Papers by Carolyn Roy-Bornstein
Pediatric Blood & Cancer, Sep 22, 2020
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Pediatrics, 1994
Immune globulin for injection or infusion has been used as a prophylactic and therapeutic treatme... more Immune globulin for injection or infusion has been used as a prophylactic and therapeutic treatment in such diverse conditions as Kawasaki disease, idiopathic thrombocytopenic purpura, Guillain-Barré syndrome, and hepatitis B.8 Pediatricians may care for Jehovah's Witness children who have these disorders. The biological precedent of active immunoglobulin transfer during fetal life identifies immune globulin as different than red blood cells and provides a rationale for Jehovah's Witnesses to accept immune globulin therapy for their children without compromising their religious beliefs.
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Pediatrics in review / American Academy of Pediatrics, 2010
A 10-year-old girl presents with left eye pain 1 day after being hit in the face with a palm tree... more A 10-year-old girl presents with left eye pain 1 day after being hit in the face with a palm tree leaf that sprang back at her while playing. She immediately complained of eye pain, tearing, and blurry vision following the incident. Her pain is improving today, but the tearing and blurred vision remain, and the eye still looks red. She has no fever or headache, and she does not wear glasses or contact lenses. Her past medical history is unremarkable. Physical examination reveals a well-appearing girl in no acute distress, who prefers to keep her left eye closed. Vital signs are normal and visual acuity is 20/15 in the right eye and 20/200 in the left eye. She has no signs of head or facial trauma. She has moderate photophobia, increased tear production, and significant conjunctival injection in the left eye. Extraocular movements are normal. There is no anisocoria, subconjunctival hemorrhage, or chemosis. Fluorescein is placed in the left eye, and examination under a Woods lamp does not reveal any obvious uptake of dye on the cornea or conjunctiva. The child is taken for urgent consultation with the ophthalmologist, who makes the diagnosis. A 2½-year-old girl presents to a community hospital with fever and a limp. Her blood culture grows methicillin-resistant Staphylococcus aureus (MRSA), and she is treated empirically with 3 days of intravenous (IV) clindamycin but remains febrile. She is transferred for additional management. Significant findings on her past medical history include a MRSA skin abscess on the left knee treated 3 months ago with trimethoprim-sulfamethoxazole, speech delay, pneumonia, and asthma. The fair-skinned girl weighs 12.5 kg (25th to 50th percentile), has a temperature of 37.5°C, and has other vital signs within normal range for age. She has blonde hair and bluish-gray eyes. There is full passive range of …
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JAMA, 2010
A Room With a View THE COMMUNITY HEALTH CENTER WHERE I WORKED FOR 13 years was a storefront clini... more A Room With a View THE COMMUNITY HEALTH CENTER WHERE I WORKED FOR 13 years was a storefront clinic in a shopping plaza sandwiched in-between a Dollar Store and the Registry of Motor Vehicles. The waiting room and reception area had ceiling-to-floor windows that looked out onto the parking lot. But the physicians’ offices and exam rooms were at the opposite end of the space, deep in the belly of the building, without windows or fresh air. We knew it was raining only when our patients came in shaking their umbrellas, and the only time we heard the sounds of nature was when a sparrow got stuck in the rafters above the suspended ceiling. I’ve been in private practice for a couple of years now. I first rented space on the fifth floor of a medical office building. We had windows that looked out over the high school stadium. We could watch the football team scrimmage in the fall and catch the fireworks after hours on the Fourth of July. But the windows were hermetically sealed. We couldn’t open them to catch a breeze, and the only sounds that penetrated were catastrophic: car alarms, ambulance sirens, and the occasional helicopter transporting a patient into town. Last summer I moved my practice to a tiny first-floor condominium in a long white building with a brick front that housed other professionals: orthopedists, dentists, and chiropractors. I have two French windows I can crank open nine months of the year here in New England. I can hear birds, feel cool breezes, and smell fresh honeysuckle in season. But along with the songs of birds, signs of spring, and the smells of summer comes something else: views of my patients. My office window looks out onto our little parking lot, the end of which is less than 50 feet from my open window. I watch patients come and go. I see mothers struggling with diaper bags and infant seats. I see children crossing from car to office door all holding hands like a family of ducklings. I see the vehicles my patients arrive in: the minivans and Jeeps, even the occasional motorcycle. And while it’s nice to have that little window looking out onto my patients (Don’t mark the Mitchells down as noshows. I just saw them pull in!), what I see in that parking lot presents dilemmas. Some things are easy. One morning I saw a mother pull into our lot while talking on her cell phone. I can warn her about that one. Or a father taking the last few drags of his cigarette, crushing the butt under his foot as he pulled open the car door. A no-brainer. But other cases are not so cut-and-dried. The other day I heard shrill screaming coming from the parking lot. I peeked out through the crabapple trees. To my surprise and horror it was the mother of one of my patients thundering at her 2-year-old to “Get out of that car seat!” The woman is perfectly charming in the office. So what am I supposed to do with that? Another time, a young patient was very late for an appointment. Just as we were about to pull him off the schedule, I noticed his parents standing in the parking lot, locked in an argument, the father furiously waving his arms in the air, the mother wiping tears from her eyes. In a way, it’s none of my business. After all, they could be just having a bad day. This could be a fluke fight, no violence involved. On the other hand, it is my business. Their children are my business. My patients’ environment is my business. So what do I do? I have this information: the screaming mom, the fighting couple. I can’t un-know these things. For now, I’ve framed my conversations with families in generalities: the importance of a loving environment on children’s development, the harmful effects of witnessing intimate partner violence on a child’s psyche. I haven’t mentioned what I’ve seen through the trees outside my office window. I haven’t told them about my room with a view.
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Archives of Pediatrics & Adolescent Medicine, 2011
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Archives of Pediatrics & Adolescent Medicine, 2011
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Archives of Pediatrics & Adolescent Medicine, 2012
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Archives of Pediatrics & Adolescent Medicine, 2010
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Patient Education and Counseling, 2011
I got the call around one o’clock in the morning. The mother of one of my patients was refusing t... more I got the call around one o’clock in the morning. The mother of one of my patients was refusing to leave the emergency room, insisting that her 7-year-old son be admitted. He had a chest X-ray which showed pneumonia, but his oxygen saturation was 100%, he was not dehydrated and there was no reason to believe he would not tolerate oral antibiotics. He was a perfect candidate for outpatient management except for one thing. His mom. The ER doctor’s irritation with the woman was seeping around the edges of his voice as he presented the case to me over the phone. ‘‘Look, Cal. I got an MI tryin’ to die on me and an MVA on the way in. Your kid? I gotta treat him and street him. See what you can do with this mother, will ya?’’ With that, he transferred me back to the nurses’ station so I could try reasoning with this ‘‘unreasonable’’ mom. As I waited for the mother to pick up the phone, I thought back over our time together. She had come to my practice just over a year ago. She was new to the area, a single mother in an abusive relationship. Her son was a handful. Cute as a button and smart as a whip, he was having a lot of behavior problems at school which brought him into my office on a sometimes weekly basis. I had come to understand that what could look like anger in this woman was actually a fierce advocacy for her child in what she saw as a sometimes hostile world. I supported her when she left her abuser. I started treating her son for ADHD and he was succeeding in school like never before. Now in the office, I saw her taking a real pleasure in her boy, where before she had been snappy and critical with him. She had really come a long way. Eventually my patient’s mom came to the phone. Relationship
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Papers by Carolyn Roy-Bornstein