Respiratory distress in a 2-month-old infant: Is the primary cause cardiac, pulmonary or both?

A 2-month-old female with worsening cough, respiratory distress and an abnormal chest X-ray was referred to our institution for further evaluation of suspected scimitar syndrome. She was found to have normal pulmonary venous drainage with a large patent ductus arteriosus and severe pulmonary arterial hypertension. Chest CT was suggestive of interstitial lung disease. Wedge lung biopsy revealed alveolar simplification and patchy pulmonary interstitial glycogenosis. A definitive diagnosis of Filamin A deficiency was made with genetic studies. The patient is currently showing clinical improvement on systemic glucocorticoid therapy.

Provider Perspectives on Adding Biomarker Screening for Tobacco Smoke Exposure to Lead Screening at Well-Child Visits.

INTRODUCTION: Measurement of cotinine, a biomarker of tobacco smoke exposure, can accurately identify children at risk of health consequences from secondhand smoke. This study reports perspectives from pediatric health care providers on incorporating routine cotinine screening into well-child visits. METHODS: Key informant interviews (N = 28) were conducted with pediatric primary care providers: physicians, nurse practitioners, and registered nurses. RESULTS: Themes identified in the interviews included the following: (a) Cotinine screening would assess children's exposure to tobacco smoke more reliably than parental report; (b) Addressing positive cotinine screening results might require additional resources; (c) Wheezing and a history of emergency department visits increased the salience of cotinine screening; and (d) A better understanding of the significance of specific cotinine test values would improve utility. DISCUSSION: Pediatric providers see advantages of biomarker screening for tobacco smoke exposure at well-child visits, especially for children with wheezing, but have concerns about limited capacity for follow-up with parents.

Physicians, guidelines, and cognitive tasks.

Using a case study analysis of the Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Treatment of Asthma, this article compares the workflows and knowledge requirements of primary care practice to the structure and content of a well-respected set of clinical guidelines. The authors show that there are discrepancies between physician workflow and the structure of the EPR-3, as well as between physicians' knowledge requirements and the content of the EPR-3. The analysis suggests that closing the gap between medical knowledge and practice will require alternative ways to represent guidelines' knowledge and recommendations.