Bedside Leukocyte Esterase Testing to aid in Diagnosing Bacterial Conjunctivitis in Children.

BACKGROUND: Conjunctivitis is a frequent symptom in pediatric emergency departments; however, the etiology of conjunctivitis is difficult to clinically differentiate. OBJECTIVE: Our study objective was to evaluate the test performance characteristics of leukocyte esterase (LE) test strips in diagnosing bacterial conjunctivitis. METHODS: Patients aged from 3 months through 21 years presenting to an emergency department with symptoms of conjunctivitis were prospectively enrolled from September 2018 to March 2020. A swab of the affected eye was applied to the LE test strip and another swab was sent for culture processing. The primary outcome was the association between LE test results and eye culture results. RESULTS: We enrolled 189 patients. Overall, 117 eye cultures (62%) were positive. The sensitivity and specificity of LE testing was 96% (95% CI 90-98%) and 14% (95% CI 7-25%), respectively. Positive predictive value was 64% (95% CI 57-71%) and negative predictive value was 67% (95% CI 39-87%). CONCLUSIONS: The LE test strip had limited ability to differentiate bacterial conjunctivitis from other etiologies.

Current risk landscape of point-of-care ultrasound in pediatric emergency medicine in medical malpractice litigation.

BACKGROUND: Point-of-care ultrasound (PoCUS) is expanding as a diagnostic tool in pediatric emergency medicine. Pediatricians are apprehensive to take on the risk of malpractice from incorrect interpretation of PoCUS imaging, therefore limiting its use. Although current studies provide reassurance to this concern, none look directly at the risk for pediatric emergency medicine physicians. Our study aims to evaluate the current medicolegal risk landscape posed by PoCUS in pediatric emergency medicine. METHODS: A search of case law was performed utilizing the LexisNexis caselaw database for the period of January 2011 through December 2021. Initial search results were reviewed by the attorney co-authors for relevance to medical malpractice surrounding PoCUS. The remaining cases were reviewed by physician co-authors to ensure their relevance to both ultrasound and the acute care setting. Identified cases were then classified into categories as per the reason for the claim. RESULTS: No cases of malpractice litigation were identified that directly related to PoCUS. Ten cases of ultrasound in the acute care setting were identified, 7 of which were in pediatric patients. The majority of these cases related to appendicitis or testicular torsion. Of these 10 cases, 2 cases claimed failure to consider the ultimate diagnosis, but ultrasound would have been an appropriate study had the diagnosis been considered. Of the 8 remaining cases, 6 were based on failure to perform or delay performing ultrasound, 1 claimed that improper ultrasound study was initially performed, and 1 case was based on an improper diagnosis made by ultrasound. DISCUSSION: PoCUS does not appear to pose a significant risk of malpractice litigation in pediatric emergency medicine.

Utility of Point-of-Care Ultrasound for the Diagnosis of Hill-Sachs Deformity in the Pediatric Emergency Department.

ABSTRACT: We report a case of a 20-year-old man presenting to our pediatric emergency department with an anterior shoulder dislocation. Point-of-care ultrasound demonstrated a Hill-Sachs deformity. The potential role of ultrasound and the clinical importance of identifying patients with Hill-Sachs deformities are discussed.

Competency to stand trial evaluations in a multicultural population: Associations between psychiatric, demographic, and legal factors.

Data were examined from an archival sample of Competency to Stand Trial (CST) reports of 200 consecutive New York City pre-trial defendants evaluated over a five-month period. Approximately a fourth of defendants in the present study were immigrants; many required the assistance of interpreters. The examiners conducting the CST evaluation diagnosed approximately half of the defendants with a primary diagnosis of a psychotic disorder and deemed over half not competent. Examiners reached the same conclusion about competency in 96% of cases, about the presence of a psychotic disorder in 91% of cases, and affective disorder in 85% of cases. No significant differences between psychologists and psychiatrists were found for rates of competency/incompetency opinions. Compared to those deemed competent, defendants deemed not competent had significantly higher rates of prior psychiatric hospitalization and diagnosis of psychotic illness at the time of the CST evaluation but lower rates of reported substance abuse.

The assessment of the phenomenology of sleep paralysis: the Unusual Sleep Experiences Questionnaire (USEQ).

Previous research has found a relationship between sleep paralysis (SP) and anxiety states and higher rates have been reported among certain ethnic groups. To advance the cross-cultural study of SP, we developed a brief assessment instrument (which can be self-administered), the Unusual Sleep Experiences Questionnaire (USEQ). In this article, we report on a pilot study with the USEQ in a sample of 208 college students. The instrument was easily understood by the participants, with one quarter reporting at least one lifetime episode of SP. As in previous studies, SP was associated with anxiety (in particular, panic attacks).

Values of fathers for themselves and their newborns.

The paternal role has been neglected in parenting research. The present study focused on the values of fathers of newborns. Values of fathers of newborns drawn from the inner-city lower-class were compared with values of fathers of newborns drawn from the middle class. Highest goals of fathers from both groups for themselves were economic ('family security'); values for their children were morally focused ('honest'). Inner-city fathers placed a higher value on a clean and obedient child, whereas middle-class fathers placed a higher value on a loving and imaginative child. When values of these fathers were compared with values of a similar sample of mothers of newborns, socioeconomic status remained an important predictor of values. Sex of parent was significant in the inner-city sample as these fathers placed a higher valuation on goals associated with autonomy than did inner-city mothers.

A comparative study of values and attitudes of inner-city and middle-class postpartum women.

This study compared postpartum women from the inner city (n = 94) and postpartum women from the urban middle class (n = 80) on values and goals for themselves and their newborn children. Terminal values of inner-city women for themselves related more to social and religious goals in contrast to the more intrapersonal and personal goals of middle-class women. Instrumental values of inner-city women for their newborn children demonstrated concern with conformity and control, whereas for the middle class there was more concern with competence. Goals for the near future of the inner-city mothers were based on a desire for jobs and education.

Flashbulb memories of personal events of 9/11 and the day after for a sample of New York City residents.

The present study assessed consistency of recollections of personal circumstances of the 9/11 World Trade Center attack and events of the day before (9/10), and the day after (9/12), in a sample of 100 New York City college students. The day before 9/11 represented an ordinary event. A questionnaire was administered twice, 1 wk. and 1 yr. after the 9/11 attack. Students were asked to describe their personal circumstances when hearing about the news of the World Trade Center attack and for the same time of day for 9/10 and 9/12. 18 students returned the follow-up questionnaire. Consistency of initial and follow-up responses for the central categories for both 9/11 and 9/12 of where, who, and activity was very high (9/11: "Where"--100%, "Who"--100%, "What"--94%; 9/12: "Where"--100%, "Who"--100%, "What"--80%). Recollections of 9/10 were significantly less consistent ("Where"--79%, "Who"--71%, "What"--71%). Analysis indicated that students formed vivid, consistent recollections during the events of both 9/11 and 9/12. It is likely that the events of 9/12 also became flashbulb memories, vivid recollections of traumatic events, because the emotional impact of the stressful events, i.e., police and military presence, disrupted schedules, relating to the 9/11 attack endured beyond the day of the attack.