Advanced Pediatrics

100 East Street SE, Suite 301

Vienna, VA 22180
(P) 703.938.5555

(F) 703.319.8580




CLINICAL RESEARCH


A few of our publications that we believe initiated a change in the diagnosis or management of sick children:

1. Schwartz RH, Rodriguez WH, Khan WN, Ross S. Acute purulent otitis media in children older than five years. Incidence of Haemophilus as a causative organism.  JAMA 1977; 236:1032-3.   Prior to this publication ampicillin treatment for AOM changed at age 5-years to penicillin treatment.


2.     Schwartz RH, Rodriguez WJ, Khan WN, Ross S. The increasing incidence of ampicillin-resistant Haemophilus influenzae?  A cause of otitis media.     JAMA  1978; 239:320-3. Highlighted the high resistance rate of H. influenza in northern Virginia.  Was the highest frequency In the US.


3.  Schwartz DM, Schwartz RH. Acoustic impedance and otoscopic findings in young children with Down’s syndrome.  Archiv Otolaryngol 1978; 194: 653-6.

Study performed in summer season, a low season of middle ear disease.  Results of study with young children with Down syndrome showed more than 60% had middle ear effusion.


4.  Schwartz RH, Quinnell RK. Throat cultures in the office. Am Family Physician 1980; 21;72-8.  Results from 100,000 in-office throat cultures.


5.  Schwartz RH, Rodriguez WJ, Brook I, Grundfast KM. The febrile response in acute otitis media. JAMA 1981; 245:2057-8.  Only 35% of children who presented with opacified bulging dysmobile eardrums had fever documented at home or in primary care office


6.  Schwartz RH, Stool SE, Rodriguez WJ, Grundfast KM. Acute otitis media: Toward a more precise definition. Clin Pediatr 1981; 20:549-54.  One of first American studies to conclude that bulging of TM was necessary to diagnose AOM.  Now it is a Guideline for diagnosis.


7.  Schwartz RH, Wientzen RL, Pedreira F, et al. Penicillin for group A streptococcal pharyngotonsillitis: A randomized trial of seven versus ten days of therapy.  JAMA 1981; 246:1790-5.  Re-affirmed the requirement that indeed, 10 days of therapy was needed for antibiotic treatment of streptococcal pharyngitis.


8.  Schwartz RH, Rodriguez WJ, Grundfast KM. Pharmacologic  compliance with antibiotic therapy for acute otitis media: Influence on subsequent middle ear effusion. Pediatrics.  1981; 68:619-22.  Proof that treatment of middle ear effusion that persisted after antibiotic therapy for AOM did not require a second course of antibiotic therapy.


9.  Schwartz RH, Wientzen RL, Barsanti RG. Vulvovaginitis in prepubertal girls: The importance of group A streptococcus.  South Med J 1982; 75:445-7.  One of several articles to highlight the possibility of Streptococcus pyogenes as cause of prepubital vulvovaginitis.


10.  Schwartz RH, Rodriguez WJ, Khan WN, et al. Evaluation of cefaclor in acute otitis media caused by ampicillin- resistant H. influenzae. Clin Pediatr 1982; 21:402-4.  One of first publications to show that cefaclor is poor choice for treatment of AOM caused by ampicillin-resistant H. influenza.


11.  Schwartz RH, Goldenberg RI, Park C, Keim D. The increasing prevalence of bacteremic ampicillin-resistant Haemophilus influenzae infections in a community hospital. Pediatr Infect Dis J 1982; 1:242-4.  Bacteremic ampicillin-resistant H. influenza was very high in northern Virginia and a forerunner of things to come in rest of US


12.  Schwartz, Wientzen RL. Occult bacteremia in an office setting. Clin Pediatr 1982; 21:659-63.  Showed that occult bacteremia does occur in primary care pediatric office, #1 was as in hospital ED, Streptococcus pneumonia.


13.  Howie VM, Schwartz RH. Acute otitis media: One year in a general pediatric practice. Am J Dis Child 1983; 137:155-8.  !2-month study of incidence of AOM by single pediatrician using bulging and dullness of TM as primary diagnostic criteria.


14.  Schwartz RH. Pneumatic otoscopy: Getting the most out of the ear exam. J Respir Dis 1983; 4:82-92.  Discussed proper technique of pneumatic otoscopy using biphasic suction as well as puffing on the TM.


15.  Schwartz RH. Research in a pediatrician’s office: An idea worthy of your consideration. Pediatr Infect Dis J 1983; 2:348-51.


16.  Schwartz RH, Rodriguez WJ, McAveney W, Grundfast KM.  Cerumen removal: How necessary is it to diagnose acute otitis media?  AM J Dis Child 1983; 137:1064-5.  The importance of cerumen impaction and its removal in diagnosis of AOM.


17.  Schwartz RH. Marijuana: A crude drug with a spectrum of underappreciated toxicity. Pediatrics 1984; 73:455-8.  As a special article published in Pediatrics, it called needed attention to the problems associated with marijuana use by adolescents.


18.  Schwartz RH, Rodriguez WJ, Grundfast KM. Duration of middle ear effusion after acute otitis media. Pediatr Infect Dis J   1984; 3:204-7.   Plotted out time to disappearance of middle ear effusion (without antibiotic treatment) after bout of AOM.  Took as much as 90 days for some effusions to resolve.


19.  Shulman ST, Amren DP, Bisno AL, Dajani AS, Durack DT, Gerber MA, Kaplan EL, Millard HD, Sanders WE, Schwartz RH.  Prevention of bacterial endocarditis: A statement for health professionals by the Committee on Rheumatic Fever and Bacterial Endocarditis of the Council on Cardiovascular Diseases in the Young.  American Heart Association. Am J Dis Child 1985; 139:232-5.  AHA Periodic guideline on management of Strep Throat and bacterial endocarditis. 


20.  Shprintzen RJ, Schwartz RH, Daniller A, Hoch L.  The morphologic significance of bifid uvula. Pediatrics.  1985; 75:553-61.  Series of 24 children in primary care practice with bifid uvula, including the mildest uvual notching, and confirmed (by nasopharyngoscopy) occult submucus cleft in more than 70%.  Published in Pediatrics.


21.  Schwartz RH, Hawks RL. Laboratory detection of marijuana use. JAMA 1985; 254:785-92. Co-author recognized as national expert in laboratory drug detection.  Published in JAMA.


22.  Schwartz RH, Cohen PR, Bair GO. Identifying and coping with a drug-using adolescent: Some guidelines for pediatricians and parents. Pediatr in Rev 1985; 7:133-9. A useful guide to help manage and direct treatment for an adolescent drug user.


23.  Schwartz RH, Hayden GF, Getson PR, DiPaola A. Drinking patterns and social consequences: A study of middle-class adolescents in two private pediatric practices. Pediatrics  1986; 77:139-43.  Published in Pediatrics: explains drinking habits of middle class adolescents in Vienna and Reston Virginia.


24.  Schwartz RH, Hayden GF, Wientzen R. Children less than three years old with pharyngitis  Are group A streptococci really that uncommon?   Clin Pediatr 1986; 25:185-8.  Refutes the oft-quoted truth that it is unnecessary to search for group A strep in young children.


25.  Schwartz RH, Hayden GF. Marijuana use among middle-class adolescents.  South Med J 1986; 79:927-30.  Not really as harmless for young adolescents.


26.  Barriga F, Schwartz RH, Hayden GF. Adequate illumination for otoscopy: Variations due to power source, bulb, and head and speculum design.  Am J Dis Child 1986; 140:1327-40.  The only study about maintenance of office otoscope. 


27.  Schwartz RH, Rodriguez WJ, Hayden GF, et al. The re-evaluation visit for acute otitis media.J Fam Pract.  1987; 24:145-8.  Evidence that routine 10-14 day re-evaluation visit after episode of AOM is without value. 


28.  Schwartz RH, Willette RE, Hayden GF, et al: Urinary cannabinoids in monitoring abstinence in a drug abuse treatment program.  Arch Path Lab Med 1987;111:708-11. Refutes the oft-repeated statement that THC will be detectable in urine specimen for 30-days after last use.  True, in about 20% of daily pot-smokers. Majority will have detectable levels of THC for perhaps 4-5 days for daily pot smokers and only 2-3 days for occasional pot smoking.


29.  Schwartz RH, Comerci GD, Meeks JE: LSD: Patterns of use by chemically-dependent adolescents.J Pediatr 1987; 111:936-41. One of only studies of large number of LSD users in an adolescent treatment center.


30.  Schwartz RH, Bogema S: Ingestion of megadoses of ascorbic acid will not produce “clean” urine from marijuana smokers.   Archiv Path Lab Med 1988 112:769(Le).


31.  Schwartz RH, Cohen P Hoffmann NG, Meeks JE: Self-harm behaviors (carving) in female adolescent drug abusers. Clin Pediatr 1989;28:340-346.  Data from large group of female substance abusers who carve their arms (or legs).


32.  Schwartz RH. Heavy marijuana use and recent memory impair­ment.   Psychiat Annals 1991; 21:80-82.  Based on published study of frequent marijuana users in treatment setting. Battery of neuropsychiatric tests given a few days after admission to the treatment program and repeated several weeks later.  Significant auditory and visual short term memory impairment


33.  Banks BA, Silverman RA, Schwartz RH, Tunnessen WW: Attitudes of teenagers toward sun exposure and sunscreen use. Pediatrics. 1992; 89:40-2.  Warning about teens ignoring advice about sunscreen use and avoidance of tanning parlors.


34.  Schwartz, RH: Prohibition, 1920-1933: An overview of its effects on public health and the economy. South Med J. 1992;85:397-402.  Honest and factual account of the good and bad of US prohibition. 


35.  Schwartz RH, Beveridge RA: Marijuana as an antiemetic drug?      How useful is it today? Opinions from clinical oncologists.  J Addict Med. 1994; 13:53-65.  Refutes the “usefulness” of smoked THC as an effective, harmless antiemetic.


36.  Schwartz RH, Voth EA: Marijuana as medicine: Making a silk purse out of a sow's ear. J Addict Med. 1995; 14:15-21.  Marijuana as medicine is maybe 20% science and 80% propaganda.


37.  Dappen A, Schwartz RH, O'Donnell R: A survey of adolescent smoking patterns. JABFP (J of Amer Board of Fam Pract). 1996;9:7-13.  Study done in the mornings at two Fairfax County High Schools (permission obtained from FCSS).  Measured exhaled carbon Monoxide by special instrument and measured saliva cotinine.  Heavy smokers had lasting CO in exhaled breath.


38.  Schwartz RH, Little DL: Let's party tonight: Drinking patterns and breath alcohol values at high school parties.    Family Practice. 1997; 29:326-31.  Breath alcohol measured at party entry and departure by senior high school cheerleader.


39.  Bisno AL, Gerber MA, Gwaltney JM, Kaplan EL, Schwartz RH:  Diagnosis and Management of group A strep­tococcal pharyngi­tis: Diagnosis and Management: A practice guideline. Clin Infect Dis. 1997;25:574-83.  Another Guideline by IDSA.


40.  Schwartz RH: MDMA (Ecstasy) and the Rave: A review. Pediat­rics.  1997; 100:705-8.


41.  Schwartz RH, Weaver AB: Rohypnol, The date rape drug.    Clinical Pediatr. 1998:37;321. Describes the effects of date rape drug, Rohypnol.


42.  Schwartz RH, Milteer R, Sheridan MJ, Horner CP. Beach week: A  high school graduation rite of passage for sun, sand, suds, and sex. Arch Pediatr Adol Med 1999; 153:180-3.  Tells it all, by “observer” teen ager who tested breath alcohol levels at actual parties.  Teens got paid about $20.00 for anonymous participation.


43.  Schwartz RH. Enhancing children’s satisfaction with antibiotic therapy: A taste study of several antibiotic suspensions. Current Therapeut Res 2000;61:570-81.  Chocolate syrup was best flavor disguiser and clindamycin was the most difficult to disguise.


44.  Schwartz RH, Bahadori R. Examining the eardrum of infants with Down syndrome.  Infect Dis in Children  2002:15:8.  Explains in detain this difficult procedure.


45.  Schwartz RH, Freedy AS, Sheridan MJ. Selective mutism: Are primary care physicians missing the silence? Clin Pediatrics 2006; 45:43-48.  Study of a not uncommon anxiety disorder.


46.  Schwartz RH, Guthrie KL. GERD: Lessons my new grandchild taught me. Infect Dis Child 2006;19:   Real and practical article on GERD effect on expanded family.


47.  Martin MS, Schwartz RH. Tackling Ankyloglossia in the office.  Contemporary Pediatr  2008;25:59-64.  One of first articles on sublingual ankyloglossia, diagnosis and treatment, directed at primary care pediatricians.


48.  Pappas DE, Hendley JO, Schwartz RH: Respiratory viral RNA on toys in pediatric office waiting rooms.  Pediatr Infect Dis J   2010;29:102-104.  In a working primary care pediatric office, only one RSV viral isolate and very few Rhinovirus isolates were recovered from large container of fluffy toys and dollar store dinosaurs.


49.  Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Schwartz RH et al.  Clinical Practice Guideline: Tonsillectomy in Children.  Otolaryngol Head Neck Surg 2011; 144: S1.  Guideline from American Academy of Otolaryngology and AAP.


50.  Shaikh N, Hoberman A, Kaleida PH, Schwartz RH. Otoscopic signs of otitis media. Pediatr Infect Dis Jour 2011; 30:822-26.  Study using photos of pneumatic otoscope views through cineotoscope.


51.  Schwartz RH, Badalyan V, Bahadori RS.  Neonatal pre-auricular pits/sinuses: Survey of management strategies by pediatric otolaryngologists.  Open Journal of Pediatrics 2012; 2:181-85.  This article was instrumental in stopping the requirement for follow-up brain stem evoked potential audiograms at yearly intervals for neonates born with isolated unilateral or bilateral pre-auricular pit/sinus.


52.  Lieberthal AS, Carroll AE, Chonmaitree T, Schwartz RH.  Diagnosis and Management of Acute Otitis Media: Pediatrics 2013; 131:e964-999.  The new 2013 AAP Guideline for diagnosis and treatment of AOM.


53.  Minosh C, Schwartz RH, Badalyan V.   Hypnosis in 53 Children with Anxiety Disorders, Nocturnal Enuresis, or Insomnia.  Internat J Clin Pediatr  2013; 2:61-67.  One of very few long-term follow up studies of effectiveness of clinical hypnosis for children with anxiety problems or nocturnal enuresis. 


54.  Halegoua J, Schwartz RH.  Vision photoscreening of infants and young children in a primary care office: Can it identify asymptomatic treatable amblyopic risk factors.  Clin Pediatr  2015; 54: 33-39.  This study was unique in that it was done in working primary care pediatric offices and we linked the SPOT photoscreener with diagnosis of pediatric ophthalmologist.


55.  Brenton JN, Schwartz RH, Madoo L.  Anti-NMDA Receptor Encephalitis, A review. Contemporary Pediatrics 2015.  Published in primary care pediatric journal and excellent review of literature with 400 cases of NMDAR encephalitis in children.


56. Schwartz RH, Kim D, Martin M, MD, Pichichero  ME.  Is it okay to return to school the day after strep throat treatment.  Pediatr Infect Dis J    2015; 34:1302-1304.