Drug-exposed infants.

The problem of drug-exposed infants has been a societal concern for more than a decade. The Future of Children devoted its first journal issue in spring 1991 to this topic and has provided information updates in subsequent journal issues. The 1991 issue reviewed the major trends in judicial, legislative, and treatment responses to this problem, reporting that, for the most part, appellate courts were rejecting attempts to prosecute pregnant substance-abusing women, and state and federal legislative efforts were creating more treatment programs for, rather than punishment of, these women. With only limited exceptions, these trends continue today. Evaluations of treatment programs funded through the federal initiatives of the late 1980s and early 1990s show some level of treatment effectiveness. However, they also highlight the continuing need for rigorous evaluations of treatment outcomes.

The role of physicians in reporting and evaluating child sexual abuse cases.

Physicians become involved in child sexual abuse when they must report suspected abuse or when they are asked to medically evaluate a child who is an alleged victim of abuse. This article reviews recent progress in the medical profession's attention to child sexual abuse and discusses current issues surrounding reporting and medical evaluation. The reporting requirement raises several concerns for pediatricians. Their legal responsibilities as reporters may conflict with their traditional relationship with the family as a unit and with the confidentiality of the doctor-patient relationship. Knowledge about pediatric anogential anatomy is in a relatively early stage of development, and few pediatricians receive training adequate to enable them to determine whether medical observations are consistent with sexual abuse. Even fewer pediatricians receive training in the unique considerations and needs present when taking the medical history of a possible abuse victim or when preserving evidence for possible later use in court. The medical evidentiary evaluation of suspected sexual abuse also raises a number of concerns. There is great variability in referral patterns, which determine whether a medical examination will be requested and whether a general practice physician or a specialist will be asked to conduct the exam. Although professional medical associations have laid out broad outlines of recommended procedures for medical exams when sexual abuse is suspected, more detailed protocols are needed for addressing the many cases where findings are ambiguous or subtle. Often physicians need training in forensics and assistance in coordinating services with multiple agencies and professions. Finally, attention must be given to ensuring adequate cost reimbursement for medical evaluations.

Immediate versus postponed combination chemotherapy (CAMP) for unresectable non-small cell lung cancer: a randomized trial.

A randomized control trial was performed in good performance status patients with unresectable non-small cell lung cancer to test a strategy of early aggressive combination chemotherapy (CAMP [cyclophosphamide, doxorubicin, methotrexate, and procarbazine]) versus a strategy of delaying such treatment until clinical deterioration. Thirty-seven patients received immediate CAMP and 35 patients received initial low-dose single-agent CCNU (CAMP was postponed). Immediate CAMP therapy produced an objective response rate of 44% in patients with measurable lesions, and CCNU produced none. Median survival was 193 days for the immediate-CAMP group and 175 days for the postponed-CAMP group (P = 0.26). Measures of quality of life were made and no difference emerged between the two treatment strategies. This trial failed to show substantial benefit from immediate combination chemotherapy in minimally symptomatic patients with non-small cell lung cancer.