Comparison of pediatric and general emergency medicine practice patterns in infants with fever.

OBJECTIVES: To evaluate and compare the management approaches of pediatric and general emergency medicine physicians in infants presenting to the emergency department (ED) with complaint of fever. METHODS: Infants 90 days of age or younger with a chief complaint of fever were included for review. Vital signs, laboratory workup, disposition, and final diagnosis were collected. Compliance with guidelines was assessed and compared between EDs. RESULTS: Compliance with admission guidelines was not significantly different in any of the 3 age groups evaluated between the pediatric and general ED (PED and GED). Compliance with guideline recommendations for laboratory workup was not significantly different between the 2 EDs, nor was overall compliance with guideline recommendations. CONCLUSIONS: No significant variations in the management of febrile infants or compliance with published guidelines between PED and GED physicians were observed. Young infants can be safely treated for fever in the PED or GED.

Subjective and novel objective radiographic evaluation of inflatable bone tamp treatment of articular calcaneus, tibial plateau, tibial pilon and distal radius fractures.

There is a growing need to develop tools that allow for better reductions of difficult to treat fractures in minimally disruptive ways. One such technique has been developed using the inflatable bone tamp and a fast setting calcium phosphate. KYPHON(®) XPANDER Inflatable Bone Tamp and the KYPHON(®) Osteo Introducer(®) System were used to reduce the articular fractures and a fast-setting calcium phosphate was introduced into those voids and metal hardware was applied as deemed necessary. Subjects were skeletally mature patients treated for articular fractures of the calcaneus, tibial plateau, tibial pilon, or distal radius. Post-operative day zero and week 12 radiographs were objectively and subjectively evaluated by three independent orthopaedic surgeons. Their objective scores were then translated into subjective categories based on the Heiney-Redfern scaled scoring (H-R score) system established herein. Overall, the thorough radiographic analysis by independent reviewers indicates that the technique is capable of obtaining and maintaining articular reductions in a good or adequate manner at 12-weeks post-operatively. Introduced is a potential novel evaluation scale scoring system for these articular fractures that evaluates the important anatomic considerations reproducibly in fracture reductions. There are many potential benefits that remain speculative to this type of tool within a procedure, and therefore this tool and technique warrants further research.

Effect of insurance payer status on the surgical treatment of early stage breast cancer: data analysis from a single health system.

The effect of insurance payer status on surgical treatment of early stage breast cancer is unclear. This retrospective study examined the effect of insurance payer on mastectomy rates of 1539 women treated within a single health system. Women with Medicaid had significantly larger tumors compared with those with private insurance (PI) at diagnosis (3.3 cm vs 2.1 cm, P < .05) and were more likely to be treated with mastectomy for larger tumors compared with women with PI. However, women with PI were more likely to have mastectomy for smaller tumors; among women with tumors less than 2 cm, 11% with Medicaid underwent mastectomy compared with 47% with PI (P < .05). Overall, when compared with those with PI, women with Medicaid were more likely to receive mastectomy (60% vs 39%, P < .05).

Eating disorder training and attitudes among primary care residents.

BACKGROUND: The ability to diagnose eating disorders (ED) is important and difficult for primary care physicians (PCPs). Previous reports suggest that PCPs feel their training is inadequate. OBJECTIVE: To explore residents' interest and comfort diagnosing and treating ED. METHODS: An internet survey was sent to primary care residencies. Logistic regression models were fitted to identify factors correlated with residents' interest and comfort in diagnosing and treating ED. RESULTS: Family Medicine and Internal Medicine residents had higher interest in ED than Pediatric residents, as did female residents and residents exposed to teenagers with unexplained weight loss. Residents in programs with an ED program and faculty interested in ED were more comfortable diagnosing ED. CONCLUSIONS: Interest in, and comfort diagnosing and treating ED are associated with specialty type, presence of an ED program, presence of faculty interested in ED, and resident exposure to ED outpatients and teenagers with unexplained weight loss.