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F H Lovejoy

Publications and source records attributed to F H Lovejoy.

At least 19 recordsLinked to original sources
PubMed1993

Academic careers: choice and activity of graduates of a pediatric residency program 1974-1986.

In summary, our data suggest that the playing field for academic medicine is changing. It is more patient care oriented, more multifaceted and supported more by clinical dollars than in the past. Greater flexibility in what constitutes "academic success" is necessary to assure a supportive environment in which tomorrow's academic faculty can develop and flourish. To accomplish these goals promotion systems that reward not only research but also teaching and clinical care accomplishments will be necessary. Clinicians will need to be compared with clinicians, teachers with teachers, clinical investigators with clinical investigators and basic investigators with basic investigators. Sources of support will need to be more clearly targeted along activity lines with clinical dollars supporting the clinician, medical education dollars supporting the teacher-educators and federal and foundation dollars supporting research. In our department, time and effort for research (45%) approximates dollar support for this activity (44%), while clinical dollars (43%) fund to a greater degree time and effort committed to clinical care (34%), and administration and teaching dollars (13%) under fund time and effort committed to these activities (21%). This suggests the need to identify increased funding to support teaching and education. Promotion expectations for women will need to be more flexible and adjusted to family responsibilities and demands. Most of all, however, we academic faculty must support enthusiastically the importance and joy of our work. We must be encouraging to our colleagues and our students and continue to recognize that for all of the difficulties and challenges, academic life is a rewarding and fulfilling enterprise.

Academic Medical Centers↗
PubMed1992

The use of digoxin-specific Fab fragments for severe digitalis intoxication in children.

BACKGROUND: Because life-threatening digitalis intoxication is unusual in children, treatment with digoxin-specific-antibody Fab fragments (Fab) has rarely been reported. We describe the efficacy of Fab in the treatment of children with severe digitalis intoxication. METHODS: Twenty-nine children with intoxication due to digoxin (28) or digitoxin (1) received Fab at 21 participating hospitals between 1974 and 1986. Data were gathered about the patients' medical illnesses, doses and serum concentrations of digitalis, responses to Fab therapy, and outcomes. RESULTS: In the infants and young children with acute digoxin intoxication, the digoxin doses ranged from 0.30 to 0.96 mg per kilogram of body weight; two adolescents had severe intoxication after doses of only 0.20 and 0.26 mg per kilogram. The serum digoxin concentrations ranged from 3.0 to greater than 100 ng per milliliter (mean, 13.8). Atrioventricular block (present in 22 patients [76 percent]) was the most common sign of toxicity. All the patients in this series had severe disturbances of cardiac rhythm, hyperkalemia (mean serum potassium concentration, 5.4 mmol per liter), or both. In 27 patients (93 percent), digitalis toxicity resolved after the administration of Fab. Of the 19 patients for whom data were available on the timing of the response to Fab, 15 responded within 180 minutes. Three patients required retreatment with Fab. Seven died of complications unrelated to the administration of Fab. CONCLUSIONS: We recommend that Fab be used in the treatment of digitalis poisoning in infants and young children who have ingested greater than or equal to 0.3 mg of digoxin per kilogram, who have underlying heart disease, or who have a serum digoxin concentration of greater than or equal to 6.4 nmol per liter (greater than or equal to 5.0 ng per milliliter) in the elimination phase; and who also have a life-threatening arrhythmia, hemodynamic instability, hyperkalemia, or rapidly progressive toxicity. Adolescents, who are more sensitive to the toxic effects of digoxin than younger children, may require treatment with Fab after ingesting lower doses.

Acute Disease↗
PubMed1992

Effect of acute versus chronic intoxication on clinical features of theophylline poisoning in children.

OBJECTIVES: To determine whether the method of intoxication influences the metabolic disturbances and pattern of life-threatening events that occur after theophylline intoxication in children. METHODS: Five-year prospective observational study of consecutive pediatric patients referred to a regional poison control center with a theophylline concentration (theo) greater than or equal to 30 micrograms/ml. At the time of referral, intoxication was categorized as acute (single toxic exposure), chronic (long-term toxic exposure), or acute-on-therapeutic (single toxic exposure superimposed on maintenance therapy). RESULTS: One-hundred twenty-five patients were monitored. Mean age was 12 years (range, 3 days to 20 y). Seventy-four patients (59%) had acute intoxication, 31 (25%) had chronic intoxication, and 20 (16%) had acute-on-therapeutic intoxication. Mean peak serum (theo) was 55 micrograms/ml. Life-threatening events occurred in 12 patients (10%). Patients with acute intoxication had a significantly lower serum potassium level (3.04 vs 3.80 mmol/L; p less than 0.001) and higher serum glucose level (10.8 vs 7.0 mmol/L (194 vs 127 mg/dl); p less than 0.001) than did children with chronic intoxication. Although life-threatening events (seizures or arrhythmias) occurred at a similar rate across categories, the (theo) at which these events occurred was significantly higher in patients with acute intoxication than in those with chronic intoxication (100 vs 42 micrograms/ml; p = 0.02). Among children with chronic intoxication, those who had life-threatening events had (theo) similar to those who remained well (42 vs 47 micrograms/ml) but were significantly younger (1.6 vs 8.0 years; p less than 0.001). CONCLUSIONS: These data indicate that method of intoxication has significant effects on the metabolic and clinical consequences of theophylline poisoning. Life-threatening events occur in those with acute theophylline intoxication at significantly higher (theo) than in those with chronic intoxication. After chronic intoxication, peak (theo) does not identify patients at risk for life-threatening events; young age appears to be the primary risk factor. These findings potentially complicate the management of theophylline poisoning, given the difficulty of extracorporeal drug removal in young infants.

Acute Disease↗
PubMed1992

Careers chosen by graduates of a major pediatrics residency program, 1974-1986.

Knowing the career choices of a residency program's graduates helps those who direct the program improve their intern selection process, fashion a more appropriate curriculum, and assess the professional choices of their trainees. This report presents a summary of data the authors obtained in 1988 and 1989 on the career choices of 270 of the 276 graduates who had served at least two years in the pediatrics residency at The Boston Children's Hospital between 1974 and 1986. The study findings are compared with the findings of two other national surveys of career choices of pediatrics residents. The data indicate that 66% of the 270 graduates were in academic pediatrics careers, which is much higher than the 20-23% of those involved in such careers nationwide. The remaining graduates were either in pediatrics practice (31%) or in other professional activities (3%), such as working at the National Institutes of Health, in public health, and for industry. There was a steady increase in the percentage of women over the 12-year period covered by the study, from 30% to 39%. These and many more findings brought to light program deficiencies in a number of areas, which are now being remedied.

Boston↗
PubMed1992

Prospects for academically trained pediatricians in academic medicine.

There is widespread concern about the commitment and ability of physicians to enter careers in academic medicine. We studied MEDLINE citations by 150 academically trained pediatricians to determine whether they remained in academic medicine and to assess the nature of their contribution. We identified 2098 citations by 122 of the 150 individuals which reflected substantive involvement in clinical and basic research. Most individuals published their first papers within three years after residency and thereafter exhibited a stable level of productivity. Individuals who published prior to completing residency were most likely to enter academic medicine and achieve a high level of productivity. These reassuring data suggest that individuals who pursue an academic track may assume the traditional role of the physician scientist, and suggest measures which may be taken to attract more physicians to academics.

Academic Medical Centers↗
PubMed1992

A service chief model for general pediatric inpatient care and residency training.

Pediatric training programs are faced with rapid, fundamental changes in hospital practice and an increasingly rigorous regulatory and fiscal environment. Traditional models for providing care and teaching students and house officers may not be sufficiently responsive to these challenges. In 1986, the Department of Medicine at Children's Hospital, Boston, reorganized the general inpatient program and implemented a "service chief" system adapted from British hospital "firms." Three age-based inpatient services (Thomas Morgan Rotch infant/toddler service, Kenneth Daniel Blackfan school-age service, and Charles Alderson Janeway adolescent/young adult service) were created, each headed by an experienced clinician and teacher (service chief). The service chiefs developed age-appropriate curricula, recruited a balanced faculty of generalists and specialists to serve as attending physicians and provide teaching in their areas of expertise, and established strong collaborative relationships with nurse managers on their respective wards. Implementation of the service chief system has been associated with development of faculty esprit de corps, standardized tracking of faculty performance, enhanced supervision and counseling of housestaff, and improved continuity of patient care. Relationships with referring physicians have improved dramatically, as measured by formal satisfaction surveys. Accountability and documentation have been emphasized, and departmental billings have increased sharply. Ongoing quality indicators have been developed, and collaborative patient care, teaching, and quality-improvement projects have been initiated with the nursing staff. Naming the services for distinguished past physicians-in-chief has provided a focus for fund-raising.(ABSTRACT TRUNCATED AT 250 WORDS)

Accreditation↗
PubMed1991

Results of multicenter studies of digoxin-specific antibody fragments in managing digitalis intoxication in the pediatric population.

Digitalis toxicity continues to be a problem for pediatric patients undergoing therapy with cardiac glycosides for heart failure or arrhythmias, as well as in accidental ingestions. In this article the previous use of digoxin-specific antibody Fab fragments to treat digitalis overdose or intoxication in children is reviewed. The case reports cited in the medical literature and the 57 pediatric cases gathered as a result of the multicenter clinical trial and postmarketing surveillance study reported here indicate that digoxin-specific antibody Fab fragments are effective in ameliorating signs of digitalis poisoning in children. Not only can Fab fragments rapidly eradicate potentially life-threatening arrhythmias and conduction defects, but they are also effective in treating hyperkalemia and other noncardiac manifestations of digitalis toxicity. In the small samples of patients studied to date, complications have been minimal and no allergic reactions to digoxin-specific Fab fragments have been observed. Recommendations for the management of digitalis intoxication in children are outlined.

Adolescent↗
PubMed1990

The influence of age vs peak serum concentration on life-threatening events after chronic theophylline intoxication.

To identify risk factors for the development of seizures and cardiac arrhythmias after chronic, unintentional theophylline intoxication we monitored the clinical course of 72 consecutive patients referred to a regional poison center with chronic theophylline intoxication (serum theophylline concentration, greater than or equal to 167 mumol/L after protracted use). The median age of the sample was 47.5 years (range, 4 days to 91 years). Median peak theophylline concentration was 239 mumol/L, with a range of 167 to 722 mumol/L. A life-threatening event (LTE) occurred in 28 patients (39%) that included seizures in eight and a major cardiac arrhythmia in 22. The median peak (theophylline) of patients who had an LTE vs those who did not was 235.8 vs 238.7 mumol/L. However, the median age of patients with an LTE compared with those without an LTE was significantly greater (70.5 vs 18.0 years). Stratification of data by chronologic age revealed a stepwise increase in the frequency of LTE with advancing years: patients more than 75 years old had a 16.7-fold greater risk of LTE than patients less than 25 years old (95% confidence interval, 3.56, 77.5) despite comparable intergroup median serum (theophylline). These data suggest the primary determinant of LTEs after chronic theophylline intoxication is chronologic age. Elderly patients have an inordinately greater risk of LTE than younger patients. Peak serum theophylline concentration cannot predict which patients with chronic theophylline intoxication will have an LTE. Finally, these data indicate that theophylline should be used cautiously and with frequent monitoring of serum theophylline concentrations in elderly patients.

Age Factors↗
PubMed1989

Hypokalemia after theophylline intoxication. The effects of acute vs chronic poisoning.

To characterize the frequency and pattern of hypokalemia (serum potassium level less than 3.5 mmol/L) after theophylline poisoning, we prospectively evaluated 88 consecutive patients with theophylline intoxication (serum theophylline concentration greater than or equal to 0.165 mmol/L). This mean admission serum theophylline concentration of this cohort was 0.331 mmol/L, with a range of 0.165 to 0.982 mmol/L. The simultaneous mean serum potassium concentration was 3.36 mmol/L (range, 2.20 to 5.80 mmol/L). Fifty-three patients (60%) were hypokalemic on hospital arrival. When, on the basis of recent ingestion, patients were separated into acute, chronic, or acute-on-chronic categories of theophylline intoxication, significant differences in serum potassium were found: Patients with acute theophylline intoxication had a mean serum potassium concentration of 2.94 mmol/L; 85% were hypokalemic. In contrast, patients with chronic theophylline intoxication had a mean serum potassium concentration of 3.83 mmol/L, with a 32% frequently of hypokalemia. These data demonstrate that hypokalemia is common after theophylline intoxication and has a significantly higher incidence after acute overdose. The difference in the frequency of hypokalemia between patients with acute vs chronic intoxication has unclear origins but may be related to the disparities in clinical course (particularly the appearance of seizures and cardiac arrhythmias) that have been observed after acute vs chronic theophylline intoxication.

Acute Disease↗
PubMed1989

Acute thyroxine ingestion in pediatric patients.

During a 1-year period, 15 cases of acute thyroxine (T4) overdose with documented serum T4 concentrations were studied. All patients were less than 5 years of age and 80% were boys. All were examined within 1 to 6 hours of ingestion and all were asymptomatic. Estimated dose ingested in 10 patients ranged from 1.5 to 8.8 mg (0.1 to 0.73 mg/kg). Three patients with initial T4 serum concentrations greater than 75 micrograms/dL manifested signs of toxicity within 12 to 48 hours (fever, tachycardia, hypertension, and/or agitation) that resolved within 24 to 60 hours. The mean elimination half-life of T4 in 7 patients with multiple serum concentrations was 2.8 +/- 0.4 days, whereas the mean elimination half-life of triiodothyronine was 6 +/- 1.7 days. It was concluded that (1) the majority of acute pediatric T4 overdoses are not severe and may be managed on an outpatient basis, (2) the absence of early clinical manifestations does not preclude delayed onset of toxicity that may be better predicted by initial T4 concentrations, and (3) the elimination half-life of T4 is shorter and the elimination half-life of tri-iodothyronine is longer than with therapeutic doses.

Child, Preschool↗
PubMed1986

Poison exposures and use of ipecac in children less than 1 year old.

Poison exposures in children less than 1 year old and the safety and efficacy of syrup of ipecac in children 9 to 12 months old were evaluated in a prospective eight-month study conducted at the Massachusetts Poison Control Center. Poison exposures in children less than 1 year old represented approximately 9% of the 38,080 calls received. Mobile children (in walkers, crawling, or walking) were at the greatest risk of poisoning. The majority of children (94%) were asymptomatic and none were hospitalized or died. The products involved were primarily plants (38%) and household products (30%). All 21 patients, ages 9 to 12 months, were given 10 mL syrup of ipecac under medical supervision and vomited within one hour. The mean time to vomit was 21.7 (SEM +/- 2.8) minutes. The patients vomited 3.3 (SEM +/- 0.3) times and all episodes of vomiting abated by 26.4 (SEM +/- 6.6) minutes. No significant side effects were noted. The use of the syrup of ipecac in the 9- to 12-month-old child appears to be safe and effective.

Female↗