Giving to Our Patients—Should We Draw the Line?

Lawrence F. Nazarian

doi:10.1542/pir.8.3.67

Giving to Our Patients—Should We Draw the Line?

Pediatrics in Review ◽

10.1542/pir.8.3.67 ◽

1986 ◽

Vol 8 (3) ◽

pp. 67-67

Author(s):

Lawrence F. Nazarian

Keyword(s):

Emergency Room ◽

Routine Examination ◽

After Hours ◽

Mother’S Voice

"We've got a cut finger here. Can we meet you at the office right away?" The mother's voice on the phone was calm but insistent. "Which child is this?" I asked. " Well, actually, it's me. My doctor doesn't do suturing and I don't feel like waiting around the emergency room." I had no problem telling her politely that I would call the hospital to let them know she was coming. Clearly, this was an inappropriate request to make of a pediatrician covering a large practice on a weekend, especially when other help was available. But what about the parent who calls after hours regarding a diaper rash? How about the father who insists that you put a diagnosis other than "well child" on the charge slip, so his insurance will cover the routine examination? Does it change your mind when he points out that you discussed the child's headaches during the visit? How about the mother who wants erythromycin for her child "because it's the only thing that clears up his ears?" Our orientation is to give our patients what they need. We are there to help and to give. Rightly so. And most of the time it is appropriate to give what is requested.

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Detection of Senile Scleral Plaque after Head Trauma

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v12i4.325 ◽

1970 ◽

Vol 12 (4) ◽

pp. 229-230

Author(s):

Sarah Guigui ◽

Tova Lifshitz ◽

Amjad Baidousi ◽

Ronit Yagev ◽

Jaime Levy

Keyword(s):

Computed Tomography ◽

Foreign Body ◽

Elderly Patients ◽

Emergency Room ◽

Head Trauma ◽

Late Onset ◽

Computed Tomography Scan ◽

Routine Examination ◽

Prognostic Implications ◽

Tomography Scan

Senile scleral plaques are late onset ocular calcifications, and are usually detected incidentally on orbital computed tomography scan following trauma. This report is of 4 elderly patients with senile scleral plaques who were admitted to the emergency room following trauma to the head. A head/orbital computed tomography scan was performed as part of the routine examination. In all 4 patients, computed tomography scan revealed a clear retina and no scleral perforation or foreign body intrusion, but bilateral radiodense areas were located anterior to the insertion of the horizontal rectus muscles. These areas were diagnosed as senile scleral plaques. Even though these ocular calcifications are benign, they have important prognostic implications, and should therefore be identified correctly and not confused with other ocular pathologies.

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PEDIATRIC CENTERS TO PROVIDE OFF-HOUR CARE

PEDIATRICS ◽

10.1542/peds.84.3.a42 ◽

1989 ◽

Vol 84 (3) ◽

pp. A42-A42

Keyword(s):

Emergency Room ◽

Common Sense ◽

Heart Attack ◽

Metropolitan Areas ◽

Insurance Companies ◽

Emergency Rooms ◽

Hospital Emergency ◽

Hospital Emergency Room ◽

After Hours ◽

Pediatric Illnesses

It's a common trial of parenthood. A child wakes at night with an earache and the pediatrician's office is closed. So it's off to the hospital emergency room, where after hours of waiting, a frazzled parent and screaming child are finally seen by a tired medical resident, who probably knows little about pediatric illnesses. But at least in some places, an alternative is arriving off-hour pediatric centers that deliver immediate care, but only at night and on weekends. Much cheaper than costly emergency rooms and more specialized, the centers are being welcomed by parents who before had nowhere to turn but hospitals. Not surprisingly, emergency-room staffs and insurance companies are glad to see them as well. Studies show that 90% of pediatric visits to hospital emergency rooms are unnecessary. . . . Such use partly explains the long waits for parents with mildly or moderately sick youngsters. Hospital triage rules and common sense dictate that heart-attack and accident victims get treated before a child's strep throat. In contrast, the longest wait is usually no more than 15 minutes at one of the clinics, where several pediatricians generally are on duty. . . . Fees for visits run from $35 to $65, compared with emergency-room bills that can start at more than $100. While the clinics seem ideal, there are a few drawbacks. For one, they aren't open all night, but rather from late afternoon until midnight or so—although clinics say most night cases occur in that period. Staffing can also pose a problem . . . because it isn't easy finding quality pediatricians, let alone ones who will work evenings and weekends. These centers also need a certain population density to thrive, so their growth is likely to be limited to burgeoning metropolitan areas.

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On the Origin of the Microscystalline Structure in Rapidly Solidified IN-100 Powder

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100078821 ◽

1977 ◽

Vol 35 ◽

pp. 260-261

Author(s):

J. M. Walsh ◽

K. P. Gumz ◽

J. C. Whittles ◽

B. H. Kear

Keyword(s):

The Other ◽

Coarse Grained ◽

Microcrystalline Structure ◽

Routine Examination ◽

Atomization Process ◽

Centrifugal Atomization ◽

Splat Quenching ◽

Powder Particles ◽

Dendritic Microstructures ◽

Rapidly Solidified

During a routine examination of the microstructure of rapidly solidified IN-100 powder, produced by a newly-developed centrifugal atomization process1, essentially two distinct types of microstructure were identified. When a high melt superheat is maintained during atomization, the powder particles are predominantly coarse-grained, equiaxed or columnar, with distinctly dendritic microstructures, Figs, la and 4a. On the other hand, when the melt superheat is reduced by increasing the heat flow to the disc of the rotary atomizer, the powder particles are predominantly microcrystalline in character, with typically one dendrite per grain, Figs, lb and 4b. In what follows, evidence is presented that strongly supports the view that the unusual microcrystalline structure has its origin in dendrite erosion occurring in a 'mushy zone' of dynamic solidification on the disc of the rotary atomizer.The critical observations were made on atomized material that had undergone 'splat-quenching' on previously solidified, chilled substrate particles.

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Nuclear Reactions in Deuterium Titanium

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100134260 ◽

1990 ◽

Vol 48 (2) ◽

pp. 134-135

Author(s):

D.M. Vanderwalker

Keyword(s):

Nuclear Reactions ◽

Ion Beam ◽

Exothermic Reaction ◽

Pure Titanium ◽

Fundamental Interest ◽

Transmission Electron ◽

Iodide Titanium ◽

A Cell ◽

After Hours ◽

Quantity Of Heat

There is a fundamental interest in electrochemical fusion of deuterium in palladium and titanium since its supposed discovery by Fleischmann and Pons. Their calorimetric experiments reveal that a large quantity of heat is released by Pd after hours in a cell, suggesting fusion occurs. They cannot explain fusion by force arguments, nor can it be an exothermic reaction on the formation of deuterides because a smaller quantity of heat is released. This study examines reactions of deuterium in titanium.Both iodide titanium and 99% pure titanium samples were encapsulated in vacuum tubes, annealed for 2h at 800 °C. The Ti foils were charged with deuterium in a D2SO4 D2O solution at a potential of .45V with respect to a calomel reference junction. Samples were ion beam thinned for transmission electron microscopy. The TEM was performed on the JEOL 200CX.The structure of D charged titanium is α-Ti with hexagonal and fee deuterides.

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