Associate and baccalaureate degree final semester students' perceptions of self-efficacy concerning community health nursing competencies.

A quantitative study was undertaken to examine whether final semester associate degree nursing (ADN) and baccalaureate degree nursing (BSN) students who experienced community health nursing content perceived themselves as self-efficacious to work as community health nurses (CHNs) with individuals, families, and communities. Additionally, the study examined the variance of perceived self-efficacy (PSE) accounted for by antecedent variables, performance accomplishments (PA), vicarious experience (VE), verbal persuasion (VP), and emotional arousal (EA). Questionnaires were mailed to faculty liaisons from 34 randomly selected National League for Nursing (NLN)-accredited schools in the United States. Statistical analysis revealed that the ADN and BSN final semester students perceived themselves to be equally self-efficacious to work with individuals and families. Significant differences were found, however, between the ADN and BSN students on PSE to work with communities. PA and VE explained 15% of the PSE variance suggesting that actual and VE contributes positively to a students' PSE to work as a CHN.

Stool appearance in intussusception: assessing the value of the term "currant jelly".

This study surveyed the stool appearance descriptions of 107 inpatient children with intussusception. Fifty-six patients presented with grossly bloody stools (passed spontaneously), 10 of which were determined on chart review to resemble currant jelly. Of the 51 patients without grossly bloody spontaneously passed stools, 35 patients had rectal examination results charted. Eight of these children had grossly bloody stools noted on rectal examination, 4 of which were determined on chart review to resemble currant jelly. While most of the grossly bloody stools were not consistent with pure currant jelly, the most common terms used in describing the grossly bloody stools were "bloody," "mucus," "red," and "diarrhea." Since stools truly resembling currant jelly account for a minority of the grossly bloody stools in intussusception, the term "currant jelly stools" should be assessed in the teaching of intussusception. Generic terms such as blood, mucus, burgundy, red, etc, are more objective and sensitive at identifying cases of intussusception. Junior physicians who are taught the classic presentation of intussusception with currant jelly stool should also be taught that intussusception should be considered in the differential diagnosis of children passing any type of bloody stool. As a result, physicians with limited experience will be more likely to appropriately consider the diagnosis of intussusception, permitting a more timely diagnosis and a better outcome.

Oxygen saturation changes during the pediatric emergency department treatment of wheezing.

This study examined the oxygen saturation (OSAT) changes measured by pulse oximetry during emergency department (ED) bronchodilator treatment of wheezing patients. Data were collected prospectively on two cohorts (November 1987 to November 1988, 2,468 patients; and December 1988 to October 1990, 4,913 patients) presenting to a pediatric ED with wheezing-associated respiratory illnesses. Initial, posttreatment, and discharge OSAT was recorded in many of these patients. Improvement in OSAT following ED bronchodilator administration was noted in most patient groups. Initial OSAT was indicative of severity as measured by the need for hospitalization and the number of bronchodilator treatments administered in the ED. Subcutaneous epinephrine and aerosolized albuterol were compared in OSAT improvement and side effects. Aerosolized albuterol was not shown to be superior to epinephrine. Improvements in OSAT following bronchodilator administration documents the presence of relative preexisting hypoxemia which is reversed to some degree with bronchodilators. Pulse oximetry is an objective means of assessing asthma severity.

Triage in the emergency department.

Accurate patient triage to provide early identification of potentially seriously ill or high-risk infants and children is an important part of any emergency care system. Use of the SAVE-A-CHILD mnemonic in a busy ED setting provides systematic organization of important clinical observations that may serve as markers of serious disease. Early recognition of the high-risk patient will reduce morbidity and mortality. The discussion included may be helpful to emergency physicians in training their staff to provide a safe triage environment.

Pulse oximetry to identify a high-risk group of children with wheezing.

To investigate the value of pulse oximetry in children with wheezing presenting for emergency medical treatment, initial oxygen saturations (OSAT) were measured in 1,101 of 1,235 patients presenting to a pediatric ED over a 5-month period with wheezing-associated respiratory illnesses. The mean OSATs were 95.4% for wheezing children and 98.7% for controls. An initial OSAT of 95% or more indicated a low need for hospitalization. An initial OSAT less than 85% indicated a high need for hospitalization (positive predictive value, 90%). Pulse oximetry may be useful in identifying children with wheezing who are at high risk, as demonstrated by the need for hospitalization, during the early phase of an ED encounter, at which time more aggressive therapeutic interventions may be considered.

Hyperostotic meningioma presenting as an asymptomatic forehead bulge in a 7-year-old girl.

The case of an asymptomatic 7-year-old girl with a hard bulge in the left forehead is presented. The radiological evaluation disclosed a hyperostotic mass with a large intracranial extension. A surgical specimen revealed a meningioma. The presence of a localized cranial bulge as the only sign of an intracranial tumor and the diagnostic value of computerized tomography (CT) are discussed.