bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coagulase-Negative Staphylococcal Bacteremia Among Very Low Birth Weight Infants: Relation to Admission Illness Severity, Resource Use, and Outcome
Authors: Gray James E. , Richardson Douglas K. , McCormick Marie C. , Goldmann Donald A. 
Published: December 2021

Objective. To examine the impact of admission-day illness severity on nosocomial bacteremia risk after consideration of traditional risk determinants such as birth weight and length of stay.
Methods. The hospital courses for 302 consecutive very low birth weight (less than 1500 g) infants admitted to two neonatal intensive care units were examined for the occurrence of nosocomial coagulase-negative staphylococcal bacteremia. Using both cumulative incidence and incidence density as measures of bacteremia risk, we explored the relation between illness severity (as measured by the Score for Neonatal Acute Physiology [SNAP]) and bacteremia both before and after birth weight adjustment. In addition, the effect of bacteremia on hospital resource use was estimated.
Results. Coagulase-negative staphylococcus was the most common pathogen noted in blood cultures drawn at 48 hours after admission or later. It was isolated on at least one occasion in 53 patients (cumulative incidence of 17.5 first episodes per 100 patients). These episodes occurred during 7652 days at risk, giving an incidence density of 6.9 initial bacteremias per 1000 patient-days at risk. As expected, when compared with the nonbacteremic group, bacteremic patients were of lower birth weight (888 ± 231 vs 1127 ± 258 g; P &lt; .01) and gestational age (26.4 ± 2.1 vs 28.9 ± 2.8 weeks; P &lt; .01). In addition, these patients were more severely ill on admission (SNAP 17.3 ± 6.5 vs 12.2 ± 5.8; P &lt; .01). Even after birth weight stratification, the risk of bacteremia by both measures increased with higher SNAP scores. For example, among infants with birth weights greater than 1 kg, 25% of the most severely ill patients (SNAP 20 and higher) experienced at least one bacteremic episode, whereas the rates seen in infants with intermediate (SNAP 10 to 19) and low illness severity (SNAP 0 to 9) were 8.6% and 3.0%, respectively (χ2 for trend = 7.25; P &lt; .01). Multivariate linear regression showed that bacteremia was associated with a prolongation of neonatal intensive care unit stay of 14.0 ± 4.0 days (P &lt; .01) and an increase in hospital charges of $25 090 ± 12 051 (P &lt; .05), even after adjustment for birth weight and admission-day SNAP.
Conclusions. Nosocomial coagulase-negative bacteremia is an important complication among very low birth weight infants. Assessment of illness severity with SNAP provides information regarding nosocomial infection risk beyond that available from birth weight alone.
Financing of Substance Abuse Treatment for Children and Adolescents
Authors:   Committee on Child Health Financing,   Committee on Substance Abuse
Published: December 2021

The American Academy of Pediatrics (AAP) recognizes the impact of substance abuse on society and particularly on infants, children, and adolescents. Policy statements and a manual published by the AAP have recently discussed the role of the pediatrician in the management of substance abuse,1,2 the identification and treatment of drug-exposed infants,3 and generic guidelines for the selection of substance abuse treatment facilities.4 Inadequate financing, however, remains a very significant impediment to the implementation of AAP policy and often has grave implications for families and children.
PROBLEMS IN FINANCING SERVICES FOR SUBSTANCE ABUSE
Private and public financing of chronic disease services, including those involved with substance abuse services are conflicting, confusing, and inadequate for children and adolescents. The following four main problems occur: 1) many children and adolescents, even if they are well-insured for other medical services, lack coverage for substance abuse services; 2) even when substance abuse coverage exists, copayments and deductibles make access difficult; 3) reimbursement often partially covers treatment but not prevention; and 4) services are not continuous or coordinated because of financing difficulties.
Patients are often treated for substance abuse in inpatient settings unnecessarily because of the limitations of financial coverage for outpatient substance abuse services.5 These limitations increase patient reliance on public financing. The provision of comprehensive services, including anticipatory guidance and prevention, risk assessment, early diagnostic evaluation, treatment, and follow-up care, is seldom consistent or continuous. As a result, health care providers are frequently pressured into recommending inappropriate levels of care based on third-party payer reimbursement considerations rather than on medical and psychosocial assessment and needs.
In-Hospital Mortality for Surgical Repair of Congenital Heart Defects: Preliminary Observations of Variation by Hospital Caseload
Authors: Jenkins Kathy J. , Newburger Jane W. , Lock James E. , Davis Roger B. , Coffman Gerald A. , Iezzoni Lisa I. 
Published: December 2021

Objective. To examine the impact of hospital caseload on in-hospital mortality for pediatric congenital heart surgery.
Design. Population-based, retrospective cohort study.
Setting. Acute care hospitals in California and Massachusetts.
Patients. Children undergoing surgery for congenital heart disease, identified by the presence of procedure codes indicating surgical repair of a congenital heart defect in computerized statewide hospital discharge abstract databases. Cases were grouped into four categories based on the complexity of the procedure.
Main outcome measures. Adjusted odds ratios (OR) for in-hospital death were estimated using generalized estimating equations that account for the intra-institutional correlation among patients.
Results. A total of 2833 cases at 37 centers were identified. Compared with centers performing &gt;300 cases per year, after controlling for patient characteristics, centers performing &lt;10 cases per year had an OR for in-hospital death of 7.7 (95% confidence interval (CI) [1.6-37.8]); 10 to 100 cases, OR = 2.9 (95% CI [1.6-5.3]); 101 to 300 cases, OR = 3.0 (95% CI [1.8-4.9]). Independent risk factors for mortality included procedure complexity category (P &lt; .0001), use of cardiopulmonary bypass (P &lt; .0001), young age at surgery (P = .001), and transfer from another acute care hospital (P &lt; .0001). Few differences were found by hospital caseload in length of stay or total hospital charges.
Conclusions. For children with a congenital heart defect who underwent surgery in California in 1988 or Massachusetts in 1989, the risk of dying in-hospital was much lower if the surgery was performed at an institution performing &gt;300 cases annually. This study was limited by the absence of clinical detail in discharge abstract databases. If these findings are corroborated by other studies, health care delivery strategies that direct children requiring surgical correction of congenital heart defects to high-volume centers may substantially reduce overall mortality.
Health Supervision for Children With Achondroplasia
Authors:   Committee on Genetics
Published: December 2021

This set of guidelines is designed to assist the pediatrician in caring for children with achondroplasia confirmed by radiographs and physical features. Although pediatricians usually first see children with achondroplasia during infancy, occasionally they are called on to advise the pregnant woman who has been informed of the prenatal diagnosis of achondroplasia or asked to examine the newborn to help establish the diagnosis. Therefore, these guidelines offer advice for these situations as well.
Achondroplasia is the most common form of disproportionate short stature.1 The diagnosis is based on very specific features on the radiographs, which include a contracted base of the skull, a square shape to the pelvis with a small sacrosciatic notch, short pedicles of the vertebrae, rhizomelic (proximal) shortening of the long bones, trident hands, a normal length trunk, proximal femoral radiolucency, and, by mid-childhood, a characteristic chevron shape of the distal femoral epiphysis. Hypochondroplasia and thanatophoric dysplasia are part of the differential diagnosis, but achondroplasia can be distinguished from these because the changes in hypochondroplasia are milder and the changes in thanatophoric dysplasia are much more severe and invariably lethal. Achondroplasia is an autosomal dominant disorder, but approximately 75% of cases represent new dominant mutations. The gene for achondroplasia has recently been found. Achondroplasia is due to a change in the genetic information for fibroblast growth factor receptor 3.2,3 Almost all of the mutations have been found to occur in exactly the same spot. Now that the gene has been found and the mutation known, potential therapies and diagnostic methodologies are likely to be developed.
VASCULAR ENDOTHELIAL GROWTH FACTOR IN OCULAR FLUID OF PATIENTS WITH DIABETIC RETINOPATHY AND OTHER RETINAL DISORDERS
Authors: L. J. F. 
Published: December 2021

Background. Retinal ischemia induces intraocular neovascularization, which often leads to glaucoma, vitreous hemorrhage, and retinal detachment, presumably by stimulating the release of angiogenic molecules. Vascular endothelial growth factor (VEGF) is an endothelial-cell-specific angiogenic factor whose production is increased by hypoxia.
Conclusions. Our data suggest that VEGF plays a major part in mediating active intraocular neovascularization in patients with ischemic retinal diseases, such as diabetic retinopathy and retinal-vein occlusion.
DOES PROGRESS DEMAND THAT SCIENTISTS NOW PUT INTERNET ADDRESSES ON ALL COMMUNICATIONS?
Authors: L. J. F. 
Published: December 2021

Each of us eventually will have a unique Internet address. We owe it to ourselves and the science community to use it—as well as our mailing addresses, AIP codes, fax numbers, and phone numbers—on all correspondence, whether print or electronic. As far as "clutter" is concerned, most Internet addresses are brief enough— not much longer than an international telephone number.
...For starters, you can buy a rubber stamp or sticker to update your letterheads to include your street addresses, your phone and fax numbers, and your E-mail addresses.
THE ASSAULT ON TEACHING HOSPITALS
Authors: L. J. F. 
Published: December 2021

The quality of American health care—unarguably the best in the world—is under siege. Republicans released budget plans last week that would cut subsidies to teaching hospitals that train doctors and perform clinical research. Meanwhile, the private market, whose reform Congress bungled last year, has been doing the same. The two-pronged assault is alarming.
American physicians provide innovative, technically advanced care whose quality can be traced in part to generous subsidies for basic research that Congress has provided through the National Institutes for Health (NIH). The NIH estimates that the Senate budget plan could reduce these subsidies for non-AIDS research over the next seven years by as much as 25%; the cut is deeper if inflation is taken into account.
The proposed NIH cuts are easily identified and will be subject to public scrutiny. Two other threats are harder to spot.
The Federal Government, when reimbursing hospitals for treating Medicare patients, pays an average of 30% extra if treatment is provided in a teaching hospital. The extra payments cover costs associated with training doctors and translating basic research into clinical practice ... Under the GOP budgets, these payments could fall between 30 and 60%.
The other dagger aimed at teaching hospitals comes from the private sector. Private insurers have also paid more for patients treated in teaching hospitals. That practice is ending. Wielding new-found market power, health maintenance organizations and other managed-care groups are driving down hospital rates. They refuse to pay for training or research that does not directly benefit their enrollees.
REASSESSING THE THERAPEUTIC RANGE FOR THEOPHYLLINE ON LABORATORY REPORT FORMS: ANOTHER VIEWPOINT
Authors: Kamada Alan K. 
Published: December 2021

The therapeutic utility of theophylline and the recommended range for serum concentrations are debated in a series of three editorials by noted contributors in this area. In the first, it is pointed out that the role of theophylline has evolved into an "adjunctive" therapy for asthma and chronic obstructive pulmonary disease. Serum concentrations of 10 to 15 µg/mL do not sacrifice significant clinical benefit, whereas there is increased risk for adverse effects at higher concentrations. Changing laboratry report forms to designate a lower therapeutic range of 5 to 15 µg/mL for an increased margin of safety (with &gt;20 µg/mL continuing as the lower limit of the toxic range) is advocated and a stepwise approach for implementing this change is proposed.
The second paper supports the view that theophylline remains more important than a third- or fourth-line agent in the treatment of asthma, particularly in selected patients. A higher target serum concentration range of 10 to 15 µg/mL may be desirable in more severe asthmatics (requiring oral steroids despite treatment with inhaled steroid), those with nocturnal symptoms, acute exacerbations requiring hospitalization and mechanical ventilation, and in patients for whom this is a more economical or preferable therapy. In these patients a serum concentration of 5 µg/mL may be too low to achieve sufficient benefit. Designation of "10 to 15 µg/mL (5 to 20)" as the therapeutic range is suggested to emphasize the midrange as the target while indicating that levels between 5 and 20 µg/mL are acceptable, although not ideal from either an efficacy or safety standpoint.
In the third and final viewpoint presented, much data supporting the efficacy of theophylline in the treatment of chronic asthma and its relationship to serum concentrations are presented. Evidence for potential anti-inflammatory effects of theophylline is also reviewed. Severe toxicity, a rare event, is noted to be not a result of serum concentrations slightly above the therapeutic range, but from massive overdosage and/or drug interactions or concomitant illnesses that alter elimination of the drug. No changes in the recommended therapeutic range of theopylline, which might alter its effectiveness, are proposed. Rather, more careful use and monitoring through education of prescribers is advocated.
Letters to the Editor
Authors: Wissow Lawrence S. , Roter Debra 
Published: December 2021

Drs Nelson, Trumbull, Ravenel, and Larson raise important issues in the debate over the use of corporal punishment. They ask if sufficient justification exists to propose that parents abstain from corporal punishment, and suggest that the debate requires careful use of terminology and agreement on the outcomes to be studied. We agree with the need for a careful, dispassionate reading of the literature.
Dr Nelson suggests that experts in the field of child behavior do not support avoidance of corporal punishment.
Special Needs of Vulnerable and Underserved Populations: Models, Existing and Proposed, to Meet Them
Authors: Shirley Aaron 
Published: December 2021

The rapidly changing environment in the health care industry offers great challenges, especially to those providers who traditionally have cared for vulnerable and underserved populations. These populations have special health care needs resulting from various factors, including race, geography, environment, and lack of access.
Some promising existing publicly funded models serve these populations well. Partnerships between these programs and private practitioners would be mutually beneficial to the practices and improve access to care.
Effectiveness of Individualized Developmental Care for Low-Risk Preterm Infants: Behavioral and Electrophysiologic Evidence
Authors: Buehler Deborah M. , Als Heidelise , Duffy Frank H. , McAnulty Gloria B. , Liederman Jacqueline 
Published: December 2021

Objective. We assessed the effectiveness of individualized developmental support in the special care nursery for low-risk preterm infants.
Setting. A university-affiliated teaching hospital.
Participants. Twelve healthy full-term infants, and 24 low-risk preterm infants randomly assigned to a control or an experimental group.
Design. The preterm control group received standard care and the preterm experimental group received individualized developmental care at the same special care nursery.
Outcome Measures. Medical, behavioral (Assessment of Preterm Infants' Behavior and Prechtl's Neurological Examination of the Full-Term Newborn Infant), and electrophysiologic outcome (using quantitative electroencephalography with topographic mapping) of all three groups was assessed 2 weeks after the expected due date.
Results. No between-or among-group medical differences were seen for this low-risk, healthy sample. The preterm experimental group showed behavioral and electrophysiologic performances comparable to those of the full-term group, whereas the preterm control group performed significantly less well. Behavioral measures suggested significantly poorer attentional functioning for the preterm control group. Electrophysiologic results implicated the frontal lobe.
Conclusions. Individualized developmental intervention supports neurobehavioral functioning as measured at 2 weeks post-term. It appears to prevent frontal lobe and attentional difficulties in the newborn period, the possible causes of behavioral and scholastic disabilities often seen in low-risk preterm infants at later ages.
Discontinuation of Antiepileptic Drug Treatment After Two Seizure-free Years in Children With Cerebral Palsy
Authors: Delgado Mauricio R. , Riela Anthony R. , Mills Janith , Pitt Alan , Browne Richard 
Published: December 2021

Objective. The risk of seizure relapse after antiepileptic drug (AED) discontinuation in children has been reported to vary between 6% and 40%. It has been suggested that neurologic deficit and mental retardation are poor prognostic factors for seizure relapse after AED discontinuation. Because epileptic children with cerebral palsy (CP) have neurologic deficits, and many have mental retardation, it is important to know their risk for seizure relapse.
Methods. AED treatment was discontinued in 65 children with CP and histories of epilepsy after 2 seizure-free years. All of the patients were followed until they had seizure relapses or for at least 2 years without seizures after AEDs were stopped. Multiple factors were analyzed for possible association with seizure relapse.
Results. Twenty-seven patients (41.5%) had seizure relapses. Patients with spastic hemiparesis had the highest relapse rate (61.5%), and those with spastic diplegia had the lowest rate (14.3%). No other factor correlated significantly with the risk of seizure relapse.
Conclusions. Discontinuation of AEDs in children with CP can, and should, be practiced when possible after patients have been seizure-free for at least 2 years. AED discontinuation in patients with spastic hemiparesis is significantly more likely to lead to seizure relapse than in patients with other CP types, but no other factor is yet known to increase the chance of relapse.
Salivary Testosterone Levels in Male Adolescents With Cystic Fibrosis
Authors: Boas Steven R. , Cleary Deborah A. , Lee Peter A. , Orenstein David M. 
Published: December 2021

Purpose. Salivary testosterone concentrations have been used for monitoring testosterone levels in male adolescents and have been found to correlate closely with serum values. Data are lacking on such measurements in male adolescents with cystic fibrosis (CF), in which salivary gland abnormalities are commonly seen. Delayed sexual maturation occurs in many patients with CF, particularly those with severe disease. We examined the usefulness of salivary testosterone collection and measurement in male adolescents with CF.
Methods. Forty boys with CF and 35 healthy control boys participated in the study. All boys were Tanner staged and had serum and salivary testosterone concentrations measured. Testosterone assays were performed using standard radioimmunoassay techniques.
Results. The boys with CF were slightly older, lighter in body weight, and shorter. Serum and salivary testosterone concentrations were lower in the CF group than in the control group. A significant correlation was found between serum and salivary testosterone levels for boys with CF (r = .84) and for the control boys (r .86). Mean salivary testosterone increased as age progressed and as Tanner stage advanced.
Conclusions. These results demonstrate that salivary testosterone measurements correlate well with serum values in male adolescents with CF and can be used in the monitoring of pubertal status.
Faculty Development of Pediatric Practitioners: Complexities in Teaching Clinical Precepting
Authors: Roberts Kenneth B. , DeWitt Thomas G. 
Published: December 2021

Community physicians should be ideal role model preceptors for residents to learn office-based primary care. These physicians are the specialists at what they do, just as the organ-based subspecialists are the experts in their field. The faculty development course we developed considered the knowledge, skills, and attitudes necessary for clinical preceptors and attempted to address potential difficulties, such as reservations practitioners might have about accepting the role.
It should be axiomatic that once the objectives are defined and are recognized to involve skills and attitudes as well as knowledge, lectures alone (although time-efficient) will not suffice: they are unlikely to change behavior. The key is practice over time, with supervision and reinforcement by respected "experts" and peers.
Faculty development for clinical precepting is complex, because clinical precepting, particularly in pediatrics, is complex. Attention to relationships and feelings (anxiety, discomfort, stress) should be built in, along with efforts to improve knowledge and skills.
Psychosocial Problems in Refugee Children Exposed to War
Authors: McCloskey Laura Ann , Southwick Karen 
Published: December 2021

At any one time there are about two dozen armed conflicts throughout the world. It has been estimated that during 1993 alone violent upheavals generated about 16 million refugees worldwide. The United States has received a significant refugee population from war zones. The two largest groups of refugees entering the country since 1975 were from Southeast Asia (about 820 000) and Central America (between 800 000 and 1 900 000). Although exact statistics are unavailable, it appears that as many as half of the Central American immigrants were children.
Various studies have documented common physical health problems in refugee children entering North America. Inactive tuberculosis and hepatitis are prevalent health risks for Southeast Asian youth; intestinal parasites and respiratory tract infections (eg, otitis media) are widespread in both Southeast Asian and Latin American refugee children. Histories of malnutrition and incomplete immunizations are common.
Although physicians are well-equipped to treat the range of physical ailments of refugee children, some of the most serious symptoms are likely to be psychological. Recovery from physical deprivation appears to be more rapid and complete than recovery from emotional trauma and loss. The symptoms of posttraumatic stress disorder (PTSD), described below (Table 1), can be disabling and persistent and are often undetected by adult caretakers. Other psychological problems resulting from war-induced trauma and displacement, as well as immigration and chronic poverty, place refugee children at heightened risk.
Pediatricians are typically the first and often the only contact these mothers and children have with any form of health care or social service.