7% of the programs where a student failed the entire clerkship if they failed in the examination for the fund of knowledge or written record evaluation, respectively. The survey demonstrated a fair amount of consistency in clerkships across programs when compared with data obtained in 1981 and 1986. There was a noticeable increase in the well-baby nursery rotation; however, there was a decline in direct observation to assess physical examination or clinical performance.

Issues in the formulation of drugs for oral use in children: role of excipients.

An ideal oral drug for children should be effective, well tolerated, be of low cost and have good palatability, i.e. acceptable taste, after-taste and smell. Many of the drugs used for children are not available in suitable forms (such as chewable or liquid). Liquid forms may need to be prepared using appropriate excipients at the time of dispensing by the pharmacist. Modern medications are complex mixtures containing many other components besides the active ingredient. These are called 'inert ingredients', or excipients, and consist of bulk materials, flavorings, sweeteners and coloring agents. These excipients increase the bulk, add desirable color, mask the unpleasant taste and smell, and facilitate a uniform mixture of the active ingredient in the final marketed preparation. Unlike the active ingredients, excipients are not well regulated in most countries. Although mostly well tolerated, some adverse events and idiosyncratic reactions are well known for a variety of excipients. These components play a critical role, especially in liquid and chewable preparations that are mostly consumed by infants and children. This article reviews excipients commonly used in pediatric oral preparations.

Volunteer faculty: what rewards or incentives do they prefer?

BACKGROUND: Clerkship directors and college administrators have concerns about recruitment and retention of practicing physicians for volunteer teaching. There is a paucity of data regarding the rewards and incentives offered to, or desired by, the nonsalaried community-based practicing physicians who volunteer their time to teach. PURPOSE: This study was designed to gain information about rewards and incentives from volunteer teachers in pediatric, family practice, and internal medicine clerkships. METHODS: We surveyed nonsalaried physician teachers of internal medicine, family medicine, and pediatrics across the United States. The survey focused on teachers' evaluation of the rewards or incentives offered by the programs in the following categories: educational opportunities, services or gifts, recognition bestowed by the school, academic appointments, and monetary payments. Respondents rated each item from 1 (not appreciated) to 5 (very much appreciated). They also were asked to rank order the rewards or incentives (with the addition of a category of personal satisfaction) from 1 (least appreciated) to 6 (most appreciated). RESULTS: Educational opportunities received high ratings, especially when the school bore the cost of providing a service. Payment for teaching was offered to 37% of the respondents, and those who were paid rated it higher. Overall, payment for teaching had a mean appreciation score of 3.94, second only to travel and meeting registration reimbursement (4.27). However, in the rank order listing, personal satisfaction had the highest rank (5.16). In contrast, payment for teaching (2.92) and gifts or services from the college (2.53) were at the bottom of the rank order. CONCLUSION: The survey asked practicing physicians the value they placed on awards and incentives provided to them by the college. This information should help administrators and clerkship directors in recruiting and retaining community-based practicing physicians for teaching.