GENERAL PEDIATRICS AND PEDIATRIC EDUCATION 239A ETHICAL IMPLICATIONS OF STUDENT-PATIENT INTERACTION 769 ON PEDIATRIC SERVICES: A STUDY OF PEDIATIC CHAIR- , ..& PERSONS. Daniel L. Cohen, Rosslyn I. Kessel, Laur- ence McCullough, Aristide Y. Apostolides, Errol R. Alden, USUHS, Dept. of Peds., Bethesda, MD; University of Maryland, Baltimore; Georgetown University, D.C. (Spon. by Gerald Fischer) Should parents be informed that medical students may perform invasive procedures on their children? Surveys were sent to a l l university pediatric dept. chairpersons (n=124) to ascertain policy governing ethical aspects of student involvement in the care of children. Surveys were returned from 99 chairpersons (80%). Seventy percent of pediatric departments specifically inform parents that students will be involved in the general care of their children but only 8% of depts. specifically obtain permission for student participation in aspects of care. Depts. were less likely to obtain specific permission for in- volvement in noninvasive aspects of care (18%) than in invasive aspects (46%). The common explanation was the presumption that students are part of the hospital team; therefore specific per- mission for their participation was not necessary (60%). Four- teen percent of chairpersons felt that seeking permission for student involvement in some aspects of care might, through par- ental rejection, be detrimental to the students' education. With respect to invasive procedures 65% of depts. invoked the team concept - "we w i l l do it together" while 4% actually informed parents that students would perform the procedures. There i s considerable variability in the approach to the ethical issues surrounding student involvement with pediatric patients, and thus variability in conforming with federal and JCAH guidelines. USE OF A HANDHELD PROGRAMMABLE CALCULATOR FOR FLUID 770 AND NUTRITIONAL MANAGEMENT IN THE INTENSIVE CARE .., NURSERY. Edwing A. Contreras, Evelyn R. Lohla, Javier J. Bustamante, Doanh K. Phan and A. Ray Farmer (sponsored by Surendra K. Varma) Texas Tech University Health Sciences Center, Department of Pediatrics, Division of Neonatology, Lubbock, Texas. Desk-iep microcomputers programmed to calculate the daily fluid and nutritional requirements of infants admitted to neonatal intensive care units are being used with increasing frequency. We would like to report our experience with a rela- tively inexpensive, small, battery powered, handheld programn- able calculator: the Hewlett-Packard 41 CV (HP-41CV). This calculator has an Alpha-numeric display, is simple to program and does not require prior knowledge of computer language. The small size and portability of the HP-41CV allows i t to be carried during rounds with the calculations made a t the bedside. The main program allows the physician to evaluate fluid balance and caloric intake for the previous day and project values, depending on any changes planned for the following day. An additional program designed to individualize total paren- teral nutrition orders with special features of automatic calculations for glucose infusion rate (mglkglmin) and maximum allowance for amino acids based on total calories to be expended has been very useful. Similar advantages with microcomputers include rapid execution and elimination of errors in mathemati- cal computations. W e feel that the use of this calculator is an excel lent alternative if cost and portability are considered. MICROCEPHALY IN PRETERM INFANTS: INCIDENCE .f. 771 AND ASSOCIATED DEVELOPMENTAL PROBLEMS. ' I I I M. Hoffman-Williamson, J. Bernbaum, A. Daft, (Spon. by W.W. Fox) Univ. of PA. Sch. of Med., Dept. of ~ e d s , w e n ' s Hosp. of Phila., Phila., PA. Given the paucity of data that exist regarding microcephaly in an ex- clusively preterm population, we studied the occurrence of abnormalities in toddler head circumference (THC) and the relation of THC to develop- mental status. In those with small THC, birth head circumference (BHC) was also analyzed. HC, WT and L and developmental status (Bayley Scales of Infant Development) at 18-36 months were determined in 117 infants with BW 41750 gm. 91 (78%) had THC in the normal range. Of the remaining 26 (22%) who had THC&-2 S.D., 3 were clearly micro- cephalic (MC) (L-3 SD); 10 were suspected MC (L-2 SD); and 13 were near MC (at -2SD). Only one child in each MC group exhibited abnormal WT and L in addition t o small head size. The table demonstrates the developmental status of each THC group (excluding 5 toddlers with normal THC untestable due to blindness or behavior ~roblems). Devel. Status MC Suspected MC Near MC Normal THC normal 0% 40% 46% 67% mild-mod 67% 30% 38% 22% sev impaired 23% 20% 16% 5% Review of BHC of those 26 toddlers with small THC revealed 14 (54%) who were initially microcephalic (~lO%ile) and 12 (46%) who had normal BHC. Condusions: 1) There is a higher incidence of microcephaly or near rnicrocephaly in toddlers who were preterm as compared to those who were born at term. 2) A higher % of delays exists in those with THCL-2SD. 3) A normal BHC does not preclude a later decline in HC%ile and the related risk for developmental problems. ACOUSTIC OTOSCOPY (A.O.) COMPARED WITH TYM- 772 PANoMETRY AND MYRINGoToMY IN THE DIAGNOSIS OF MIDDLE EAR EFFUSION IN CHILDREN AND INFANTS. Virgil M. Howie, Yi Tsong and William D. Clark, University of Texas Medical Branch, Departments of Pediatrics, Biostatistics and Otolaryngology, Galveston, Texas. 216 outpatients had 346 middle ear aspirates for either acute otitis media (866) or insertion of pres- sure equalization tubes (1150). A.O. was available immediately prior to aspiration in 346 ears and both tympanometry and A.O. were available in 162 ears. The sensitivity of the A.O. was 85% with a specificity of 64% in the 346 ears aspirated. The sensitivity of tympanometry was 90% and specificity was 67% in the 162 ears for which both measurements were made. These sensitivities and specificities are not signif- icantly different, but the specificities are better than the prediction of an experienced pediatrician using pneumatic otoscopy on the same patients. r1111a., ra. ICN-G often are discharged with unresolved problems to families (F) whose anxiet is increased by the homecoming. lb improve outcome . o f IC&G and decrease . ! 3 .anxiety we a r e assesslnq the e ficacy of HVN who make unllmlted hone c a l l s and 4 v i s i t s h 2 wk stud e c l o d f o r ICN-G h o s p i t a l i z e d wk. In 15 mos. 79 ICN+ Y$. C and $2 S) have completed ' & I $ studv. mere were no sianlflcant differences between S and C ANOTHER LOOK AT CAREER CHOICE AND LEARNING STYLES. 774 Leslie Sewett, Ed.D., Larrie W. Greenberg, M.D., Richard P. Foley, Ph.D., Rhonda M. Goldberg, M.A., Chariklia T. Spiegel, M.D., Carol Green, M.D. Children's Hospi- t a l National Medical Center, George Washington University School of Medicine, University of Illinois Center for Educational Dev. Few relationships have been found between physicians' career choices and learning and personality styles. This study re-examines physicians' career choices utilizing a learning pre- ference inventory which assesses approaches to learning. METHOD: The m a j o r i t y of r e s i d e n t s in the specialties of internal =e (62), obste;t'rics/gynecology (16), pediatrics (521, psychiatry (15), and surgery (24) completed the Rezler Learning Preference Inventory, and the FIRC-B Scale. The analysis method to determine differences was an ANOVA. RESULTS: Residents in a l l specialties except psychiatry had strong preferences for concrete, practical learning while many psychiatry residents prefer learning theoretically (p .05). Significantly more (p .05) psychiatry residents preferred teacher structured learning while residents in other specialties were more likely to prefer student-structured learning (p .05). Pediatric residents preferred learning with others (p .05) while ~b/~yn residents preferred independent learning such as reading (p .05). On the FIRO-B Scale which measures typical ways individuals interact with other people, pediatric residents as compared to the other specialties were more likely to Want others involved in their activities and to have warm and per- sonal relationships instead of doing things alone or have businesslike relationships.