Building bridges: qualitative assessment of a clinical faculty exchange between a naturopathic and an allopathic medical training program.

RESEARCH QUESTION: What are the perceived benefits of a clinical exchange experience designed as part of a program to promote acceptance and use of evidence-based medicine (EBM) in naturopathic clinical practice? METHODS: Nine faculty members participated in a focus group (n = 6) or a structured interview (n = 3) to assess experience in the program. Investigators independently analyzed transcribed notes for common experience themes. ANALYSIS AND INTERPRETATION: Six major themes emerged: integrating EBM into naturopathic clinical teaching, strengthening of professional relationships, exposure to clinical experiences outside the usual naturopathic scope, reaffirmation of naturopathic training and profession, observation of clinical and administrative resources and practices, and recommendations for future clinical exchanges. MAIN RESULTS: A clinical exchange experience was viewed as a favorable way to promote EBM appreciation within the complementary and alternative medicine educational community and to foster improved clinical experiences for faculty and their students and patients.

Accidental foot burns in children from contact with naturally heated surfaces during summer months: experience from a regional burn center.

BACKGROUND: Foot burns in children often result from contact with heated surfaces due to high ambient temperatures during summer in the southwestern United States. The objective of this study was to describe the unique cause and clinical characteristics of this type of injury. METHODS: A retrospective review of medical records of pediatric patients presenting with contact burns of the foot in Arizona Burn Center, which is the third largest burn center in the United States. Participants included children 5 years and under who were treated for pedal burns during a 5-year period between January 2000 and August 2005. RESULTS: Seventy-four children with contact burns of the foot were treated of which 34 (46%) were from naturally heated surfaces. When compared with those who sustained pedal burns as a result of contact with other hot objects, children with burns from naturally heated surface more commonly had bilateral (82.4%), second degree (82.4%) burns involving primarily the plantar surface (94.1%) of the foot and the injury usually occurred in the peak of the summer. Also, physical abuse was more commonly suspected in this group. CONCLUSION: Contact with a hot surface during summer months is a dominant cause of foot burns in small children in the southwestern United States with characteristic clinical presentation and calls for preventive educational interventions.

Evaluation of nonpharmacologic methods of pain and anxiety management for laceration repair in the pediatric emergency department.

BACKGROUND: Nonpharmacologic interventions, such as distraction, have been shown to be powerful adjuncts in reducing pain and anxiety in children with both acute and chronic painful conditions. There are no controlled studies evaluating these interventions as adjuncts to facilitate completion of painful procedures in the pediatric emergency department (ED). OBJECTIVE: We assessed the effectiveness of distraction techniques in reducing the sensory and affective components of pain among pediatric patients undergoing laceration repair in the ED. METHODS: Eligible children between 6 and 18 years of age (N = 240) presenting to the ED for laceration repair were randomly assigned to an intervention or control arm. Those assigned to the intervention arm were given a choice of age-appropriate distracters during laceration repair. Quantitative measures of pain intensity, situational anxiety, and pain distress (as perceived by the parent) were assessed by using the 7-point Facial Pain Scale, State Trait Anxiety Inventory for Children, and a visual analog scale, respectively, before and after laceration repair. The State Trait Anxiety Inventory for Children was performed in children > or = 10 years of age. RESULTS: There was no difference in mean change in Facial Pain Scale scores between the control and the intervention groups in children < 10 years of age. Multivariate analysis in this same age group showed that the intervention was independently associated with a reduction in pain distress as perceived by parents based on the mean change in visual analog scale scores. In older children, the intervention was independently associated with reduction in situational anxiety but not in pain intensity or in parental perception of pain distress. CONCLUSIONS: The use of distraction techniques is effective in reducing situational anxiety in older children and lowering parental perception of pain distress in younger children. This technique may have a role in improving the quality of management of procedural pain in a pediatric ED setting.

Screening for adolescent depression in a pediatric emergency department.

OBJECTIVES: To describe the prevalence of depressive symptoms in adolescents presenting to the emergency department (ED) and to describe their demographics and outcomes compared with adolescents endorsing low levels of depressive symptoms. METHODS: The Beck Depression Inventory-2nd edition (BDI-II) was used to screen all patients 13-19 years of age who presented to the ED during the period of study. The BDI-II is a 21-item self-report instrument used to measure the presence and severity of depressive symptoms in adolescents and adults. Demographics and clinical outcomes of screening-program participants were abstracted by chart review. Patients were categorized into one of four severity categories (minimal, mild, moderate, or severe) and one of three presenting complaint categories (medical, trauma, mental health). RESULTS: Four hundred eighty-seven patients were approached, and 351(72%) completed the screening protocol. Participants endorsed minimal (n = 192, 55%), mild (n = 52, 15%), moderate (n = 41, 11%), or severe depressive symptoms (n = 66, 19%). Those with moderate or severe depressive symptoms were more likely to be hospitalized. Of patients completing the BDI-II, 72% with psychiatric, 12% with traumatic, and 19% with medical chief complaints endorsed either moderate or severe depressive symptoms. CONCLUSIONS: Depressive symptoms are prevalent in this screening sample, regardless of presenting complaint. A substantial proportion of patients with nonpsychiatric chief complaints endorsed moderate or severe depressive symptoms. A screening program might allow earlier identification and referral of patients at risk for depression.