Biomedical subjects

Richard Lichenstein

Publications and source records attributed to Richard Lichenstein.

8 recordsLinked to original sources

PubMed2006

Airway infectious disease emergencies.

Upper and lower respiratory infections are encountered commonly in the emergency department. Visits resulting from occurrences of respiratory disease account for 10% of all pediatric emergency department visits and 20% of all pediatric hospital admissions. Causes of upper airway infections include croup, epiglottitis, retropharyngeal abscess, cellulitis, pharyngitis, and peritonsillar abscesses. Lower airway viral and bacterial infections cause illnesses such as pneumonia and bronchiolitis. Signs and symptoms of upper and lower airway infections overlap, but the differentiation is important for appropriate treatment of these conditions. This article reviews the varied clinical characteristics of upper and lower airway infections.

Child↗

PubMed2005

Unintended pregnancy risk in an emergency department population.

OBJECTIVE: To assess unintended pregnancy risk and associated factors among female urban Baltimore emergency department (ED) attendees. METHODS: A cross-sectional anonymous questionnaire study was completed by 790 women, sufficient to detect a 5% difference of unintended pregnancy risk in the national population and a 10% intersite difference with 80% power. The results were analyzed with chi-square tests, univariate and multivariate logistic regression analyses. RESULTS: Female ED attendees are at greater risk for unintended pregnancy (33.5%), particularly those of lower income (p=.006) and without a primary care provider (p=.003). Unintended pregnancy risk did not vary between sites by any variable except young age despite the fact that sites varied significantly by race, insurance and income measures. CONCLUSION: Women using the ED are at increased risk for unintended pregnancy and are less likely to have access to a regular medical care source; thus, the ED represents a possible contraceptive provision site.

Adolescent↗

PubMed2005

Primary care services for an emergency department population: a novel location for contraception.

OBJECTIVE: To assess contraceptive provision site preferences in female urban Baltimore emergency department patients. METHODS: This cross-sectional questionnaire study was completed by 790 women, a population sufficient to detect a 10% intersite difference. The results were analyzed with chi-square, univariate and multivariate logistic regression analyses. RESULTS: Obtaining contraception other than from a physician's office was acceptable to 57.2% of the subjects, particularly those uninsured (p=.006) and without primary care providers (p<.001). Contraceptive provision in the emergency department (ED) was acceptable to 44.0%, particularly those who are frequent ED users (p=.003) and those at risk for unintended pregnancy (p=.024; pooled, p<.001). Care in nontraditional settings may preclude pelvic examination; 34.0% of the subjects felt safe obtaining contraception without this examination, significantly for those desiring contraceptive provision in the ED. CONCLUSION: Contraceptive services are acceptable in nontraditional settings, including the ED, particularly to women of limited resources. This service is acceptable without pelvic examination for a sizable proportion of the women using the ED.

Adolescent↗

PubMed2005

Mental health visits in a pediatric emergency department and their relationship to the school calendar.

OBJECTIVES: Over the past decade, there has been a significant increase in the rate at which children and adolescents present to emergency departments (EDs) with mental health complaints. The goal of the current study was to assess the rate of ED usage for children and adolescents and to determine if there was an association between mental health emergencies and the school year. METHODS: Retrospective chart review of 719 psychiatric consultations to an urban ED affiliated with an academic medical center. Records of consultations from April 2001 to March 2002 were reviewed and abstracted for variables such as age, sex, time and date of presentation, and psychosocial factors. RESULTS: Chi2 analyses reveal significant associations between presentation to the ED for a psychiatric complaint and time of day, day of week, and month of year. One-way analyses of variance also demonstrated mean differences in presentations for day of week and month of year. CONCLUSIONS: The current study supports previous research findings of an association between the school year and child and adolescent mental health emergencies. In the current study, the school year appears to exacerbate childhood problems, as there is a greater frequency of psychiatric emergencies while children are in school. Implications for ED program development and school-based mental health service delivery are reviewed.

Academic Medical Centers↗

PubMed2003

Pediatric pneumonia.

Respiratory disease is common in pediatrics and diagnosing pneumonia may be clinically challenging. Changes in pneumococcal resistance and immunization practices continue to change the incidence and etiologies of pneumonia. Careful attention to epidemiologic, seasonal, and specific pediatric clinical factors and using adjunct radiographs and laboratory tests should guide the emergency physician in his or her management strategy, including selection of antibiotics and inpatient or outpatient disposition.

Adolescent↗

PubMed2002

An unusual presentation of stridor: blunt pediatric laryngotracheal trauma.

A case report is presented to review pediatric blunt laryngotracheal trauma. The common presenting symptoms of stridor and respiratory distress and their implications for the pediatric trauma patient are discussed. Use of computed tomography and direct endoscopy of the airway should help optimize airway management in these patients.

Accidents, Traffic↗

PubMed2002

Psychiatric emergencies in children.

OBJECTIVE: To examine the demographic and clinical characteristics of children using the pediatric emergency department (ED) in a medical center in Baltimore, Maryland. The rate of admission and length of stay for children who were evaluated in the ED were also examined. SETTING: A large, urban medical center with approximately 15,500 visits per year. RESULTS: During a 13-month period, more than 600 visits to the ED were made for mental health concerns for children aged 2 to 18 years, with psychiatric visits constituting more than 5% of total visits to the ED. Psychiatric visits averaged more than 5 hours' duration in the ED and involved significant effort by medical staff, with approximately one half of visitors undergoing psychiatric admission. Interviews conducted with the ED staff revealed that addressing psychiatric problems in children is a considerable burden and that there is a general lack of resources within the ED and the surrounding community to respond to the needs of children with psychiatric emergencies. CONCLUSION: The challenge in most communities is to build a true system of care that involves proactive and more preventive care in natural settings, such as schools, and coordination and improvement of care for youth with more serious problems.

Adolescent↗

PubMed2002

Respiratory viral infections in hospitalized children: implications for infection control.

BACKGROUND: Identification of children with respiratory viral infections may augment infection-control practices on inpatient units. There are clinical syndromes leading to morbidity among hospitalized children, however, in which a viral etiology of the illness might not be considered. METHODS: Virus infection rates among 243 children aged <1 to 19 years hospitalized between October 1993 and April 1994 with asthma, pneumonia, bronchiolitis, fever, apnea, croup, or respiratory distress were evaluated as part of a University of Maryland Medical Center infection-control protocol. Anonymous data collected included admission diagnoses, age, and virus-identification result. RESULTS: Seventy-one children (29%) had a virus identified, including 19 of 123 (15%) with asthma, 4 of 12 (33%) with pneumonia, 27 of 47 (57%) with bronchiolitis, 13 of 41 (32%) with fever, 4 of 9 (44%) with apnea, 2 of 3 (67%) with croup, and 2 of 8 (25%) with unspecified respiratory distress. CONCLUSION: This study reinforces the concept that clinicians should consider respiratory viruses for a broad range of diagnoses. This heightened awareness may help reduce the number of nosocomial respiratory viral infections.

Adolescent↗