Convenience store robberies in selected metropolitan areas. Risk factors for employee injury.

Circumstances of injury were abstracted from police reports for 1835 convenience store robberies that occurred during 1992 or 1993 in selected metropolitan areas of seven eastern states. Subset analyses were performed using the data (758 robberies) from four states with relatively complete risk factor information. The purpose of this study was to estimate the risk of injury in a robbery situation for various risk factors. The overall risk of employee robbery-related injury could not be estimated because the probability of robbery is unknown. Of the 1835 robberies, 59% of the total robberies occurred at nighttime (9 p.m. to 3 a.m.), 47% occurred in stores previously robbed in the study period, 63% involved the use of a firearm, and 12% were associated with an injury to at least one employee. In the subset analysis of 758 robberies in four states, the employee probability of injury in a robbery was lower with firearm use compared with no weapon or use of a blunt instrument, and the probability of severe injury (defined as death, or an injury necessitating a trip to a hospital) was lower with a firearm compared with the use of a blunt instrument. However, all five fatalities were firearm-related. Other factors that were associated with a lower probability of employee injury included robbery occurrence in stores that had been robbed multiple times, compared with stores robbed only once; having 1 to 999 dollars stolen, compared with having no money stolen; and the presence of a customer(s) in the store at the time of the robbery. The employee risk of injury was not significantly different between one- (0.106) and multiple-employee (0.111) stores. Similarly, the employee risk of severe injury was not significantly different between one- (0.029) and multiple-employee stores (0.022). We conclude that there are several potential risk factors for employee injury in convenience store robberies, some of which are amenable to interventions. Further research on these factors and their relationship to employee injury is indicated.

Acute otitis media: making an accurate diagnosis.

The diagnosis of acute suppurative otitis media is not as easy and straightforward as it may seem. Many of the signs and symptoms in children with acute otitis media are also observed in children without it. Furthermore, several of the "classic" findings of acute otitis media, such as fever and earache, are often absent, even in cases confirmed by myringotomy. An otoscope with a fresh bulb and a good power source, as well as a view of the tympanic membrane that is not obstructed by cerumen, are essential to making the diagnosis of acute otitis media. A bulging, cloudy, immobile tympanic membrane is highly associated with otitis media. Erythema of the eardrum alone, however, is often the result of viral infection, crying or attempts to remove cerumen and should not be the sole basis for the diagnosis of acute otitis media. To avoid the common problem of overdiagnosing acute otitis media, the clinician should consider the predictive values of the various symptoms and physical examination findings associated with ear infections.

Home phototherapy: use and attitudes among community pediatricians.

Rather than using home phototherapy (HP), many pediatricians admit neonates to the hospital for the treatment of unconjugated hyperbilirubinemia. This study investigates the concerns and experiences of pediatricians related to HP use. A questionnaire was sent to 150 pediatricians in the Philadelphia, PA, area and 94 returned questionnaires. Of the responders, 30 of 94 had used HP. Twenty-nine users and 62 of 64 nonusers answered detailed questions regarding HP. Few practitioners follow American Academy of Pediatrics guidelines in selection of HP candidates. Among 29 pediatricians, prematurity (7), Rh incompatibility (13), positive direct Coombs (21), and ABO incompatibility (22) were not considered contraindications, although the American Academy of Pediatrics recommends all as contraindications. Almost all (29/30) HP users identified at least one problem with home treatment. The most commonly reported problems were parental anxiety, blood testing difficulties, and reimbursement issues. Nonusers (62) were asked their reasons for not using HP. The most common replies related to concerns about noncompliance (25), medical-legal issues (23), and administrative difficulties (22), none of which were cited as problems by HP users.

The pediatric program director. An analysis of the role and its problems.

A questionnaire designed to elicit information about the work environment, knowledge, and stresses of pediatric residency program directors was mailed to the 235 member programs of the Association of Pediatric Program Directors (APPD). At the time that the 187 respondents (80% return rate) assumed responsibility for their training programs, many rated their knowledge of various aspects of residency program administration as "poor." The respondents indicated that a lack of time, the pressures of too many other academic responsibilities, and a fear of not "filling" all positions in the National Intern Matching Program created much personal stress. Most program directors felt that educational conferences designed to teach educational methods, and administrative skills, and provide technical information knowledge necessary for residency program supervision would be beneficial.

Investigating stress levels of residents: a pilot study.

A pilot study of the levels of stress among residents was conducted in three departments in a university hospital prior to initiating a programme in stress management for residents. The Beck Depression Inventory, which is a brief, standardized self-report measure of depression, was given to residents in anaesthesiology, paediatrics and psychiatry. Six additional questions were asked about the functioning of peers and services residents would like to have available. Of the 113 residents surveyed, 16% were experiencing a mild mood disturbance. The researchers feel this is probably under-reported. Residents felt that about 15% of their colleagues were emotionally impaired; 10% may have a drug and/or alcohol problem; 12% were having marital problems. Eighty per cent of all residents studied said that they would attend support groups if they existed. Approximately 60% thought coping skills/stress management seminars would be useful, and 30% of the paediatric and anaesthesiology residents (60% of the psychiatry residents) said they would use confidential individual psychotherapy if it were available.

Pregnancy during pediatric residency. Attitudes and complications.

Questionnaires were mailed to 116 female physicians who completed their pediatric training within the last 5 years. The questionnaire contained items focusing on (1) maternal complications, (2) health of the infant, and (3) attitudes toward the pregnancy experience. Thirty-five (38%) of the 93 respondents were pregnant during their residency. Seventeen complications occurred in 14 (36%) of the 39 pregnancies. Of the 17 complications, 6 (35%) were serious enough to require hospitalization. Complications resulted in time lost from work in 40% (15/39) of the pregnancies. When asked to describe the experience of being pregnant during residency, only 24% felt that it was "pleasant," while 52% said the experience was "tolerable" and 24% found it "miserable"! Thirty-seven percent (13/35) stated that they would not get pregnant during residency if they had it to do over again.

Confidence weighted answer technique in a group of pediatric residents.

Physicians who are excessively underconfident or overconfident about their knowledge may have impaired clinical judgement. Confidence weighting of multiple choice examinations asks test-takers to state how confident they are that the answers they selected are correct. This previously described method allows the examinee to receive 'overconfidence' and 'underconfidence' scores. This study was designed to test the hypothesis that these scores would correlate with faculty assessment of pediatric residents' confidence level as observed in the clinical setting. Thirty-three pediatric residents took an examination of general pediatric knowledge using confidence weighting method. Percentage of questions answered correctly ranged from 40 to 81%. There was an association between increasing overconfidence and lower examination scores (r = 0.58; p = 0.001). Increasing overconfidence was also associated with decreasing underconfidence (r = 0.38; p = 0.04). Five faculty members, the program director and the chief resident were asked to rate their perceptions of the residents' confidence on a Likert-type scale. The period of observation ranged from 9 months to 3 years. Linear regression demonstrated an association between underconfidence indices and observed confidence in the clinical setting (r = 0.39; p = 0.03). In addition, three of four residents who left the program had either over- or underconfidence indices greater than one standard deviation from the mean. These results indicate that the multiple choice examination with confidence weighting can predict residents who will be judged as underconfident by clinical preceptors. This finding is important in light of our impression that such house officers often have difficulties later during their residencies.

The predictive validity of a resident selection system.

This paper describes a new system for resident selection that uses a descriptive rating scale and a microcomputer to create a rank order list for the National Resident Matching Program. The methods utilized to analyze the time efficiency, interrater reliability, and predictive validity of the system are reported. Interrater reliability was found to be high. The rank list was shown to correlate with both clinical performance of Pl-1 and Pl-2 pediatric residents and the American Board of Pediatrics In-training Examination. Correlations for the Pl-2 year were stronger than for the Pl-1 year.

Cost effectiveness in the choice of antibiotics for the initial treatment of otitis media in children: a decision analysis approach.

If the initial use of amoxicillin fails to cure otitis media, a family will be burdened with medical costs for a second medication, additional office visit fees and time lost from employment. For some families the initial choice of a more expensive but more effective antibiotic may be more cost effective. Using a decision analysis approach we compared the cost effectiveness of amoxicillin and cefaclor. As the amoxicillin efficacy rate decreases or as parental salaries are increased, the cost-effective advantage moves towards cefaclor. With the decision analysis method described, a practitioner can use costs and efficacy rates relevant to his or her practice to determine the most cost-effective initial antibiotic for a child with otitis media.

The pharmacological treatment of delusional depression: Part II.

This study investigated the pharmacological treatment of delusional depressives by assigning patients on a random double-blind basis to amitriptyline (AT) alone, perphenazine (PER) alone, or AT + PER. As reported in an earlier paper, the combination of AT + PER was the superior treatment with a response rate of 78% compared with 41% for AT alone and 19% for PER alone. This difference is both clinically and statistically significant (p less than 0.01). In this second article, the authors report that the patients on AT + PER had higher plasma levels of AT and its pharmacologically active metabolite nortriptyline (NT) than the patients on AT alone. Although the response rate had a direct relationship to AT + NT plasma levels, an analysis of variance showed that the group of patients treated with AT + PER still had a significantly higher response rate, even after controlling for the plasma levels of AT + NT (p less than 0.05). There was also a correlation between PER plasma levels and clinical response.

Treating delusional depressives with amitriptyline.

Thirty-five delusional depressed patients were treated for either 28 or 35 days with amitriptyline. The 12 responders could not be differentiated from the nonresponders on a variety of demographic and clinical characteristics. Patients with amitriptyline+nortriptyline plasma levels above 250 ng/ml were significantly more likely to be responders than were patients with levels below that value (p less than .05). A review of the relevant literature revealed that, although some delusional depressives do respond to treatment with tricyclic antidepressants, the presence of delusions is a predictor of poor response to tricyclic antidepressants.

Synaptic organization of dorsal area of the turtle, Pseudemys scripta elegans.

The dorsal ventricular ridge is a subcortical structure receiving sensory information from the thalamus in reptiles. In the red-eared turtle, Pseudemys scripta elegans, it contains four cytoarchitectonic areas each characterized by distinct thalamic projections. This is an electron microscopic study of one of these, the dorsal area, which receives its thalamic input from the tectorecipient nucleus rotundus. It contains four concentric zones, internal to the ependymal zone, each of which is distinguished by the distribution of spiny and aspiny neurons. The ependymal zone of dorsal area contains tanycytes whose tails extend into zones 2 and 4. Synapses, usually with asymmetric junctional complexes and round synaptic vesicles, occur on these processes. Zone 1 neurons have fusiform somata and dendrites that parallel the ventricular surface. Their cytoplasm contains rough endoplasmic reticulum located primarily in Nissl bodies, lipofuchsin granules, multivesicular bodies, extensive arrays of Golgi apparatus, and large numbers of mitochondria. Synapses occur mainly on dendritic spines and shafts of zone 1 neurons and less frequently on somata. The majority have round vesicles and asymmetric junctional complexes. In contrast to those in zone 1, neurons in zones 2 and 4 have large amounts of rough endoplasmic reticulum, giving their cytoplasm an electron-dense quality. Synapses occur mainly on spines and shafts of zone 2 and 4 neurons. As in zone 1, the majority have round synaptic vesicles and contain asymmetric junctional complexes. Zones 2 and 4 contain clusters of neurons distributed among isolated neurons. The clusters are larger and less frequent in zone 2. Protoplasmic and fibrous glial processes, axon boutons, dendrites, and axon fascicles surround the neuron clusters. Though less numerous, the same structures also occur inside the clusters. Most synapses inside the clusters have round synaptic vesicles, asymmetric junctional complexes, and occur mainly on spines. Some neurons in clusters have somata whose plasma membranes are in direct apposition. In contrast to dorsal ventricular ridge in snakes, no specialized intercellular contacts were seen between somata in clusters.

The pharmacological treatment of delusional depression.

The authors investigated the pharmacological treatment of delusional depression by assigning patients on a random double-blind basis to amitriptyline alone, perphenazine alone, or a combination of the two. Fourteen (78%) of the 18 patients assigned to amitriptyline plus perphenazine were responders, compared with seven (41%) of 17 patients treated with amitriptyline alone and three (19%) of the 16 patients treated with perphenazine alone. The combination of amitriptyline and perphenazine was clearly superior (p less than .01).

Condyloma acuminata in children.

The problem of condyloma acuminata in prepubertal children seems to be more common today than in the past. Transmission of the etiology virus may occur during delivery, from close family contact, or from sexual encounters. Thirty cases of condyloma acuminata in young children have been reported, to which we add four new cases. This article reviews the 34 cases with regard to age and sex, the nature and location of the lesions, and the mode of transmission of the virus. Various modes of therapy are discussed. Because of the possibility that children with condyloma acuminata have been sexually abused, a thorough medical and social evaluation is essential.