Bronchiolitis.

Bronchiolitis is a commonly encountered disease of infants and young children. Mortality is low, but morbidity is significant. Treatment requires considerable commitment of time from medical and nonmedical personnel. Decisions about treatment modalities remain controversial. Patients may remain susceptible to pulmonary problems for years and may be predisposed to the development of asthma. Much is known about this disease, but much remains to be learned.

Child abuse: a model for the use of structured clinical forms.

OBJECTIVE: To assess the effectiveness of structured forms in the collection and documentation of information essential to the evaluation of abused children. DESIGN: Retrospective chart review. PARTICIPANTS: Five hundred sixty-seven children were evaluated for physical or sexual abuse during a 24-month period. MEASUREMENTS AND MAIN RESULTS: Specific items crucial to the evaluation of abuse were selected for both physical and sexual abuse. By using these items as markers, we compared the data obtained and documented during abuse evaluations after the introduction of the forms with those obtained before their introduction. The information that occurred more frequently when using the structured forms included: a history of the assault from both the child and an adult (and in cases of physical abuse, a developmental history); specific sexual acts; mechanism of injury; a detailed description of the genital examination; drawings of findings (both sexual and physical); documentation of laboratory studies, photographs, and radiographic studies; and reporting to Child Protective Services. CONCLUSIONS: Structured forms significantly increased the information collected and documented in medical records during evaluations of abused children. These forms were found to be more effective than the previously used unstructured, institutional form.

Poisoning in the elderly: characterization of exposures reported to a poison control center.

OBJECTIVE: To determine the incidence of poison center calls involving the elderly, characterize these poisonings, and compare them with poisonings that occur in people younger than 60 years of age. DESIGN: Concurrent, observational survey. SETTING: The Virginia Poison Center in Richmond, Virginia. PARTICIPANTS: All persons 60 years of age and older who were involved in a poison exposure reported to the Virginia Poison Center from October 1, 1991 through March 31, 1992. MEASUREMENTS: Incidence, type, route, location, management site, medical outcome of exposures and reasons for these exposures. RESULTS: Exposures in persons 60 years of age and older accounted for 2.3% of all poison center calls during the 6-month study period. These calls were most likely to involve women who unintentionally ingested extra doses of medications. The majority of these exposures occurred in the home and resulted in either no effect or minor effects. For those exposures that necessitated an emergency room visit, elderly persons were more likely to be admitted to the hospital than younger persons (P < 0.05). CONCLUSIONS: The majority of poisonings that occur in persons 60 years of age and older are unintentional and may be amenable to poison prevention education.

School health services.

Since compulsory public education began in the United States, a component of that system which now is titled, School Health Services, has existed. Even with this history, the concept remains somewhat nebulous, even in the minds of its supporters, because of a paucity of verifiable, reproducible research in the area. Until research catches up with practice, and legislation is guided by firm data, it is essential to continue to clarify and strengthen the existing system. That system with a professionally prepared school nurse as its central focus provides the greatest hope for addressing the problems that are within the scope of school health service practice.