bluuebunny/crossref_metadata_2025_split huggingface dataset:
Administrative Data for Quality Improvement
Authors: Schwartz Rachel M. , Gagnon David E. , Muri Janet H. , Zhao Q. Rose , Kellogg Russell 
Published: December 2021

This article discusses the use of administrative data for quality improvement in perinatal and neonatal medicine. We review the nature of administrative data and focus on hospital discharge abstract data as the primary source of hospital- and community-based assessments. Although discharge abstract data lack the richness of primary data, these data are the most accessible comparative data source for examining all patients admitted to a hospital. When aggregated to the state level as occurs in more than 30 states, hospital discharge data reflects hospital utilization and outcomes for an entire geographic population at the state and community level.This article reviews some of the weaknesses of administrative data and then focuses how these data can be used for hospital- and community-based assessment of perinatal care citing as examples the measures of perinatal process and outcome used by the National Perinatal Information Center in its Quality/Efficiency Reports for member hospitals and a study of perinatal high-risk care in the State of Florida. The use of discharge abstract data for performance measurement at either the hospital or the system level requires a thorough understanding of how to select a patient group, its characteristics, the intervention, and the outcomes relevant to that patient group. In the perinatal arena, the National Perinatal Information Center has selected and presents those measures that rely on data items shown to be the most reliable based on validity studies and clinician opinion, delineation of the intervention, and the measurement of what occurred.As hospitals respond to the recent pressures of the Joint Commission on Accreditation of Healthcare Organizations and other quality assurance entities, the accuracy of the discharge data will improve. With accepted caution, these data sets are invaluable to researchers studying comparative populations over time or across large geographic areas.
Behavioral and Self-Concept Changes After Six Months of Enuresis Treatment: A Randomized, Controlled Trial
Authors: Longstaffe Sally , Moffatt Michael E. K. , Whalen Jeanne C. 
Published: December 2021

Background.Previous studies have suggested changes in self-concept with successful treatment of primary nocturnal enuresis (PNE), but behavioral changes have not been reported as a consistent associated finding.Objective.To determine if self-concept and behavior change after 6 months of treatment of monosymptomatic PNE by conditioning alarm or desmopressin acetate (DDAVP).Design.Randomized, controlled trial in an inner-city hospital clinic. Subjects were 182 children referred or recruited through media publicity, randomly assigned both to 1 of 8 pediatricians and 1 of 3 treatment groups (alarm, DDAVP, or placebo). Included were children &gt;7 years old with PNE, no daytime symptoms, bladder capacity &gt;50% expected, and wetting &gt;3 times a week. Excluded were children with central nervous system disorders or developmental delays, and those currently on DDAVP or alarm. Subjects completed thePiers-Harris Children's Self-Concept Scale and Harter's Perceived Competence Scale for Children (PCSC) at initial visit and after 6 months of treatment. Parents completed the Achenbach Child Behavior Checklist (CBCL) at the same times.Results.After 6 months of treatment the Piers-Harris total score showed a highly significant treatment by period interaction effect for DDAVP, a significant effect for alarm, and no effect for placebo. For children who achieved 75% dryness the CBCL showed a treatment by improvement interaction effect that was highly significant for DDAVP and placebo with no effect for alarm. For the PCSC there were no treatment or outcome interaction effects.After 6 months of treatment there were significant changes over time unrelated to outcome or treatment in the Piers-Harris Subscales and in the CBCL Internalizing and Externalizing Scores, and the Social Thought and Attention Problems Subscales. The PCSC was more stable with no changes in total score, and positive changes over time in only 2 Subscales, Scholastic and Social.Conclusion.Children's self-concept improved with the type of treatment and amount of success. Parents' perceptions of behavior improve with type of treatment and amount of success. Children rate their self-concept and some physical attributes better after treatment with any of DDAVP, alarm, or placebo regardless of outcome. Frequent follow-up with emotional support and encouragement appear to be important components of an efficacious intervention for children with nocturnal enuresis.
The Associations Among Pediatricians' Knowledge, Attitudes, and Practices Regarding Emergency Contraception
Authors: Sills Marion R. , Chamberlain James M. , Teach Stephen J. 
Published: December 2021

Objectives.
To quantify practitioner administration of the emergency contraceptive pill (ECP) among adolescent patients, and to determine if such administration is associated with physician knowledge and attitudes regarding efficacy, side effects, and appropriate use.

Design.
Survey of pediatricians.

Setting.
The survey address list was generated from a database of active Fellows of the American Academy of Pediatrics in the District of Columbia metropolitan area.

Main Outcomes Measures.
Prescription of the ECP in the previous 12 months, or counseling of an adolescent patient about the ECP.

Results.
Of the 236 questionnaires distributed, 143 (61%) were returned and 121 (51%) were usable. Twenty-four pediatricians (20%) reported prescribing the ECP, and 29 (24%) had counseled adolescent patients about the ECP. Of the practice-related variables surveyed, both the number of adolescents seen per week and the practice setting were significantly associated with these outcomes. Of the knowledge-related variables surveyed, knowledge of the timing and the Food and Drug Administration-labeled status of the ECP were significantly associated with outcomes. None of the attitude-related variables surveyed were associated with outcomes.

Conclusions.
This study demonstrates that knowledge deficits, not attitude-related variables, are significantly associated with the low level of ECP administration and counseling among District of Columbia pediatricians. Because knowledge deficits are amenable to educational interventions, our data suggest that informing pediatricians about the ECP may increase its administration among their adolescent patients.emergency contraceptive pill, pediatricians, adolescents.
PRESIDENT'S ADDRESS
Authors: QUILLIAN WARREN W. 
Published: December 2021

Economic and social progress in our practice depends upon the sustained interest and the effort of the individual physician. Courage and faith are necessary foundations for action in this critical year of decision, and there is every reason to believe that the new generation of pediatricians has every qualification necessary to continue the quest for better health among children. His adventure in "practical idealism" will not be an easy one. But, fortified by the assurance of his noble heritage of accomplishment and adherence to high standards, he will accept the challenge of the future with a deep sense of responsibility. He will keep faith with those who have gone before, and attempt to retain the confidence and trust of the people as did our fathers, by holding high the banner of service.
The price of success in this undertaking involves a determination to reach our objectives regardless of adverse circumstances, concentration on the immediate problems, and by long range plans for fulfilling our obligations to the children of America. Frustration and differences of opinion are inevitable. Changing conditions require flexibility in our adaptation to existing needs. Let us keep our eyes upon the stars, but our feet upon the ground! Our responsibilities are great. The Dean of the School of Medicine at the University of Wisconsin, Dr. William S. Middleton, recently stated the challenge in these words: "Make no small plans; they have no magic to stir man's soul!"
Medicine progresses, even in a troubled world. Changes in governments, in laws and controls, have not interfered with this progress. Civilizations of the past have been destroyed by the decay and infamy and greed within their own structure. Let us renew our faith in the simple basic principles, which have characterized the growth and development of the Academy for 22 years.
CONGENITAL DISLOCATION OF THE HIP
Authors: PLUMMER GEORGE W. 
Published: December 2021

Physical and roentgen examinations were performed on 227 nine month old Japanese infants to discover all cases of congenital dislocation of the hip. Twenty-seven cases were found in which the roentgenograms of the hips were interpreted as abnormal; of these, 15 showed only lack of calcification of the acetabular rim, and the other 12 showed some degree of displacement of the femoral head, in addition to the deficiently calcified acetabulum.
A large percentage of these 27 infants had no physical signs relative to hip deformity.
Repeat examinations at 18 months and 25 months of age demonstrated that all infants with only deficient acetabular calcification and 7 of 12 with some displacement of the femoral head had either healed completely or showed marked improvement without treatment. Five cases had persistent and aggravated dislocation of the hip.
Limitation of abduction of the flexed thighs is the most consistent and valuable sign of congenital dislocation of the hips, and this is in accord with other investigators' conclusions.
It is proposed that inadequate muscular and ligamentous support to the hip joint is the primary physiologic defect in congenital dislocation of the hip. This view is important in that it serves to direct attention to the fact that early support to the hip without immobilization of the infant is the most desirable therapy—from a physiologic standpoint—which will prevent deformity of the bony parts of the joint.
Round Table Discussion
Authors: PERLSTEIN MEYER A. , MCDONALD EUGENE T. 
Published: December 2021

Chairman Perlstein: In neuromuscular disabilities there are many problems to consider. However, about half of these comprise that group of diseases we know as cerebral palsy. We will start by orientating ourselves toward cerebral palsy, and in the discussion taking up the question of differential diagnosis and related subjects.
Cerebral palsy is not a single disease but a group of conditions which have in common a disorder of the motor system. It can be paralysis, incoordination, tremors or excessive motions, due to involvement of the motor centers of the brain. In other words, palsy and cerebral are defined. The important thing about cerebral is that the motor centers must be involved. If the problem is lack of development because of mental deficiency, you can exclude it. Likewise, spinal palsy, polio, and other causes of motor defects not due to involvement of the motor center are excluded. In schools for children with physical handicaps of all types, about half the children are cerebral palsied. So, from the viewpoint of frequency, cerebral palsy is the most frequent of the disabling conditions.
Much confusion exists in the terminology and classification of cerebral palsy. The term "Little's disease" has often been used as a generic term to cover all forms of cerebral palsy. Actually, Little described only one of the many types. Likewise, the term "spastic" is often used by the doctor and laymen to cover all categories. This tendency is conducive to loose thinking. A logical classification of the types of cerebral palsy would help to clarify this confused subject.
COMPARISON OF THE THERAPEUTIC EFFICACY OF FOUR AGENTS IN PERTUSSIS
Authors: AMES ROSE G. , COHEN SOPHIA M. , FISCHER A. E. , KOHN J. , MCPHERSON A. Z. , MARLOW JEANETTE , RUTZKY J. , ALEXANDER HATTIE E. 
Published: December 2021

The results of the study suggest that H. pertussis infection is usually a mild disease in all age groups if there is effective control of most secondary bacterial infections by penicillin. Not one of the four therapeutic agents studied, streptomycin, chloramphenicol, antipertussis rabbit serum and hyperimmune human serum, was shown to bring about prompt elimination of the signs of pertussis. On the basis of duration of the infection in the patients studied, however, only 30% were suitable clinical material for comparing therapeutic agents in pertussis.
The hypothesis is advanced that prompt recovery from pertussis can be anticipated only when effective therapy is instituted early in the course of the disease; the preparoxysmal stage is recommended.
While the data failed to show convincing therapeutic value of any of the four specific agents tested, they suggested some modification by each. A significant difference in degree of influence among the four treatments was not demonstrated. On the basis of toxicity, case of administration and cost, chloramphenicol is for the present the agent of choice.
In a comparison of the capacity of the four treatments to eliminate H. pertussis from the nasopharynx, rabbit antiserum was best and chloramphenicol next.
All four specific therapeutic agents showed some influence on the characteristic response in the white blood cell count.
PERIPHERAL CIRCULATORY RESPONSE TO FEEDING IN THE NEWBORN INFANT
Authors: Yao Alice C. , Wallgren C. Göran , Sinha Sachchida N. , Lind John 
Published: December 2021

The peripheral circulatory response to feeding was studied in 39 normal term infants, age ranging from 24 hours to 9 days. Blood flow to calf of left leg was measured by the venous occlusion plethysmographic method before and half hourly after feeding for 3 to 3½ hours. Arterial pressure was monitored in nine infants via an umbilical arterial catheter simultaneously and regional vascular resistance to flow in the leg calculated. Changes in pulse rate, and skin and rectal temperatures were also monitored. A significant drop in the calf perfusion averaging 49% of the control value was observed at the 30 minutes postprandial recording. This was due to an increased regional vascular resistance and blood pressure remained unchanged during the time of study. As a rule, a superseding hyperperfusion of the limb overshooting the control value by 40 to 50% occurred 1½ to 3 hours after feeding. This was comparable to the hyperkinetic phase described in adult man and other species after meals. The early postprandial vasoconstriction in the leg seems unique to the newborn.
It is suggested that having the early circulatory demand provoked by feeding is relatively bigger in the newborn than in the adult and is met partly at the expense of lower limb perfusion.
Selective Hearing Loss: Clues to Early Identification
Authors: Holm Vanja A. , Thompson Gary 
Published: December 2021

The child in this report was thought at various times to be mentally retarded, emotionally disturbed, and brain damaged before his selective hearing loss was discovered at age 53¼ years. He had developed puzzling behavior secondary to the confusing verbal messages he received and his unpredictability in turn had had a disturbing effect on his environment. Physicians will assist in the early identification of these children if they:
(1) Recognize conditions in infancy associated with high risk of hearing handicap.
(2) Listen to parents' observations about their child's language development and take their concerns seriously.
(3) Pay attention to language development in the 2-year old; delay can easily be demonstrated on the Denver Developmental Screening Test.
(4) Remember that prolonged jargoning, poor enunciation, and excessive use of gestures are suspicious symptoms of hearing loss.
(5) Are aware of the fact that informal hearing screen may fail to identify partial hearing loss.
(6) Refer the child suspected of hearing impairment to the audiologist regardless of the child's age, developmental level, and behavior. The audiologist is the professional best qualifled to determine the degree of testing accuracy that can be obtained.
ENCEPHALOPATHY AND FATTY DEGENERATION OF THE VISCERA IN NORTHEASTERN THAILAND. CLINICAL SYNDROME AND EPIDEMIOLOGY
Authors: Olson Lloyd C. , Bourgeois Curtis H. , Cotton Robert B. , Harikul Supha , Grossman Richard A. , Smith Thomas J. 
Published: December 2021

Encephalopathy and fatty degeneration of the viscera (EFDV) is a common cause of death among children in northeastern Thailand. During a clinical and epidemiological study in 1969, 67 cases of EFDV were studied.
Clinical features of this disease and Reye's syndrome were found to be similar. The incidence of the disease increases during the latter part of the rainy season. Almost all cases occur in children from rural areas. In Thailand, there is a geographic and seasonal association between the incidence of EFDV and the distribution of aflatoxin, indicating a possible etiologic relationship.
MANY AMERICAN MOTHERS A CENTURY AGO WERE UNABLE TO BREAST FEED THEIR INFANTS, ACCORDING TO DR. EDWARD H CLARKE OF BOSTON
Authors: C. T. E. 
Published: December 2021

One of the accepted beliefs of both contemporary pediatricians and parents is that most mothers a century ago could successfully nurse their infants. That this may be a myth seems evident from the quotation below:
In the normal state, Nature has made ample provision in the structure of the female for nursing her offspring. In order to furnish this nourishment, pure in quality and abundant in quantity, one must possess a good development of the sanguine and lymphatic temperament, together with vigorous and healthy digestive organs. Formerly (prior to 1873) such an organization was very generally possessed by American Women, and they found but little difficulty in nursing their infants. It was only occasionally, in case of some defect in the organization, or where sickness of some kind had overtaken the mother, that it became necessary to resort to the wet-nurse or to feeding by hand. . . . It is a fact, that large numbers of our women (in 1873) are anxious to nurse their offspring and make the attempt: They persevere for a while–then fail. . . . There is still another class that cannot nurse at all, having neither the organs nor nourishment requisite even to make a beginning....1
Unilateral Abduction of the Infant's Foot: Relation to Carrying Position
Authors: Gorlick Gary M. 
Published: December 2021

In well-baby care one not infrequently sees infants, usually 2 to 6 months of age, who have unilateral abduction of a foot. I would like to submit for your consideration and reader response one very simple yet often overlooked cause for this condition.
On close questioning of the mothers involved, I have found that they will hold their infant regularly to one side ("on my right hip" or "on my left hip") and consequently put pressure on one of the baby's lower extremities in such a way that abduction of that foot occurs.
METACHROMASIA AND ASSAY FOR LYSOSOMAL ENZYMES IN SKIN FIBROBLASTS CULTURED FROM PATIENTS WITH CYSTIC FIBROSIS AND CONTROLS
Authors: Kraus Ilana , Antonowicz Irena , Shah Harnish , Lazarus Herbert , Shwachman Harry 
Published: December 2021

The ability of Toluidine blue 0 to stain certain cytoplasmic elements metachromatically in cultured skin fibroblasts derived from patients with cystic fibrosis (CF) has been investigated. Fifteen of 18 (83.3%) cell strains from patients with cystic fibrosis were positive, two (11.1%) borderline, and one negative (5.5%). In a control group, 8 of 18 (44.4%) were positive, three borderline (16.6%), and seven negative (38.8%). In addition to the lack of an absolute correlation between metachromasia and CF, inconsistencies in staining reaction were continually noted. Several parameters which account for these variations have been examined.
Since metachromatic granules are felt to represent lysosomal structures, a study of four lysosomal enzymes in the skin cultured fibroblasts was carried out in material from 10 patients with CF and 11 controls. No differences were noted in the activity of β-galactosidase, β-glucuronidase, aryl sulfatase, and acid phosphatase. While these studies do not support the possibility that CF is due to a lysosomal hydrolase deficiency in the metabolism of mucopolysaccharides, they do not exclude it either.
PARENTAL DRUG USAGE: EFFECT UPON CHROMOSOMES OF PROGENY
Authors: Dumars Kenneth W. 
Published: December 2021

Illicit drug usage is a serious medical problem. Parental use of LSD and the effect upon the unborn infant is in question. However, parental use of LSD has often prevented acceptance of those children subsequently relinquished for adoption.
In this study we reviewed the records and clinical state of over 1,000 consecutive infants who were relinquished for adoption. Clinical and developmental examination was conducted upon 47 and chromosomal karyotyping upon 41/47 infants whose parents were illicit drug users. In comparison with comparable controls we found no statistically significant difference in the incidence of chromosomal breakage or rearrangement.
Parental use of illicit drugs does not in itself constitute a valid reason for the refusal to accept or place an infant relinquished for adoption.
BOOK OF ACCIDENTS
Authors: Cone Thomas E. 
Published: December 2021

Children still tumble down stairs just as did the little girl of 1830 in the illustration below.1 But have contemporary children learned the lesson contained in the last line of this illustration?
In 1830 parents taught their children that God demanded of them absolute obedience to parental commands. This was a period of no "ifs" or "buts."2
REPORT OF THE A.A.P.-A.N.A. CONFERENCE ON UTILIZATION OF ALLIED HEALTH WORKERS IN MEETING THE MANPOWER CRISIS
Authors: Bergman Abraham B. , Fakkema La Verne , Connelly John P. 
Published: December 2021

On October 22, 1970 a portion of the annual meeting of the American Academy of Pediatrics in San Francisco was devoted to a conference on the utilization of allied health workers in meeting the manpower crisis. It was jointly sponsored by the American Academy of Pediatrics and the American Nurses' Association and was the third and most successful of similar meetings. The first one, held at the Academy's Chicago meeting in October, 1969, provided an introduction to the concept of pediatric nurse practitioners. The second, held at the Washington meeting of the Academy in April, 1970, resulted in a frank exchange of views of the official nursing organizations and academy representatives and pointed to the need for open discussion and collaboration on the subject.
The San Francisco meeting got down to the business of a more objective analysis of issues, and though there was much heated discussion most of it was constructive. An attempt was made by the planning committee to include on the program different models of allied health workers in pediatrics. The program highlighted discussion about discharged medical corpsmen, laboratory technologists, pediatric assistants, as well as the more familiar pediatric nurse practitioner.
Of the 418 persons in attendance, 294 were nurses, 43 physicians, and 81 were other interested persons. When one of the nurses criticized the fact that there were so few physicians in attendance, Donald Frank of Cincinnati, a member of the Academy's Manpower Committee, pointed out that there was a fivefold improvement in physician attendance since the first conference.
The opening keynote address was given by Philip R. Lee, M.D., former HEW official, now Chancellor of the University of California at San Francisco, who refreshingly offered no simple solutions.