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Biomedical subjects

R R Tanz

Publications and source records attributed to R R Tanz.

17 recordsLinked to original sources
PubMed1992

A survey of the structure and function of pediatric continuity clinics.

Continuity clinic is a mandated part of all accredited pediatric residency programs, yet there are minimal guidelines regarding structure and function. In 1988, we surveyed 101 residency programs, asking them to describe their continuity clinic experience. Eighty-seven residency programs (86%) responded to the 40-item questionnaire. The results showed clinics to be similar in many aspects, with consistent emphasis on developmental issues and anticipatory guidance. Areas of concern included lack of monitoring of the patient panel (31% did not monitor), excess care for chronic diseases or handicapping conditions (mean, 22% of patients), and lack of training in telephone advice (43% provided no such training).

Accreditation↗
PubMed1992

Emergency department laboratory evaluation of children with seizures: dogma or dilemma?

Seizure is a common problem evaluated in pediatric emergency departments. Serum chemistry analysis is often performed as a routine part of the diagnostic evaluation of children who arrive in the ED with seizure. From this retrospective study, we sought to determine 1) how often serum electrolytes (Na, K, Cl, CO2), total calcium, magnesium, ammonia, and glucose chemistries were performed, 2) the frequency of abnormalities detected, and 3) whether abnormalities resulted in a change in patient care. Three hundred eight ED charts from 12 consecutive months were reviewed. Data collected included age, sex, ED diagnosis, medical history, and physical examination. Charts were also reviewed for diagnostic tests ordered and patient management. Children were classified as having febrile (FS) or nonfebrile seizures (NFS) to establish diagnostic evaluation practices for each group as well as to determine rates of laboratory abnormalities. Three hundred eight children were enrolled, 108 (35%) FS and 200 (65%) NFS. The mean ages of FS and NFS patients were 2.1 and 5.7 years, respectively (P less than 0.05, t-test). One hundred twenty-four of 308 (40%) children had at least one test performed; no abnormal test was thought to have caused seizure; none was treated. One hundred five of 308 (34%) were experiencing their first seizure. There was no difference in the likelihood of having a test ordered for children with a first seizure, regardless of seizure category. We concluded that 1) abnormal serum electrolytes, total calcium, magnesium, and glucose rarely cause seizure in children and 2) routine use of these tests in the ED is costly and does not contribute to seizure therapy.

Adolescent↗
PubMed1991

Clindamycin treatment of chronic pharyngeal carriage of group A streptococci.

We previously demonstrated that chronic pharyngeal carriage of group A beta-hemolytic streptococci (GABHS) can be terminated by intramuscular administration of benzathine penicillin plus 4 days of orally administered rifampin. Because an effective oral regimen would be desirable, we compared clindamycin with P + R for treating GABHS carriage. Healthy, symptom-free GABHS carriers were randomly assigned to receive orally administered clindamycin (20 mg/kg per day) three times a day for 10 days or intramuscularly administered benzathine penicillin with oral doses of rifampin (20 mg/kg per day) twice a day for 4 days. Compliance was documented by antibiotic activity in urine. Throat cultures for GABHS were obtained every 3 weeks for up to 9 weeks after treatment. Patients who had positive throat cultures for their original GABHS T type 3 weeks after randomization were crossed over to the other treatment. Treatment success was defined as eradication of the original GABHS T type, with all follow-up cultures negative. Clindamycin eradicated carriage in 24 (92%) of 26 patients; penicillin plus rifampin was effective in 12 (55%) of 22 patients (p less than 0.025). Including patients crossed over 3 weeks after enrollment, clindamycin was effective in 28 (85%) of 33 treatment courses compared with 12 of 22 courses of penicillin plus rifampin (p less than 0.05). We conclude that 10 days of oral clindamycin therapy was significantly more effective than benzathine penicillin plus 4 days of orally administered rifampin for treatment of symptom-free GABHS carriers.

Administration, Oral↗
PubMed1991

Tykes on bikes: injuries associated with bicycle-mounted child seats.

We reviewed US Consumer Product Safety Commission (CPSC) data for 1978-1988 concerning injuries related to seats used for carrying children on adult bicycles, ie, bicycle-mounted child seats. There were an estimated 4960 injuries to children during the 11-year period. The peak age of injury was two years. Fifty-five percent of victims were male. Falls accounted for 80% of the estimated injuries. Head (51%) and face (21%) injuries predominated. Twenty-one percent of estimated injuries were mild, 60% were moderate, and 19% were severe. All severe injuries involved the head or face, and all mild injuries were to extremities. Riding in a bicycle-mounted child seat exposes the child to adult-level forces, risking injury because of the bicycle's size, speed, and instability and the child's size and development. Injury prevention requires recognition of this problem, use of bicycle helmets, improvements in seat design, and educational efforts by physicians and their organizations. This report demonstrates use of CPSC national injury estimates to evaluate a product-related childhood injury and underscores the need to protect potential victims when avoidance of injury is beyond their own capabilities.

Accident Prevention↗
PubMed1990

Lack of influence of beta-lactamase-producing flora on recovery of group A streptococci after treatment of acute pharyngitis.

Because production of beta-lactamase by normal pharyngeal flora could account for penicillin treatment failure, we studied the effect of anaerobic and aerobic beta-lactamase-producing bacteria on bacteriologic outcome in acute group A beta-hemolytic streptococcal (GABHS) pharyngitis. We compared 10-day courses of orally administered phenoxymethyl penicillin and amoxicillin-clavulanic acid, using a randomized, single-blind treatment protocol. Eligible patients were 2 to 16 years of age and had culture-proven acute GABHS pharyngitis; 89 patients (43 penicillin, 46 amoxicillin-clavulanic acid) were compliant with therapy. beta-Lactamase-producing organisms were isolated before therapy from the throats of 67% of patients treated with penicillin and 63% treated with amoxicillin-clavulanic acid. Throat cultures after completion of therapy were positive for GABHS in 7 (7.9%) of 89 patients. The initial GABHS T type persisted (treatment failure) in only 4 (4.5%) of 89 patients, including 3 (6.5%) of 46 who received amoxicillin-clavulanic acid and in 1 (2.3%) of 43 who received penicillin (not statistically significant). Bacteriologic treatment failure was unrelated to recovery of beta-lactamase-producing bacteria at the time of enrollment or after treatment. We conclude that beta-lactamase production by normal pharyngeal flora does not fully explain the failure of penicillin therapy for acute streptococcal pharyngitis. Using an antibiotic effective against beta-lactamase-producing bacteria will not eliminate the problem of bacteriologic treatment failure.

Adolescent↗
PubMed1988

Treating tinea capitis: should ketoconazole replace griseofulvin?

We undertook a randomized double-blind comparison of griseofulvin and ketoconazole for the treatment of tinea capitis. The outcome was based on fungal culture results and changes in clinical signs and symptoms determined by an assessment system that yielded a severity score. Patients were evaluated at 4-week intervals for 12 weeks. Seventy-nine patients were enrolled; 46 received griseofulvin, and 33 received ketoconazole. Forty-eight patients (26 griseofulvin, 22 ketoconazole) were considered evaluable. Pathogenic fungi were isolated from 78% of the enrolled and 87% of the evaluable patients. Trichophyton tonsurans was the predominant dermatophyte isolated. Potassium hydroxide preparation correlated poorly with culture results (sensitivity 59%). Of 22 evaluable ketoconazole patients, 16 (73%) were considered to have been treated successfully; 25 of 26 (96%) patients who received griseofulvin were successfully treated (chi-square = 3.54, p less than 0.10). The proportion of culture-positive patients at each follow-up visit appeared somewhat greater for the ketoconazole-treated group than for the griseofulvin-treated group, but the differences were not statistically significant. Analysis of severity scores revealed no significant differences between the groups (t test and Mann-Whitney U test). No significant hepatotoxicity or other adverse reactions were observed. We conclude that griseofulvin should remain the drug of choice for treating tinea capitis.

Adolescent↗
PubMed1988

Streptococcal pharyngitis. What's new.

Group A beta-hemolytic streptococcal pharyngitis continues to be a major problem and accounts for a large number of physician visits. The recent resurgence of acute rheumatic fever in several areas in the United States underlines the need to accurately diagnose and correctly treat streptococcal pharyngitis. Appropriate treatment with antibiotics effectively prevents rheumatic fever. Early institution of treatment also leads to prompt alleviation of symptoms. The "gold standard" for diagnosing group A streptococcal pharyngitis is the throat culture. Newer rapid diagnostic tests may be used, but the clinician must recognize that there are a substantial number of false-negative tests (low sensitivity). Therefore, patients with negative rapid tests should have standard throat cultures as well. Patients with positive rapid tests should be treated with appropriate antibiotics, as should patients with positive throat cultures. Patients with signs and symptoms that are highly suggestive of streptococcal pharyngitis can also be treated, pending throat culture results. Penicillin continues to be the drug of choice for treatment, and American Heart Association guidelines suggest the use of oral penicillin V for ten days or intramuscular benzathine penicillin G. Alternative antibiotics commonly used include erythromycin and various cephalosporins. Throat cultures need not be obtained from most patients after therapy. However, some patients may seem to be having frequent streptococcal infections or may be recognized as asymptomatic carriers. Carriers may be considered for therapy with intramuscular benzathine penicillin G plus oral rifampin.

Anti-Bacterial Agents↗
PubMed1988

The case of the slandered hamburgers.

Carbon monoxide poisoning is a common occurrence, especially during cold months. It can be overlooked, because its history and symptoms are often vague. We report a case of two children with carbon monoxide poisoning who typify the need for obtaining a careful history. A review of the literature, including clinical manifestations, diagnosis, and treatment, follows.

Carbon Monoxide Poisoning↗
PubMed1988

Carving a niche--the general academic pediatrician as consultant. Part I: The referring physicians and their patients.

The role of the general pediatrician as a specialist is often unclear to the majority of physicians and patients. The role of the general academic pediatrician (GAP) as a consulting subspecialist also is in need of definition. We surveyed a consultation service staffed primarily by three GAPs in our tertiary care children's hospital. During the 12-month survey, 275 patients with a mean age of 5.6 years were evaluated. The mean duration of the chief complaint prior to the initial visit was 12.3 months. A total of 254 (92%) were evaluated initially as outpatients; of these, 20 (8%) were eventually hospitalized. Only 29 percent of the patients were referred to pediatric subspecialists. GAPs acting as consultants in a tertiary care setting most often see patients with long-standing complaints that do not require hospitalization or subspecialist referral, but their role at times is expanded to include more acute and more complex problems. Referrals may come from primary care physicians or from tertiary care subspecialists, particularly surgeons, or by self-referral from the patients' families.

Adolescent↗
PubMed1988

Carving a niche: the general academic pediatrician as consultant. Part II: Academic, financial, and educational concerns.

The General Academic Pediatrician (GAP) may act as a consultant to both primary care pediatricians and tertiary care subspecialists. The authors surveyed a consultation service staffed by three GAP's in a tertiary care children's hospital. The service was financially successful and generated new sources of referrals for its parent institution. The increasing complexity of the role of a GAP within a department of pediatrics in regards to clinical, teaching, and research activities is explored.

Chicago↗
PubMed1987

Antibiotic administration to treat possible occult bacteremia in febrile children.

We performed a prospective, randomized, placebo-controlled, double-blind clinical trial of antibiotic administration to treat possible occult bacteremia in febrile children. A total of 955 children aged 3 to 36 months with temperatures greater than or equal to 39.0 degrees C and no focal bacterial infection were enrolled at the emergency departments of two children's hospitals from January 1982 until July 1984. Blood samples for culture were obtained, and the children were randomly assigned to receive either oral amoxicillin or placebo and were restudied approximately 48 hours after enrollment. Data were also collected on 228 children who could not be randomly assigned. Twenty-seven of the randomly assigned children (2.8 percent) had bacteremic infections with pathogenic organisms (Streptococcus pneumoniae, Haemophilus influenzae, and salmonella). There were no differences in the incidence of major infectious morbidity associated with bacteremia between the antibiotic and placebo groups--2 of 19 patients (10.5 percent) in the antibiotic group and 1 of 8 (12.5 percent) in the placebo group--although the power for this comparison was low. Antibiotics reduced fever (P less than 0.005) and improved the clinical appearance (P = 0.07) in the children with bacteremia but not in those without bacteremia. Although there were no statistically significant differences in the incidence of side effects, diarrhea tended to occur more often in the patients treated with amoxicillin (15 vs. 11 percent, P less than 0.10). We conclude that our data do not support the routine use of standard oral doses of amoxicillin in febrile children who do not have evidence of focal bacterial disease.

Amoxicillin↗
PubMed1985

Pedestrian injury. The next motor vehicle injury challenge.

Motor vehicle injuries are the leading causes of death and disability in childhood after age 1 year. Educational efforts by physicians and public policy have focused on the protection of motor vehicle occupants. However, fatal pedestrian injuries are more common than fatal occupant injuries in preschool and school-aged children. The importance of pedestrian injury as a cause of early childhood morbidity and mortality is likely to become even clearer in the coming years as passenger injury rates decline. Existing patterns and trends in pedestrian injury statistics are poorly understood. The development of effective strategies for injury prevention requires greater understanding of how and why pedestrian injuries occur. Improved knowledge is needed that concerns the roles of environmental, psychosocial, medical, and behavioral factors in child pedestrian injury. Multidisciplinary accident investigation, which involves physicians, traffic engineers, psychologists, and social scientists, is most likely to provide the information needed to develop candidate educational and environmental strategies for study. Prevention of child pedestrian injury is a challenge that has not yet been addressed by pediatricians or policymakers. Pediatricians can promote and direct a national focus on this area that has been understudied by researchers, public health officials, and policymakers.

Accidents, Traffic↗
PubMed1985

Penicillin plus rifampin eradicates pharyngeal carriage of group A streptococci.

We evaluated the efficacy of rifampin in eradicating chronic pharyngeal carriage of group A streptococci. Carriers were defined as healthy children whose throat cultures showed persistence of group A streptococci 3 weeks after receiving benzathine penicillin G intramuscularly. Subsequent M and T typing of group A streptococcal isolates and limited serologic studies confirmed that enrolled patients were carriers. Thirty-eight carriers (37 completed the study) were randomly assigned to three groups: group 1 (13 patients) received no treatment; group 2 (10) received benzathine penicillin intramuscularly; group 3 (14) received benzathine penicillin intramuscularly plus rifampin orally (10 mg/kg twice a day for eight doses). Throat cultures were obtained every 3 weeks for at least 9 weeks. Group 2 and 3 patients who still had positive cultures 3 weeks after treatment were crossed to the opposite group. Cultures became negative in 93% (13 of 14) of patients in group 3, compared with 23% in group 1 and 30% in group 2 (P less than 0.001 and P less than 0.01, respectively). Including patients crossed over, the penicillin plus rifampin regimen was effective in 17 (89%) of 19 treatment courses and was significantly superior to no therapy or to penicillin alone (P less than 0.0005 and P less than 0.005, respectively). We conclude that rifampin plus benzathine penicillin intramuscularly is an effective regimen for those selected patients in whom eradication of group A streptococcal carriage is judged to be desirable.

Administration, Oral↗
PubMed1985

Comparison of ketoconazole and griseofulvin for treatment of tinea capitis in childhood: a preliminary study.

Treatment of children with tinea capitis currently consists of griseofulvin given orally for 1 to 3 months. Ketoconazole, a newer antifungal, is effective therapy for a variety of systemic mycoses. A randomized double-blind, placebo-controlled study was undertaken to compare ketoconazole and griseofulvin treatments of children with tinea capitis. Twenty-two patients were enrolled, and 14 completed the protocol. All patients had positive initial mycologic cultures. Seven evaluated patients received each drug. The treatment groups were comparable in terms of age, weight, sex, race, duration of infection, length of therapy, and initial disease severity. Adverse reactions occurred in three ketoconazole-treated patients and in none receiving griseofulvin. After 6 weeks of therapy, ketoconazole-treated patients had improved as much as griseofulvin-treated patients and were as likely to have negative mycologic cultures. Ketoconazole shows promise as an alternative to griseofulvin for treating children with tinea capitis.

Adolescent↗