ROUND TABLE DISCUSSION ON ANTIBIOTICS

PEDIATRICS ◽  
1948 ◽  
Vol 1 (2) ◽  
pp. 270-287
Author(s):  
Ralph V. Platou ◽  
Waldo E. Nelson ◽  
Hattie E. Alexander ◽  
Erling S. Platou ◽  
Myron E. Wegman ◽  
...  
Keyword(s):  
Total Duration ◽  
Infectious Agent ◽  
Round Table ◽  
Best Interests ◽  
Round Table Discussion ◽  
Limiting Factor ◽  
The Individual ◽  
Effective Use ◽  
Micro Organisms ◽  
Antibiotic Agents

Because the participants have covered their assignments so well, a complete summary is not necessary, though it seems fair to hazard a few tentative conclusions based on our discussions. (1) No more than the broadest kind of generalizations for dosage schedules of penicillin or streptomycin are permissible at present. To serve the best interests of patients, therapy directed against any infectious agent must be individualized. Specific means for such individualization are available, and deserve wider application. (2) Probably all pathogenic micro-organisms have a number of similar mechanisms for combatting the injurious effects of antibiotic agents; some of these mechanisms have been discussed, others undoubtedly remain to be elucidated. The greatest single limiting factor for effective use of streptomycin is emergence of resistance. Some resistant organisms are probably present in any bacterial population; it is important that these be eradicated by adequate therapy at the earliest possible moment. (3) Toxic effects of penicillin are relatively minor in contrast to those of streptomycin; the danger of streptomycin therapy should be very carefully weighed against the patient's need before this agent is used. (4) Means for increasing and prolonging effective levels of antibiotic agents in body fluids at present have limited practical value, but may be of value in specific situations. (5) Clinically, "the trend" in the treatment of most infections with antibiotic agents is to increase the individual and total dosage, increase the interval between doses, reduce the number of doses and the total duration of therapy. By the very mechanism of their action, these agents should never be used to "taper off" an effective clinical response. They are rarely justified for minor infections or for an all too common indication, "just in case."

Round Table Discussion

PEDIATRICS ◽  
1952 ◽  
Vol 9 (3) ◽  
pp. 343-355
Author(s):  
HARLAN BLOOMER ◽  
CHARLES STROTHER ◽  
BURTIS B. BREESE ◽  
A. L. GLEASON
Keyword(s):  
Round Table ◽  
Speech Disorders ◽  
Child Growth ◽  
Speech Pathology ◽  
Round Table Discussion ◽  
General Plan ◽  
Close Relationship ◽  
The Individual ◽  
General Aspects ◽  
The University

Chairman Bloomer: In leading this round table I have with me Dr. Charles Strother, Professor of Clinical Psychology in the College of Medicine of the University of Washington at Seattle. I am from the University of Michigan Speech Clinic in Ann Arbor. We are very glad to be with you at this round table because it suggests the close relationship between the fields of speech pathology and pediatrics. We come to the American Academy of Pediatrics as representatives of the American Speech and Hearing Association which is the national organization for professional people interested in the study of speech disorders, their causes and their methods of treatment. Perhaps you are familiar with the official publication of the Association, the Journal of Speech and Hearing Disorders. We bring you greetings from the Association. I think you may be interested in a brief outline of our general plan of discussion for the afternoon. The first part of our discussion will review the importance of a knowledge of speech disorders to specialists in pediatrics. Next we shall discuss in some detail the nature of these disorders and the etiologic factors which are frequently encountered, and then we shall suggest methods for handling the speech problems which the individual child may present. We shall be glad to have your participation, your questions, and your comments at any time during our discussion. We feel that this subject is particularly timely because of the steadily increasing interest of pediatricians in the general aspects of child growth and development rather than in only the medical care of children.

Round Table Discussion

PEDIATRICS ◽  
1948 ◽  
Vol 2 (4) ◽  
pp. 469-479
Author(s):  
RUSSELL J. BLATTNER
Keyword(s):  
Inclusion Bodies ◽  
Cellular Response ◽  
Infectious Agent ◽  
Round Table ◽  
Chemotherapeutic Agents ◽  
Tissue Response ◽  
Round Table Discussion ◽  
Obligate Intracellular ◽  
Form Of Life ◽  
Intracellular Parasites

Chairman Blattner: During recent years, there has been increasing interest shown in diseases caused by filterable viruses, and significant work has been accomplished in this comparatively new and absorbing field of endeavor. With the advent of chemotherapeutic agents and antibiotics, the presence and action of these infectious agents has become more apparent. Viral diseases, therefore, have assumed increasing importance in medical literature in general and in pediatric literature in particular. By way of review, it is well to bear in mind that viruses are filter-passing agents, obligate intracellular parasites, capable of reproducing themselves and of producing disease in plants and animals, including man. While these agents cannot be seen except by the most elaborate methods, their presence can be detected by their injurious effects. The pathologic picture produced by viral agents is rather characteristic and can be recognized readily by experienced observers acquainted with tissue response. In some instances, inclusion bodies are produced which may be intranuclear or intracytoplasmic, and represent cytologic changes which are considered typical of the pathologic response to viral invasion. When inclusion bodies are present they may serve as sign posts for the recognition of the type of infectious agent. The nature of a filterable virus is as yet unknown. Viruses may be a form of life similar to bacteria, but infinitely smaller in size. It is conceivable that viruses are enzymes capable of reproducing themselves and capable of producing cellular response. They may be non-living, crystallizable substances, such as the Stanley tobacco-mosaic virus; or a form of life, the definite nature of which is as yet unrecognized. Dr. Thomas M. Rivers has stated : "Viruses are a heterogeneous collection of diverse agents which happen to induce a state of broad similarity." He points out that the reaction of the tissues in general, and of the cells in particular, determines the nature of the pathologic process about as much as the infectious agent itself.

Round Table Discussion

PEDIATRICS ◽  
1953 ◽  
Vol 11 (3) ◽  
pp. 270-279
Author(s):  
ERWIN NETER ◽  
MARK H. LEPPER ◽  
HAROLD WEATHERMAN ◽  
WALTER C. MCKEE
Keyword(s):  
World War Ii ◽  
Bacterial Infections ◽  
Medical Profession ◽  
Round Table ◽  
Daily Practice ◽  
Round Table Discussion ◽  
Optimal Dosage ◽  
Rickettsial Infections ◽  
Antibiotic Agents ◽  
Made In

Chairman Neter: The advances made in the treatment of infectious diseases since 1935, and more particularly during the last decade, have been nothing short of miraculous. Surveying these accomplishments briefly, it is clear that adequate chemotherapeutic and antibiotic agents are available for many bacterial and rickettsial infections and even for a few diseases caused by the larger viruses, closely related to the rickettsiae. Furthermore, the medical profession has had available for many years drugs which have proved effective in maladies caused by some protozoa, such as malaria, and substantial further advances have been made in this field during the following World War II. At the same time, we are all painfully aware that in the daily practice of pediatrics we are still lacking chemotherapeutic and antibiotic agents which are curative in diseases caused by the true viruses and, to a larger extent, in illnesses due to fungi. Also for certain bacterial infections, such as those caused by mycobacteria, Proteus, Pseudomonas and others, the ideal antibiotic will yet have to be discovered. Indubitably, the research that is going on throughout the civilized world in the search for newer and better antibiotics will, in due time, solve these all-important problems. The field of antibiotic therapy and prophylaxis has expanded at such an extraordinary rate that it has not yet been possible in all instances to determine with certainty the relative efficacy of various antibiotics in all infections and the optimal dosage schedule for each. It is quite likely that all of us, for example, use more penicillin in some patients than is needed.

Round Table Discussion

PEDIATRICS ◽  
1948 ◽  
Vol 1 (5) ◽  
pp. 668-683
Author(s):  
LEO KANNER
Keyword(s):  
Round Table ◽  
Round Table Discussion ◽  
Parent Child Relationship ◽  
Intrinsic Values ◽  
Child Relationship ◽  
The Moment ◽  
The Individual ◽  
And Function ◽  
And Behavior ◽  
Attitudes And Behavior

Chairman Kanner: Every day of man's life constitutes a transition between yesterday and tomorrow, converging in the intrinsic values of the moment. The past and present continue to shape and modify directions and goals, mostly through quiet evolution, sometimes in lively spurts. One of the liveliest spurts occurs during adolescence, at a time when a person is no longer a child and not yet an adult. Many incisive changes take place in that period. Body growth, in a remarkable upward surge, attains its maximum for the individual. The physique assumes its characteristic configuration. Sexual development reaches procreative capacity. There is striving after emancipation from sheltered existence, a trend toward increasing self-dependence in thought and action. The sphere of interest and participation expands from the confines of home, neighborhood and school to the community at large. The choice of vocation, until then a playfully considered matter, becomes a real issue. Current standards and precepts are submitted to criticism not as yet leavened by the tests of experience. The established order is challenged boldly and then, after some struggle, appropriated gradually with more or less reservation. Adolescence, in our culture, is a great translator. It translates the language of parental direction, attitudes and behavior into an individualized idiom. This is much less evident in primitive cultures. One might go so far as to say that in primitive societies there is no conceptual equivalent for that which we call adolescence. Childhood ceases abruptly when, through a set of elaborate rites, it is transported into full-fledged adulthood. Tribal ritualism, rather than personal spontaneity determines status and function. In our social structure, a child is given several years in which he is to find his way from a more or less manipulated and regimented existence to the acquisition of initiative in a loosely competitive environment in which the taboos are blurred, the semantics are equivocal, and the variety of occupational, political and theologic choices offers opportunities for perplexities. The adolescent translator's dictionary is full of confusing synonyms and antonyms. A combination of inner soundness, wholesome parent-child relationship, and guidance from understanding adults, helps most adolescents to emerge safely from the groping and floundering which precede maturing stabilization.

Round Table Discussion

PEDIATRICS ◽  
1953 ◽  
Vol 11 (1) ◽  
pp. 79-81
Author(s):  
WILLIAM S. LANGFORD ◽  
REYNOLD A. JENSEN ◽  
MILTON M. GRENNBERG ◽  
HAROLD D. LYNCH
Keyword(s):  
Growth Process ◽  
Obese Child ◽  
Round Table ◽  
Physical Growth ◽  
Round Table Discussion ◽  
Real Problem ◽  
Younger Child ◽  
The Individual ◽  
First Job ◽  
Adolescent Period

Chairman Langford: In the personality and physical growth of the individual there are some periods when the task of adjustment is a little more difficult than others. We see it at weaning, when the child starts school, at adolescence, on his first job, later when he gets married and—one of the most severe trials of all—when the individual becomes a parent. About 90% could be called normal disturbances in this area of adolescence and psychologic disturbances. Dr. Cornelia M. Carithers, Jacksonville, Fla.: When you see a marked problem such as rivalry between children, how do you convince the parent it is a real problem? Chairman Langford: One of the more common instances is the jealousy of the younger child for the older child. This may enter the picture with the obese child. Often it is the younger child who will become obese for the satisfaction he gets out of the tremendous body size. The problem of obesity may be of particular significance in the adolescent period. It may be a phase that many children go through as part of this gradual growth process but it also may be related to other factors; this suggests that when dealing with a child who is heavier than he or she should be, one ought to individualize each child who presents the problem. Therefore, it is necessary for those of us who deal with these children to determine what is a normal gain in weight for a period of time and what is outside the range of normal.

Round Table Discussion

PEDIATRICS ◽  
1952 ◽  
Vol 10 (4) ◽  
pp. 490-504
Author(s):  
STANLEY GIBSON ◽  
LEON DEVEL ◽  
WILLIAM C. VANCE
Keyword(s):  
Rheumatic Fever ◽  
Infectious Agent ◽  
Round Table ◽  
Round Table Discussion ◽  
Careful Study ◽  
Definite Diagnosis ◽  
Table Discussion ◽  
University Of Buffalo ◽  
The Subject ◽  
The University

Chairman Gibson: For a good many years, it seems to me, we have been hashing over the same old problems of rheumatic fever without making much progress in our knowledge of the disease. Recently, however, I think there are hopeful signs that we are learning a little bit more about rheumatic fever and will be a little better able to deal with it. As you all know, rheumatic fever is a disease with many varied manifestations. Some cases are so outright that even a junior medical student could make a diagnosis; other cases are so obscure that at a given time and in a given case one is quite unable to make a definite diagnosis. Yet within a wide scope of variations it seems to me that rheumatic fever does show a definite group of phenomena which, by careful study, one can usually evaluate in the course of time and thereby determine whether rheumatic fever is present. I felt we might best handle the subject by dividing our discussion on rheumatic fever into 4 parts: etiology, recognition, prevention and treatment. At this time I want to introduce to you Dr. Edward C. Lambert, who is my associate in this Round Table discussion. He is at the University of Buffalo Medical School in Pediatrics and in charge of the Cardiac Children's Clinic. Dr. Edward C. Lambert, Buffalo: About 50 years ago Dr. Osler defined rheumatic fever as an acute noncontagious febrile infection depending on an unknown infectious agent, characterized by multiple arthritis and a special tendency to involve the heart.

SELF-PRESERVATION OF THE PHYSICAL HEALTH OF STUDENTS IN THE VIEW OF THEIR PROFESSIONAL AND LABOR COMPETENCIES

2020 ◽  
pp. 31-40
Author(s):  
Pavlov B.S. ◽  
Sentyurina L.B. ◽  
Pronina E.I. ◽  
Pavlov D.B. ◽  
Saraikin D.A.
Keyword(s):  
Physical Health ◽  
Everyday Life ◽  
Healthy Lifestyle ◽  
Leisure Activities ◽  
Physical Culture ◽  
Federal Districts ◽  
The Individual ◽  
Effective Use ◽  
Academy Of Sciences ◽  
Labor Potential

The state policy of health preservation of Russians and the process of introducing a healthy lifestyle into their everyday life is hampered by the lack of sufficient self-activity and purposefulness of the individual ecological and valeological behavior of representatives of various population groups. According to the authors of the article, one of the important indicators of the maturity of professional and labor competencies of school and student youth is their readiness and desire for permanent self-preserving behavior. “With numbers in hand,” the authors show the scale of deviant deviations and the phenomena of spontaneous irresponsibility in the educational and leisure activities of students, hindering the preservation and development of physical culture, the accumulation and effective use of their psychophysiological and labor potential. The conclusions of the proposal of the authors of the article are based on the results of a number of sociological surveys conducted in 2000-2020. at the Institute of Economics of the Ural Branch of the Russian Academy of Sciences in a number of secondary schools and universities of the Ural and Volga Federal Districts.

scholarly journals Nudge Versus Boost: Agency Dynamics Under Libertarian Paternalism

2019 ◽  
Vol 130 (629) ◽  
pp. 1384-1415 ◽  
Author(s):  
Ralph Hertwig ◽  
Michael D Ryall
Keyword(s):  
Cognitive Biases ◽  
Policy Implications ◽  
Best Interests ◽  
Libertarian Paternalism ◽  
The Future ◽  
Set Up ◽  
The Individual

ABSTRACT Thaler and Sunstein (2008) advance the concept of ‘nudge’ policies—non-regulatory and non-fiscal mechanisms designed to enlist people's cognitive biases or motivational deficits so as to guide their behaviour in a desired direction. A core assumption of this approach is that policymakers make artful use of people's cognitive biases and motivational deficits in ways that serve the ultimate interests of the nudged individual. We analyse a model of dynamic policymaking in which the policymaker's preferences are not always aligned with those of the individual. One novelty of our set-up is that the policymaker has the option to implement a ‘boost’ policy, equipping the individual with the competence to overcome the nudge-enabling bias once and for all. Our main result identifies conditions under which the policymaker chooses not to boost in order to preserve the option of using the nudge (and its associated bias) in the future—even though boosting is in the immediate best interests of both the policymaker and the individual. We extend our analysis to situations in which the policymaker can be removed (e.g., through an election) and in which the policymaker is similarly prone to bias. We conclude with a discussion of some policy implications of these findings.

scholarly journals European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

2021 ◽  
Author(s):  
Yassin Eddahchouri ◽  
◽  
Frans van Workum ◽  
Frits J. H. van den Wildenberg ◽  
Mark I. van Berge Henegouwen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Expert Panel ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Ivor Lewis ◽  
Delphi Methodology ◽  
Invasive Esophagectomy ◽  
European Consensus ◽  
Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

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