The value of book distribution in a clinic-based literacy intervention program.

The purpose of this study was to determine whether anticipatory guidance at well-child visits (WCV) that included early literacy development and the provision of books by the examining physician changed family literacy practices. It was conducted in an inner-city pediatric clinic that serves as the continuity practice site for pediatric and pediatric/internal medicine residents. There were 352 children (181 treatment: 171 control), aged 2 to 24 months, enrolled in this prospective, controlled study. The health care providers underwent training on literacy and on how to incorporate this information during WCV. Anticipatory guidance on safety, development, and early literacy was given to all parents. Additionally, the treatment group received an age-appropriate book at each WCV. There were 1,263 visits made (686 treatment, 577 control). Questionnaires were completed by parents on physician helpfulness and by physicians on parental receptiveness. Parental ratings on physician helpfulness were higher in the treatment group than in the control group (p<0.05). Physician's rating of parental receptiveness was also higher in the treatment group than in the control group (p<0.05). Two years after enrollment, mother-child pairs who received guidance and a book were two times more likely to report enjoyment in reading together than the controls who received guidance but no book. We conclude that anticipatory guidance that included early literacy development and distribution of books at WCV resulted in increased family literacy orientation, parental receptiveness, and perception of physician helpfulness.

Subspecialist referrals in an academic, pediatric setting: rationale, rates, and compliance.

Appropriate referrals reduce healthcare costs and enhance patient satisfaction. We evaluated the subspecialty referral pattern of a managed care general pediatric office over a 4-month period. Three-hundred-forty-six referrals (267 meeting inclusion criteria) to 24 subspecialties were generated during 4,219 office visits, with five subspecialties receiving 59% of the referrals. The main objective of each referral was management (100), diagnostic assistance (75), special procedure (63), or a combination (29). Patients kept less than half of the referral appointments, with the highest (80%) and lowest (28%) compliance rates observed in cardiology and ophthalmology, respectively. Appointments made within four weeks of the referral were more likely to be kept than those with greater lag time (P = 0.001). The subspecialists prepared written, post-consultation responses to the referring physician in 73% of cases. Presumptive and post-consultation diagnoses were congruent in 78% of those cases in which both diagnoses were noted. Overall, the managed care format enabled our practice to track referral outcomes. The subspecialists' written responses also allowed for an educational exchange between physicians. Compliance with referral appointments is a substantial problem that needs to be addressed.

Fine needle aspiration in the evaluation of children with lymphadenopathy.

OBJECTIVE: To evaluate fine needle aspiration of enlarged lymph nodes in children. DESIGN: Retrospective study of children who were referred for fine needle aspiration of a palpable lymph node that was of concern to their clinicians. SETTING: Large, urban, tertiary care pediatric hospital. SUBJECTS: One hundred nineteen patients (123 cases) aged 10 months through 21 years during the 30-month period from January 1990 to June 1992. RESULTS: Aspirated material in 13 cases (10.6%) was deemed inadequate for cytologic diagnosis. In the remaining 110 cases, five aspirates revealed malignancy: two patients had Hodgkin's disease, one had non-Hodgkin's lymphoma, one had a leukemic infiltrate, and one had rhabdomyosarcoma. The findings in two cases were suspicious for malignancy, but the lymph nodes were found to be benign on excisional biopsy. No false-negative findings for malignancy were detected. The conditions of patients in the remaining 103 cases were diagnosed as a benign process, most commonly reactive lymphadenitis. Of 57 aspirates cultured, eight (14%) were positive for a microorganism. No significant complications were encountered in any of the 123 cases. CONCLUSION: Fine needle aspiration of enlarged lymph nodes in children is a safe, reliable (accuracy, 98%) procedure that often obviates the need for an excisional biopsy.

Bacterial tracheitis as a complication of tonsillectomy and adenoidectomy.

We describe two patients in whom bacterial tracheitis developed shortly after elective tonsillectomy and adenoidectomy. Bacterial tracheitis has not previously been reported in this clinical setting. Prompt recognition is essential if a fatal outcome is to be avoided. The cause remains uncertain, but the outcome is good if timely treatment is instituted.

Familial congenital bronchiectasis: Williams-Campbell syndrome.

Williams-Campbell syndrome was first described in 1960 as a rare form of bronchiectasis. Its pathogenesis is characterized by the absence or markedly diminished cartilage around the bronchi. Although the familial nature was postulated early on, only one possible familial occurrence has been reported in the literature. We present two family members in whom respiratory symptoms developed within the first year of life and were found to have histopathologic changes consistent with Williams-Campbell syndrome. This world lend further support of a developmental origin for this type of bronchiectasis.