PubMed Health⌕ Search

Biomedical subjects

Henry H Bernstein

Publications and source records attributed to Henry H Bernstein.

10 recordsLinked to original sources
PubMed2005

Developing and evaluating a residents' curriculum.

This study examines the impact of a Bright Futures-based curriculum designed to teach pediatric residents how to integrate health education principles into everyday clinical practice. A two-phase study was conducted to evaluate the curriculum using both quantitative and qualitative methods. To measure the curriculum's impact on residents' clinical performance, a pre- and post-objective structured clinical examination (OSCE) design was administered to 14 residents in two groups: a control group (n=8) and an intervention group (n=6). Performance scores improved in the intervention group from pre- to post-testing in three core curriculum concepts (there was no change in the control group); performance in a fourth concept improved in both groups; and for the remaining two concepts, there was no change among the intervention group but an improvement in scores among those in the control group. Residents in the intervention group reported the curriculum to be of high quality and low difficulty. This study demonstrated that the curriculum had a positive impact on a resident's perceptions of his or her practice one year after participating in the intervention. The data suggest that each of the modules can be taught, the content learned and the principles applied to one's clinical practice.

Clinical Competence↗
PubMed2005

Immunizations, neonatal jaundice, and animal-induced injuries.

PURPOSE OF REVIEW: To concisely review data published over the past year on three topics pertinent to the practicing pediatrician: immunizations, neonatal jaundice, and animal-induced injuries. RECENT FINDINGS: Updates on immunizations, including varicella and pneumococcus in the post-vaccine era, use of a polyvalent conjugated meningococcal vaccine, and influenza vaccination during a vaccine shortage are discussed. Mortality and morbidity from varicella, and risk of invasive disease from pneumococcal infections have declined. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention released guidelines for the use of a tetravalent meningococcal conjugate vaccine in adolescents 11 years and older. Infants at younger gestational age are at higher risk for developing hyperbilirubinemia. The American Academy of Pediatrics has released new guidelines emphasizing breastfeeding, systematic pre-discharge assessment for risk factors, early follow-up and intervention. Use of home nursing services in the postnatal period is cost-effective. Although the incidence of rabies is low, many receive postexposure prophylaxis. Spider bites cause fewer systemic effects in children than adults. Pet reptile carriage of salmonella necessitates handwashing after handling of animals. SUMMARY: Recommendations for adolescent meningococcal vaccination, and the impact of varicella and pneumococcal immunization on our communities reflect an evolution in our management of infectious diseases. The latest practice guidelines on hyperbilirubinemia emphasize close follow-up of all newborns after postpartum discharge and even more careful evaluation of those infants near term. Education on rabies prophylaxis, spider bites, and salmonella from pet reptiles should focus on judicious use of resources and the proper handling of pets.

Animals↗
PubMed2004

Assessing the learning needs of maternal and child health professionals to teach health promotion.

OBJECTIVE: To assess skills and preferred learning formats in teaching health promotion (HP). METHODS: A self-administered needs assessment of Maternal and Child Health (MCH) educators from multiple disciplines was conducted on a convenience sample taken nationally via e-mail using Dillman's method. Respondents rated ability to use, and desire to improve skills in, different teaching strategies (brainstorming, case method, collaborative learning, mini-presentation, reflective exercise, role play) and health concepts (partnership, communication, HP/illness prevention, time management, education, advocacy). Preferred learning formats were assessed with 5-point Likert scale and were analyzed using ANOVA. RESULTS: Fifty-seven percent of respondents (n = 180) taught in an urban setting, 26% suburban, and 17% rural. Most taught at academic health centers (35%), public health clinics (25%), or hospitals (17%). Seventy-five percent were female; average age was 42 years (SD--9.1 years). Specific disciplines showed no major difference in mean responses compared with others. The greatest barriers to integrating HP into teaching were time (82%) and budget (58%). Although a majority of all respondents felt comfortable in their abilities to use the teaching strategies and concepts, an equal percentage still wanted to improve these skills. One-third of respondents had experience using web-based study: 64% of them indicated web-based study as their preferred method of continuing education. CONCLUSIONS: While a majority of MCH educators felt confident using various teaching strategies to teach the integration of HP into practice, most still wished to improve their personal skills. Use of an inexpensive, time-efficient modality to access and learn to teach HP was appealing to respondents across disciplines.

Adult↗
PubMed2004

Immunizations, neonatal jaundice, and animal-induced injuries.

PURPOSE OF REVIEW: Published studies during the past year about three topics important to the pediatric clinician-- immunizations, neonatal jaundice, and animal-induced injuries-are concisely reviewed. RECENT FINDINGS: Recent updates regarding vaccines including the questionable link with autism, implementation of universal influenza vaccination for young children, the efficacy of pneumococcal vaccine against invasive disease, and new information on pertussis, varicella, hepatitis A, hepatitis B, measles, and rotavirus vaccination are discussed. No association between measles/mumps/rubella vaccine or thimerosal-containing pertussis vaccine and autism is evident. Universal influenza vaccination for children 6 to 23 months of age will be recommended for the 2004-2005 flu season, and this implementation should reduce significant school absenteeism as well as complications seen last year including encephalopathy, seizures, respiratory failure, and pneumonia. Pneumococcal vaccine significantly reduces rates of invasive pneumococcal vaccine in healthy and HIV-infected children, although it does not appear to greatly affect otitis media rates. A reduction in post-vaccine febrile seizures appears to be present since the introduction of acellular pertussis vaccine. Multiple outbreaks in varicella have been reported since the introduction of the varicella vaccine, and a booster vaccination may be necessary in the future. Methods for detecting and preventing severe neonatal hyperbilirubinemia are reviewed, as well as anticipated recommendations from the American Academy of Pediatrics for the detection and management of hyperbilirubinemia. High bilirubin levels in preterm infants may result in hearing dysfunction and developmental impairment. The American Academy of Pediatrics has recommended a higher level of monitoring for newborn jaundice and treatment of hyperbilirubinemia in an effort to prevent kernicterus and sequelae from elevated bilirubin levels, including post-discharge follow-up appointment by day 3 to 5 of age. Dog bites in children with resultant post-traumatic stress disorder, rabies, and salmonellosis from pet reptiles in the home are also addressed. Clinicians need to be aware of the risk for rabies bites, need to recognize that dog bites in children appear to cause post-traumatic stress disorder in more than half of cases, and need to know how to educate patients on how to prevent salmonellosis from pet reptiles and amphibians. SUMMARY: Progress has been made in immunizations, especially immunization for influenza, pneumonia, and pertussis. It is recommended that monitoring for neonatal hyperbilirubinemia be more thorough to prevent the consequences of this condition. Rabies, post-traumatic stress disorder from dog bites, and salmonellosis associated with pet reptiles constitute an important area for patient education.

Animals↗
PubMed2003

Research during pediatric residency: predictors and resident-determined influences.

PURPOSE: Participation in research during residency is thought to be a strong predictor of future research activity; however, the proportion of residents who actually engage in research is small. This study examined (1) which factors are associated with research during residency; (2) which factors influence residents' abilities to conduct research; and (3) the number of residents conducting research in a research-oriented training program. METHOD: One hundred fifteen pediatrics residents were asked at a housestaff retreat to complete a questionnaire about their attitudes toward research. Comparisons between those who were or were not conducting research during residency were made using chi-square or Fisher exact tests; stepwise logistic regression was used to identify factors associated with conducting research during residency. RESULTS: The response rate was 95% (n = 110, or 82% of the residency program). Respondents were representative of postgraduate year, gender, and residency track. Although 92% of respondents reported having conducted research before residency, only 18% were currently involved in research (p <.001). Fifty-five percent reported interest in conducting research. Advanced degrees and future career plans influenced their decisions to do research (p <.05). Respondents were more likely to conduct clinical research than basic science or laboratory-based research (14% versus 3% of all respondents, p =.007). The most commonly identified influences to conducting research were availability of time (97%), personal interest in research (84%), availability of opportunities (76%), and mentors on hand (72%). CONCLUSION: Interest in research during residency is high, but participation in research is low. There are several influences to the types and amounts of research conducted during pediatrics residency.

Attitude of Health Personnel↗
PubMed2002

Limited accuracy and reliability of infrared axillary and aural thermometers in a pediatric outpatient population.

OBJECTIVE: To evaluate the accuracy and reliability of infrared axillary and aural thermometers in the outpatient setting. STUDY DESIGN: A prospective observational study of infrared axillary, aural, and digital rectal temperature values from 198 children, aged 3 to 36 months (mean, 1.3 years). RESULTS: Sensitivity and specificity of the axillary thermometer for rectal fever were 63.5% and 92.6%, respectively (diagnostic accuracy, 83.3%); those for the aural thermometer were 68.3% and 94.8%, respectively (diagnostic accuracy, 86.4%). For all patients, the mean biases of the axillary and aural temperatures were -0.33 degrees F and -0.24 degrees F, respectively. The biases of both thermometers' measurements were significantly correlated with rectal temperature (P <.02); thus, as rectal temperature increased, the accuracy of the compared axillary and aural temperature decreased. Underestimation of rectal temperature was greatest among febrile 1- to 3-year-old children (axillary bias, -1.20; aural bias, -0.36). Age was correlated with an axillary temperature bias (P <.01). CONCLUSION: Axillary and aural infrared thermometers were comparable, albeit significantly different than rectal temperature measurements, particularly as the child's age and rectal temperature increased. These thermometers may be useful as noninvasive screening methods in outpatient settings for children who are at least 3 months old, but rectal values should be used for clinical accuracy.

Child, Preschool↗
PubMed2002

Postpartum discharge preferences of pediatricians: results from a national survey.

OBJECTIVE: To identify practice/physician characteristics that influence pediatricians' self-reported newborn discharge practices. METHODS: Of the pediatricians randomly surveyed through a national American Academy of Pediatrics periodic survey conducted in 2000, 490 were identified as routinely providing care for newborns in the nursery. These respondents rated the importance of 22 infant, maternal, and peripartum factors in determining readiness for nursery discharge on a 5-point Likert scale and reported their perceptions of optimal and minimal lengths of stay (LOS) for healthy term newborns. Importance of readiness factors was dichotomized as "high" (very important or important) versus "low" (neither, unimportant, or very unimportant). Relationships between pediatricians' responses and demographic information were explored using multivariate logistic regression. RESULTS: Most pediatricians (at least 81%) rated all 7 infant clinical factors (eg, stable, normal vital signs, successful feeding) as highly important determinants of discharge readiness. Women were 2 to 3 times more likely to rate maternal and peripartum factors such as maternal fatigue and stress, demonstration of maternal skills, breastfeeding knowledge or experience, adequacy of social support, maternal age <18 years, and low income/lack of financial resources as highly important. With respect to hospital LOS, women were twice as likely to identify an optimal LOS as >36 hours and a minimal LOS as >24 hours. Pediatricians in group settings were 3 times as likely as those in solo or 2-physician practices to advocate an optimal LOS >36 hours, and those with a high proportion of publicly insured or uninsured patients were less likely to identify an optimal LOS as >36 hours (odds ratio: 0.53). CONCLUSIONS: Female pediatricians report a more biopsychosocial approach to determining discharge readiness than their male counterparts, taking into account infant characteristics, maternal skills, and socioemotional issues that may affect the mother-infant pair's adjustment at home. The finding that those who provide care for the most financially vulnerable patients do not see the need for longer LOS is both surprising and of concern. The results support the need for a prospective critical examination of perinatal hospital discharge practices, such as the Pediatric Research in Office Settings Life Around Newborn Discharge Study.

Attitude of Health Personnel↗
PubMedDate not supplied

Postpartum discharge: do varying perceptions of readiness impact health outcomes?

OBJECTIVE: To assess maternal and pediatrician perceptions of mother-infant readiness for postpartum discharge and the impact of this decision making during the neonatal period. METHODOLOGY: We performed a prospective cohort study of mothers and healthy term infants during the first month of life. On nursery discharge and 1 month later, mothers and practitioners completed self-administered questionnaires assessing the discharge decision, maternal confidence in newborn care, and the adequacy of the length of obstetric care. We used Fisher exact tests, Wilcoxon tests, and exact logistic regression for analysis. RESULTS: Twenty percent of 55 mother-infant pairs were classified as unready at postpartum discharge. Maternal education less than high school was a significant predictor for lack of readiness (P =.01). During the month after discharge, unready mothers identified themselves as being less happy, made twice as many phone calls on behalf of their infants, and more often placed their infants in the prone sleeping position (P <.01 for each) when compared with ready mothers. The latter 2 variables remained significant in multivariate analyses. The percent agreement between mothers and practitioners about readiness was 92% on discharge but 59% (kappa = 0.09; P =.34) 1 month later. CONCLUSIONS: Maternal and pediatric perceptions of readiness for postpartum discharge of mothers and infants show substantial variation on the day of discharge and over time.

Adult↗