bluuebunny/crossref_metadata_2025_split huggingface dataset:
PSYCHOGENIC MEGACOLON MANIFESTED BY FECAL SOILING
Authors: GARRARD STERLING D. , RICHMOND JULIUS B. 
Published: December 2021

The results of surgical therapy in cases of aganglionic megacolon have tended to create the impression that all cases of megacolon can be benefited by surgery. The authors have described six patients in whom megacolon had a psychogenic origin; this group has been previously described as "functional" or "idiopathic," and its psychogenic origin has not been clearly recognized. Psychogenic megacolon may be diagnosed by the following clinical findings without the necessity of a detailed psychiatric history: admitting complaint of fecal soiling, onset in the second year of life or later, infrequent use of the toilet for defecation, defecation in the standing or supine position, inhibition of the stool, periodic voluminous stools, absence of episodes of intestinal obstruction, a feces-packed rectum, absence of a spastic segment of rectum or rectosigmoid using Neuhauser's fluoroscopic technic and a relatively benign course insofar as physical status is concerned.
A sharp clinical distinction is apparent when the following findings of the aganglionic group are considered: admitting complaint of constipation without fecal soiling, onset at birth or in the first few weeks of life, use of the toilet for defecation, defecation in the sitting position, pellet-like or ribbon-like stools, frequent episodes of intestinal obstruction, an empty rectum, and the presence of a spastic segment of rectum or rectosigmoid using Neuhauser's fluoroscopic technic.
A small additional group of cases has been described by others in which megacolon is due to anatomic obstruction; these cases can usually be diagnosed by digital examination of the rectum.
The authors have classified the symptom of megacolon into three groups and have given them the following generic designations: psychogenic, neurogenic and anatomic. Only the neurogenic and anatomic groups are benefited by surgery.
Less Aggressive Treatment of Neonatal Jaundice and Reports of Kernicterus: Lessons About Practice Guidelines
Authors: Newman Thomas B. , Maisels M. Jeffrey 
Published: December 2021

The publication of guidelines calling for less aggressive treatment of jaundice in newborns has been followed by a reappearance of case reports of kernicterus. These case reports illustrate important issues for writers and consumers of practice guidelines. One issue is the particular salience of identified patients with bad outcomes, and their potentially disproportionate influence on decision-makers. A second issue is whether, when good evidence of treatment benefit is lacking, policymakers should recommend what has traditionally been done, recommend less treatment, or not make recommendations at all. Finally, the cases raise the question of whether treatment guidelines should be more conservative than their authors actually believe is necessary, to take into account the likelihood that they will not be closely followed.We believe that case reports can serve as an important early warning system, but policymakers should be aware of their potentially disproportionate influence. In the long run, patients and clinicians will be best served by guidelines that summarize and acknowledge the limitations of existing evidence, that allow a wide range of treatment options when evidence is weak, and that recommend what the guideline authors actually believe should be done. In the short run a period of readjustment may be required, however, as clinicians become accustomed to guidelines written to be followed, rather than bent.neonatal jaundice, bilirubin, kernicterus, practice guidelines.
Inadequate Therapy for Asthma Among Children in the United States
Authors: Halterman Jill S. , Aligne C. Andrew , Auinger Peggy , McBride John T. , Szilagyi Peter G. 
Published: December 2021

Objective.
Childhood asthma morbidity and mortality are increasing despite improvements in asthma therapy. We hypothesized that a substantial number of children with moderate to severe asthma are not taking the maintenance medications recommended by national guidelines. The objective of this study was to describe medication use among US children with asthma and determine risk factors for inadequate therapy.

Methods.
The National Health and Nutrition Examination Survey (NHANES) III 1988–1994 provided cross-sectional, parent-reported data for children 2 months to 16 years of age. Analysis focused on children with moderate to severe asthma (defined as having any hospitalization for wheezing, ≥2 acute visits for wheezing, or ≥3 episodes of wheezing over the past year). We defined these children as adequately treated if they had taken a maintenance medication (inhaled corticosteroid, cromolyn, or theophylline) during the past month. Demographic variables were analyzed for independent associations with inadequacy of therapy. The statistical analysis used SUDAAN software to account for the complex sampling design.

Results.
A total of 1025 children (9.4%) had physician-diagnosed asthma. Of those with moderate to severe asthma (n = 524), only 26% had taken a maintenance medication during the past month. Even among children with 2 or more hospitalizations over the previous year, only 32% had taken maintenance medications. In a logistic regression analysis, factors significantly associated with inadequate therapy included: age ≤5 years, Medicaid insurance, and Spanish language. Children surveyed after 1991, when national guidelines for asthma management became available, were no more likely to have taken maintenance medications than children surveyed before 1991.

Conclusion.
Most children with moderate to severe asthma in this nationally representative sample, including those with multiple hospitalizations, did not receive adequate asthma therapy. These children may incur avoidable morbidity. Young children, poor children, and children from Spanish-speaking families appear to be at particularly high risk for inadequate therapy.
Reducing After-Hours Referrals by an After-Hours Call Center With Second-Level Physician Triage
Authors: Kempe Allison , Dempsey Catherine , Hegarty Teresa , Frei Nicole , Chandramouli Vijayalaxani , Poole Steven R. 
Published: December 2021

Objectives.One-third of practices signing-out to The Children's Hospital Call Center in Denver, Colorado, choose to do second-level physician (SLP) triage for calls judged by the Center to require after-hours referral (AHR). We examined: 1) the effect of SLP triage on the rate of AHRs and 2) reasons for physicians' decisions.Design.From January 1998 to August 1998 all calls from patients using a 5-member suburban pediatric practice judged by the Call Center to require AHR were referred to the practice's on-call physician who did SLP triage and completed a questionnaire.Results.There were 955 eligible calls, 22% (N = 216) of which were initially given an urgent disposition by Call Center nurses. Physician questionnaires were completed for 97% (N = 209). Of patients initially triaged for AHR, 49% (N = 103) were subsequently given an AHR, 17% (N = 35) a next day office referral, and 34% (N = 71) home care and advice. Reasons for not urgently referring included the following: 1) medical problem didn't require urgent evaluation (95%,N = 99); 2) change in the patient's condition; (40% N = 43); 3) prior knowledge of family's ability to evaluate and care for the patient (40%,N = 43); and 4) knowledge of the patient's medical history (18%, N = 19). After SLP triage the overall urgent referral rate was 11%.Conclusions.Signing out to a Call Center decreased physicians' after-hours calls by 77% and SLP triage halved the number of urgent after-hours referrals.
Self-Reported Physician Practices for Children With Asthma: Are National Guidelines Followed?
Authors: Finkelstein Jonathan A. , Lozano Paula , Shulruff Reeva , Inui Thomas S. , Soumerai Stephen B. , Ng Mitzi , Weiss Kevin B. 
Published: December 2021

Objective.To determine self-reported adherence to national asthma guidelines for children by primary care physicians in managed care; and, to analyze sources of variation in these practices by physician specialty and managed care practice type.Design.A survey of 671 primary care physicians (pediatricians and family physicians) practicing in 3 geographically diverse managed care organizations (MCO). Domains of interest included asthma diagnosis, pharmacotherapy, patient education and follow-up, and indications for specialty referral. Item formats included self-reports of usual practice and responses to case vignettes.Results.A total of 429 (64%) physicians returned surveys, 22 of whom did not meet criteria for inclusion in the analysis. Most respondents had both heard of (91%) and read (72%) the National Asthma Education and Prevention Program (NAEPP) guidelines. For diagnosis, 75% reported routine use of office peak flow measurement, but only 21% used spirometry routinely. Family physicians were more likely than pediatricians to use spirometry in diagnosis (odds ratio [OR] = 5.9), and less likely to recommend daily peak flow measurement (OR = .3). The median reported frequency of providing written care plans was only 50%. Though inhaled corticosteroids were deemed very safe or safe by 93%, almost half had specific concerns regarding at least 1 side effect, most commonly growth delay. Primary care physicians' criteria for referral to an asthma specialist differed from those of the NAEPP panel in choosing to manage more severe patients without asthma specialist input. Family physicians were more likely than pediatricians to refer a child after a single hospitalization, 2 to 3 emergency department visits, after 2 exacerbations, or if the child was &lt;3 years old and required daily medications. Responses to vignettes showed generally appropriate initial use of antiinflammatory agents, but reluctance to increase the dose in response to continued symptoms, and less frequent follow-up than recommended by the NAEPP.Conclusion.Most physicians for children report having read and adopted NAEPP guideline recommendations for asthma treatment, including generally appropriate use of medications. Opportunities for improvement exist in specific areas such as the use of written care plans, optimizing antiinflammatory dosing, and providing routine follow-up. Although physicians show evidence of awareness of national guidelines and knowledge consistent with much of their content, additional work is required to promote the use of self-management tools in practice.
Evaluation and Development of Potentially Better Practices for Improving Family-Centered Care in Neonatal Intensive Care Units
Authors: Saunders Roger P. , Abraham Marie R. , Crosby Mary Jo , Thomas Karen , Edwards William H. 
Published: December 2021

Objective. Technological and scientific advances have progressively decreased neonatal morbidity and mortality. Less attention has been given to meeting the psychosocial needs of the infant and family than on meeting the infant’s physical needs. Parents’ participation in making decisions and caring for their child has often been limited. Environments designed for efficient technological care may not be optimal for nurturing the growth and development of sick neonates or their families. Eleven centers collaborating on quality improvement tried to make the care of families better by focusing on understanding and improving family-centered care.
Methods. Through internal process analysis, review of the evidence, collaborative learning, and benchmarking site visits to centers of excellence in family-centered care, a list of potentially better practices was developed. Choice of which practices to implement and methods of implementation were center specific. Improvement goals were in 3 areas: parent-reported outcomes, staff beliefs and practices, and clinical outcomes in length of stay and feeding practices. Measurement tools for the first 2 areas were developed and pilots were conducted.
Results. Length of stay and feeding outcomes were not different before the collaboration (1998) and at the formal end of the collaboration (2000).
Conclusions. Prospective parent-reported outcomes are being collected, and the staff beliefs and practices questionnaire will be repeated in all centers to determine the impact of the project in those areas.
EXSTROPHY OF THE CLOACA
Authors: SWAN HENRY , CHRISTENSEN SCOTT P. 
Published: December 2021

Three newborn premature infants were seen with an unusual and extensive congenital abnormality involving bowel, urogenital tract, bony pelvis and anterior abdominal wall.
The term exstrophy of the cloaca is suggested as a simple term for a complex situation.
The embryologic development of this anomaly is discussed. Any satisfactory explanation must explain interposition of cecum between a bipartate bladder. It is possible that current theories regarding the development of the cloaca must be revised in the light of these observations.
A plan for the surgical correction of this anomaly is presented.
TOOLS AND METHODS OF DIAGNOSIS AND NEW TRENDS IN THE TREATMENT OF ENDOCRINE DISORDERS
Authors: WILKINS LAWSON 
Published: December 2021

I FEEL very proud but most humble on receiving the honor of the Borden Award. My humility arises from the fact that whatever has been accomplished has been due to the painstaking and hard work of a series of faithful collaborators over a period of 18 years. Drs. Walter Fleischmann, Roger Lewis, Lytt Gardner, Claude Migeon, Alfred Bongiovanni and Walter Eberlein have carried out the laboratory studies, while Drs. Robert Klein, John F. Crigler, Jr., Samuel Silverman, George Clayton, Judson Van Wyk and Melvin Grumbach have directed clinical investigations. Visiting Fellows such as Salvador de Majo, Eugenia Rosemberg and José Cara have contributed materially. I gratefully share the honor with all these colleagues. The check, I shall keep myself.
I shall seize the singular opportunity of the occasion to discuss the newer tools and methods which have made possible the advances of clinical endocrinology, and to point out new therapeutic approaches rather than to give a factual presentation of our own work.
In 1935 when Dr. Park asked me to organize a pediatric endocrine clinic, I hesitated because I felt that at least some clinical endocrinologists were perhaps somewhat overenthusiastic and uncritical, and seemed inclined to let their imaginations run wild. During the previous century great clinical masters had given to the main endocrine disorders classical descriptions which will never be surpassed. One may mention Graves' and Basedow's descriptions of thyrotoxicosis in 1834 and 1840, Addison's of adrenal insufficiency (1854), Gull's of adult myxedema (1873), Osler's of sporadic cretinism (1893), Pierre Marie's of acromegaly (1886) and Froehlich's of the hypothalamic syndrome (1901). It was obvious that less complete forms of these and other endocrine disorders must exist.
TRENDS
Authors: KENDALL NORMAN , ROSE ELIZABETH KIRK 
Published: December 2021

THE continued high neonatal mortality rate, especially of premature infants, is still considered excessive and presents a challenge to the medical profession. Further detailed analysis of the causes and contributory factors of neonatal deaths is necessary prior to further reduction of the neonatal mortality rate. The following presents an outline of the organization and procedures employed in the study of neonatal mortality. It is based on the approach used by the Philadelphia Neonatal Study Committee.
Background
The separate study of neonatal deaths was an outgrowth of an initial attempt some 20 years ago to determine the facts and preventable factors in maternal deaths. Both studies were inaugurated by a group of broad-minded physicians through the Philadelphia County Medical Society and were based on the premise that such studies offered an educational program for the physicians.
Organizationion
The Neonatal Study Committee consists of a representative from each hospital, preferably a member of the department of pediatrics. This representative reviews the final neonatal mortality data from his hospital, brings cases before meetings of the hospital staff for discussion, completes the special study form data, including autopsy findings and staff opinion on each case and forwards it to the Committee for further evaluation.
FURTHER OBSERVATIONS ON FAMILIAL DYSAUTONOMIA
Authors: RILEY CONRAD M. , FREEDMAN ALFRED M. , LANGFORD WILLIAM S. 
Published: December 2021

Studies of familial dysautonomia by a team made up of a pediatrician, a neurologist, speech therapists, psychiatrists, psychologists and a psychiatric social worker have been presented in summary form.
1. Facts supporting the theory that this is a condition of genetic origin are enumerated. They are compatible with its being transmitted by an autosomal recessive gene.
2. Evidence of disturbance of statural growth, with frequent significant dwarfing, is presented.
3. Postural hypotension as a regular part of the syndrome is demonstrated.
4. Data showing the variable neurological abnormalities are included.
5. The frequency of disturbance of speech, but not of language organization, is reported.
6. Psychological testing suggests a deterioration with advancing years in dealing with concrete tests, but no significant disturbance in abstract thinking.
7. At the psychosocial level, inadequate adjustment to daily life is seen in all patients. This difficulty is reflected in varying degree by emotional disturbance in the parents. A schematic concept of the dynamics is offered.
8. Drug treatment of the acute crisis is discussed and a plan for daily management of such cases is projected.
9. Avenues for further investigation are briefly mentioned.
NEUROBLASTOMA (NEUROBLASTOMA SYMPATHETICUM)
Authors: Uhlmann Erich M. , von Essen Carl 
Published: December 2021

It has been shown that neuroblastoma can be controlled by irradiation even after extensive spread. It must be agreed that in some instances it is highly unlikely that cancerocidal doses could have reached all the tumor cells. With the knowledge that this tumor may occasionally spontaneously regress or mature into a benign ganglioneuroma, it may be postulated that irradiation can promote or accelerate the process of maturation. To our knowledge there have been no follow-up histological studies in cured individuals. This would be of great value if biopsy of the liver or other previously involved organs could be made perfectly safe. The report of patients showing arrest and regression of disease after chemotherapy should also stimulate further interest in tile biological behavior of this unusual tumor.
Unquestionably, radiation does arrest and control this disease by direct cancerocidal action. However, the favorable results in a few instances of disseminated neoplasm render further clinical investigations highly important in solving the riddle of its biological behavior.
COMPARISON OF TERATOGENIC CHEMICALS IN THE RAT AND CHICK EMBRYOS
Authors: Murphy M. Lois , Dagg C. P. , Karnofsky David A. 
Published: December 2021

THE CHICK EMBRYO is used widely in studying drugs for teratogenic activity. Chemicals, which have been injected at the same period of incubation of the chick embryo, may produce separate and characteristic patterns of developmental abnormalities. The effects of many drugs, such as insulin, azaserine, sulfanilamide, 4-aminopteroyl glutamic acid, 8-azaguanine, physostigmine, thallium, lead, boric acid and cortisone, have been reviewed.
The chick embryo in the egg is an isolated and independent system, whereas mammalian embryos are usually intimately involved with the maternal host which may detoxify, excrete or otherwise protect the fetus against noxious chemicals. It was, therefore, of interest to determine the effects of drugs, teratogenic in the chick embryo, on the mammalian fetus. The rat was selected because of its availability and because there is considerable information on rat embryology and teratology. Because some drugs, apparently inactive in the chick embryo, have produced consistent developmental abnormalities in the rat fetus, the pregnant rat also has been used for the initial study of selected compounds.
The objectives of these studies were: 1) to determine and compare the teratogenic action of drugs on the chick and rat embryos; 2) to determine the consistency and specificity of action of each drug; 3) to determine the relation between the time during gestation when a drug is introduced and the occurrence of specific abnormalities; 4) to determine the relationship of the dose of a drug toxic to the mother, the dose toxic to the embryo, and the dose producing consistent developmental defects, and 5) to detect compounds which protect the embryo from the teratogenic action of a chemical.
NEUROLOGIC SYMPTOMS ASSOCIATED WITH CAT SCRATCH DISEASE
Authors: Paxson Edwin M. , McKay R. James 
Published: December 2021

Two cases of cat scratch disease with associated encephalopathy involving patients in the pediatric age group have been reported. They fulfill the criteria for such a diagnosis, namely: (1) history of cat scratch or of contact with a cat; (2) regional adenopathy; (3) positive skin test with cat scratch antigen; (4) histologic picture of biopsied lymph nodes consistent with cat scratch disease plus a sterile culture obtained from the same node; (5) otherwise unexplained encephalopathic symptoms developing within 6 weeks of the appearance of adenopathy. Review of the literature and this report of two cases suggests that this disease may be sudden and severe in onset but is self-limited with benign sequelae and in most cases without residual effect.
In all cases of encephalitis with associated unexplained lymphadenopathy the diagnosis of cat scratch disease should be entertained as an etiologic factor.
MILK ALLERGY
Authors: Bachman Kay D. , Dees Susan C. 
Published: December 2021

In a series of 172 infants under 2 years of age who were referred for allergy studies during 1954-1956, 109 were found to be allergic.
Thirty-three of the one hundred nine allergic infants were sensitive to cow's milk, with an incidence of 30%.
The diagnosis of cow's milk allergy was based upon the same criteria applied to a series of well babies. Namely, repeated production of one or more allergic symptoms on exposure to cow's milk, improvement on withdrawal, and with no other apparent cause for improvement, confirmed by positive skin test, and without other cause for symptoms.
The allergic symptoms due to milk were eczema, gastrointestinal abnormalities and less frequently asthma or rhinitis.
Scratch tests were frequently positive to foods. Thirty-seven infants reacted with positive skin tests to milk, of whom 33 had clinical allergy to milk. Infants from 9 to 12 months of age had the highest number of nonspecific skin reactions.