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Biomedical subjects

H L Weinberger

Publications and source records attributed to H L Weinberger.

18 recordsLinked to original sources

Child abuse, sudden infant death syndrome, and attention-deficit hyperactivity disorder.

A review of recent literature helps to clarify normal variations in the physical examination of children who are thought to have been sexually abused. In many instances, no abnormal physical findings are discovered. Clinicians must continue to pay careful attention to the history and work with other professionals to implement appropriate management, despite the lack of physical findings. Guidelines for evaluating sudden and unexpected infant deaths are reviewed. The current recommendations of the American Academy of Pediatrics for infant sleep positions are discussed in light of epidemiologic studies in the United States and other countries. Attention-deficit hyperactivity disorder appears to respond best to a combination of stimulant medication, parent training in coping with behavior of affected children, and social skill training for the affected children themselves. A review of recent research failed to reach consistent correlations between resistance to thyroid hormone and attention-deficit hyperactivity disorder.

Attention Deficit Disorder with Hyperactivity

Zinc-induced copper deficiency in an infant.

OBJECTIVE: To describe the case of a 13-month-old girl who developed copper deficiency as a result of excessive zinc gluconate ingestion. SETTING: Tertiary care hospital in Syracuse, NY. INTERVENTIONS: Cessation of zinc ingestion followed by intravenous and oral copper chloride therapy. MEASUREMENTS/MAIN RESULTS: Ingestion of zinc gluconate, 120 mg/d for 6 months, and thereafter 180 mg/d for 1 month, preceded the clinical presentation of listlessness, anemia, neutropenia, poor weight gain, abnormal sparse hair, and scorbuticlike bone changes. Findings on a bone marrow examination included ring sideroblasts and suggested copper deficiency. Plasma zinc level was 36.7 mumol/L, serum ceruloplasmin level was 20 mg/L, and serum copper level was undetectable. Clinical and laboratory abnormalities resolved shortly after initiation of copper therapy. CONCLUSIONS: This case demonstrates the reciprocal relationship of copper and zinc metabolism and exemplifies the important interrelationships of dietary trace minerals.

Bone Diseases, Metabolic

Six children with lead poisoning.

Although most commonly seen in children from lower socioeconomic backgrounds, all children are at risk for lead poisoning. Management is a potential problem for all primary care providers. Because few individuals in the primary care practice of pediatrics have many patients with lead poisoning, it may be difficult to understand the nuances of management. We describe six patients, each of whom reflects different aspects of lead poisoning in children, and discuss the lessons we have learned in the course of their treatment. We have found that graphic representation of the blood lead and erythrocyte protoporphyrin values is helpful in the longitudinal follow-up of these youngsters.

Child, Preschool

Evaluation of a communication skills course for second-year medical students.

A five-year evaluation and redesign of the communication skills component of the Introduction to Clinical Medicine course was undertaken at the State University of New York Health Science Center at Syracuse College of Medicine. The objectives of the evaluation were to determine the effectiveness of the component in teaching communication skills, identify areas of the component in need of change, and monitor the effectiveness of previous changes. In the first three years, the evaluation focused on the students' perceptions of the importance of communication skills in their training as physicians. Based on the evaluations for those three years, the component was modified substantially. One of the changes was the introduction in years four and five of simulated patients for practicing interviewing skills. The evaluations in years four and five focused on the effectiveness of using the simulated patients and the students' perceptions of how well the course objectives were met.

Communication

An analysis of 248 initial mobilization tests performed on an ambulatory basis.

Data are presented on 248 initial mobilization tests performed in an ambulatory setting over an 11-year period. Results demonstrate that there is no single, consistent predictor of body burden of lead, although the higher the blood lead level, the greater the amount of excretable (mobilizable) lead. It is recommended that an appropriate ratio of lead excreted in response to chelant is equal to or greater than 0.5 based on this series of tests. A recommendation is also made to realign the Centers for Disease Control (Atlanta) guidelines for classification of risk. This realignment would coincide with a recommendation that mobilization tests be reserved for children whose blood lead levels ranged from 1.93 to 2.57 mumol/L (40 to 60 micrograms/dL). Those with higher levels would undergo chelation without prior mobilization studies.

Ambulatory Care

A survey of pediatric resident training programs 5 years after the Task Force report.

Twenty-nine pediatric residency training programs responded to a survey with detailed descriptions of the scheduled rotations before and after the Report of the Task Force on Pediatric Education. This survey documented some changes in the overall structure of residency programming in that all programs demand 3 years of general pediatric training. Little if any changes were noted in the traditional emphasis on inpatient and neonatal training. Some changes in content area have been noted, namely a modest increase in the experiences in adolescent medicine. The survey failed to demonstrate any trend indicating increased emphasis on training experiences in the "new morbidity."

Curriculum

An attempt to identify frequency of use of technical skills and procedures by the primary care physician.

Some technical skills required and learned during residency training are not often used in primary care. Pediatricians who practice primary care in rural settings for smaller communities) tend to perform a greater variety of procedures than those who practice in urban settings. Family practitioners report that they perform more of these procedures than either rural or urban practicing pediatricians. Training programs should define the skills and procedures which residents must learn to perform and should differentiate between those needed during the training period and those which will be used in primary care practice.

Family Practice

Systematic utilization of data for analysis of a pediatric emergency-room experience.

This report describes the systematic use of emergency-room data to (1) define the experiences of a group of pediatric interns in their emergency-room rotation (especially as they relate to their role as future pediatric practitioners), (2) evaluate, supervise, and learn from their performance in this primary care setting, and (3) provide an ongoing weekly list of illnesses diagnosed in the emergency room as an epidemiological sentinel for the larger community. The future applications of this type of systematic approach, perhaps with computer technology, offer the opportunity for comparison of delivery, quality, and cost of health care between various sources of primary care (emergency-room facilities, private physicians' offices, neighborhood health centers, and health maintenance organizations.

Child