Objective To estimate the incidence, etiology and complications of pancreatitis in pregnancy and identify factors associated with adverse outcomes. Methods Chart review of all patients diagnosed with pancreatitis and pregnancy from 1992–2001 at 15 participating hospitals. Information was collected on presentation, management and outcome, along with the number of deliveries at each hospital. Results During the 10 years of the study, 101 cases of pancreatitis occurred among 305,101 deliveries, yielding an incidence of one in 3,021 (.03%). There were no maternal deaths; perinatal mortality was 3.6%. Eighty-nine women had acute pancreatitis and twelve women had chronic pancreatitis. The majority (66%) of cases of acute pancreatitis were biliary in origin, and they were associated with better outcomes than non-biliary etiologies. Cases of gallstone pancreatitis that received surgical or endoscopic intervention during pregnancy had lower rates of preterm delivery and recurrence than those that were conservatively managed, but this difference was not significant (p=0.2). Alcohol was responsible for 12.3% of acute pancreatitis and 58% of chronic pancreatitis and was associated with increased rates of recurrence and preterm delivery. A calcium level, triglycerides or both was not obtained in half of cases identified as idiopathic. Conclusion Pancreatitis is a rare event in pregnancy, occurring in approximately 3 in 10,000 pregnancies. While it is most often acute and related to gallstones, non-biliary causes should be sought, as they are associated with worse outcomes.

Abstract. Objective: To identify provider-based differences in the ED assessment and management of children presenting with uncomplicated, first-time febrile seizures. Methods: Multicenter, retrospective cohort study of seven EDs in the Chicago area: two tertiary academic pediatric EDs (PEDs) and five community-based general EDs (GEDs). The visits of all patients with a discharge diagnosis including the term ''seizure'' were identified from a 30-month period. Records of patients who met criteria for simple, first-time febrile seizure were reviewed (age 6-60 months; temperature Ն38.0ЊC; single, generalized, tonic-clonic seizure <20 minutes; ''alert'' or ''arousable'' on presentation; absence of known neurologic disease). Results: Four hundred fifty-five records were included: 330 and 125 patients presenting to GEDs and PEDs, respectively. The two groups did not differ in mean age, vital signs, reported duration of seizure, or prior antibiotic use. Lumbar puncture (LP) was performed more often in the GED group (33% vs 22%). No patients were found to have bacterial meningitis. The patients in the GED group were more likely to receive parenteral antibiotics in the ED (56% vs 22%) and to be admitted or transferred (18% vs 4%). In a logistic regression model incorporating age, temperature, seizure duration, seizure in the ED, prior antibiotic use, primary care, and insurance status, the GED patients remained more likely to have an LP (OR 1.5), receive parenteral antibiotics (OR 2.5), and be admitted or transferred (OR 2.5). Conclusions: There were significant setting-based differences in the evaluation and management of children with simple febrile seizures presenting to GEDs and PEDs. Key words: practice variation; emergency department; febrile seizure; pediatrics. ACADEMIC EMERGENCY MEDICINE 2000; 7:21-27 L ONGITUDINAL studies estimate that 2-4% of all children experience a febrile seizure before their fifth birthdays. 1,2First-time simple febrile seizures carry a benign prognosis, and extensive neurodiagnostic evaluation is seldom necessary.3-6 Such children often present to the nearest ED and are managed by practitioners with varying levels of pediatric training and experience. We hypothesized that an examination of actual clinical practice would reveal significant variation METHODSStudy Design. This was a retrospective cohort study of the ED management of simple febrile seizure. The two cohorts examined were children presenting to pediatric EDs (PEDs) and those arriving at general EDs (GEDs). Independent variables included patient clinical and demographic characteristics. The outcomes of interest were ED assessment and management decisions, including diagnostic testing, medication administration, and final disposition. The study protocol was distributed to, and approved by, the investigational review board at each institution.Study Setting and Population. Seven EDs in the Chicago area participated in this study. Five other EDs were initially approached, but were subsequently excluded: two lacked the capabilit...

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Although evidence‐based interventions to reduce underage drinking have been identified, dissemination into ‘real‐world’ communities remains challenging. The purpose of this community‐based translational research is to test SAMHSA's Strategic Prevention Framework (SPF) as a model for such dissemination and evaluate its effect on alcohol use by youth aged 12–17. From 2001–2009 in Eau Claire, Wisconsin we used the SPF to assess community needs and implement a comprehensive strategy of evidence‐based programs targeting youth, parents and the community. Over this time, youth alcohol measures from middle and high school surveys showed an 8.6% decline in past‐month alcohol use (p<.05) and a 20.5% decline in ease of obtaining alcohol (p<.05). From 2004 to 2009 there was a 5.8% decrease in binge alcohol use (p<.05) and a 12.0% increase in perceived parental disapproval of alcohol use (p<.05). Based on our findings, the SPF is a promising model for communities seeking to reduce underage drinking. © 2012 Wiley Periodicals, Inc.

The natural history of pancreatic pseudocysts in pregnancy appears similar to that in nongravid patients. Hyperlipidemia is overrepresented as a cause of pancreatic pseudocysts in pregnancy, causing more cases than alcoholic and biliary pancreatitis combined. Seventy-five percent of cases of known parity was primaparous. While in some cases percutaneous or endoscopic drainage was performed antepartum, most patients were conservatively managed until delivery. Despite two cases of successful vaginal delivery, cesarian section may be preferable for large pseudocysts to avert rupture.