bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-Course Amphotericin B Therapy for Candidemia in Pediatric Patients
Authors: Donowitz Leigh G. , Hendley J. Owen 
Published: December 2021

Objective. To determine the efficacy of short-course (7 to 14 days of therapy after the last positive blood culture) amphotericin B therapy for candidemia in children.
Design. Case series.
Setting. Tertiary care university medical center in Virginia.
Patients. Thirty patients younger than 17 years of age who had candidemia between 1983 and 1990.
Measurements and results. The charts of 30 children with 31 episodes of candidemia were retrospectively reviewed for patient data, dates of positive and negative cultures for Candida from blood and other sites, dates of removal of the intravascular catheters, duration and dosage of amphotericin B administration, and outcome. Eight patients had persistent candidemia and died. Five patients were treated not in accordance with the short-course recommendations. Two had relapses; 1 was cured with catheter removal alone, and 2 were successfully treated with 26 and 30 days of amphotericin B therapy. Eighteen episodes (two episodes in 1 patient) of candidemia were cured using 7 to 14 days of amphotericin B therapy after the last positive blood culture.
Conclusions. Once the bloodstream is sterilized, and there is no other evidence of invasive fungal disease, 7 to 14 additional days of amphotericin B at a dose of 0.5 mg/kg per day seems adequate for treatment of candidemia in children.
Jacobi Address—Pediatrics: Where Do We Go From Here?
Authors: Strain James E. 
Published: December 2021

It is only fitting that Dr Jacobi is honored by the presentation of an annual award by the American Academy of Pediatrics and the American Medical Association. In 1860, Dr Jacobi became the first teacher at the New York Medical College to give systematic instruction on diseases of children. He was later appointed Clinical Professor of Diseases of Children at Columbia University College of Physicians and Surgeons where he was succeeded by L. Emmett Holt who himself became a forceful leader and teacher of pediatrics. It is said that the entire history of American Pediatrics during the second half of the 19th century was reflected in Jacobi and his writings. Through his efforts the Section on Pediatrics of the American Medical Association was established in 1880. He was elected the first president of the American Pediatric Society in 1888 and also served as president of the New York Academy of Medicine. Samuel S. Adams said of him, "Jacobi pressed the button which set pediatrics in motion." From that beginning, pediatrics has grown into a highly regarded branch of medicine, whose future is bright. It is that future that I want to talk about today.
But before I do, I would like to acknowledge two individuals who are no longer with us, but who influenced me most in my professional life. The first is Dr Harold Palmer, former Medical Director of Denver Children's Hospital, an extremely competent pediatric pathologist who taught me the science of medicine. The second is Dr Henry Kempe, a colleague and close friend, whose keen intellect and understanding of the needs of children was an inspiration to all who knew him.
REASSESSING THE THERAPEUTIC RANGE FOR THEOPHYLLINE ON LABORATORY REPORT FORMS: THE IMPORTANCE OF 5-15 µg/mL
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: Conners Gregory P. , Chamberlain James M. , Ochsenschlager Daniel W. 
Published: December 2021

We enjoyed reading the paper by Schunk et al1 regarding the removal of esophageal foreign bodies using the fluoroscopic Foley catheter technique. We feel, however, that their sentence "Because of the potential for serious complications all impacted foreign bodies should be removed" deserves further clarification.
Impacted is defined as "pressed firmly together so as to be immovable."2 Therefore, a foreign body that is impacted in the esophagus is one that will not pass to the stomach without an intervention.
Responder—The Outlook for Pediatrician Incomes Under Managed Care
Authors: Flint Samuel S. 
Published: December 2021

Dr Hirsch analyzed a number of issues related to the economic viability of pediatric practice. I have chosen to explore one issue for my response: the outlook for pediatrician incomes under managed care. Dr Hirsch offers a disconcerting scenario. First, the demand for pediatricians is at risk, because managed care plans may want to substitute family physicians (one-stop shopping appeal) and pediatric nurse practitioners (perceived less costly substitutes) for primary care pediatricians. Second, price and premium cutting by managed care plans to maintain their market share eventually must result in lower compensation for all providers. Even now, there is evidence of price cutting for large employers in areas with high managed care penetration (Winslow R. Employer costs slip as workers shift to HMOs. Wall Street Journal. February 14, 1995, page A3). Logically, price cutting should proliferate to smaller purchasers and to all geographic regions. The conclusion is that pediatrician incomes, or at least their per-service compensation, is likely to decline as managed care becomes the norm.
This compelling theory has some supporting evidence, but I am considerably more upbeat. Although the restructuring of office practice as described by Dr Hirsch may be painful, I contend that the specialty, because it has already accomplished much of this reengineering, is preparing well for its inevitable total transformation. My optimism is based on an examination of the recent past. In 1994, more than 50 million Americans were enrolled in health maintenance organizations (HMOs),1 and an estimated 100 million were enrolled in managed care of some form.2
The Computerization of Ambulatory Pediatric Practice
Authors: Zurhellen William M. 
Published: December 2021

With the shift in pediatrics toward emphasis on preventive care and anticipatory guidance, especially in this era of care- and cost-management, quality care is becoming increasingly synonymous with good information processing. To achieve our maximum effectiveness as clinicians as well as businesspersons, because pediatrics is a business, we must learn to use the tool that the rest of the business world has long ago discovered and implemented: computerization. Most important, we must apply this technology not only to the business of medicine, but to the practice of medicine itself, for that is where our future and the future of our children lie.
From the perspective of someone who has been there, I will discuss what computerized information access and information processing has allowed us to accomplish in practice, and I will give a glimpse of what medicine will be like when we all can manipulate medical information so rapidly that it enables us to practice true preventive care aggressively, to give anticipatory guidance and parent education in a timely manner, and to assess and monitor the progress of our children effectively.
Les Nouveaux Miserables: Modem Victims of Social Asphyxia
Authors: Smith David R. 
Published: December 2021

During the past 30 years, social and economic barriers to health care services have increased for many Americans, especially for the nation's most vulnerable populations. Health status actually has declined for certain populations during this time. Meanwhile, national attention has been focused primarily on containing health care costs and on devising strategies for reforming the financing of health care rather than strategies for achieving improvements in the health status of the population.
Existing methods of financing health care services, health research priorities, the increasing centralization and compartmentalization of health care services, and the recent failure of national health reform all serve to hinder this nation's progress towards developing a comprehensive and accountable health care system focused on promoting and achieving improved health as well as treating sickness. Recent changes in the health care marketplace, however, including a growing movement toward measuring the outcomes of medical treatments and an emphasis on improving the quality of services, have increased interest among payers and providers of health care services in investing in preventive services. Health maintenance organizations and other integrated health care delivery systems are beginning to devise incentives for increasing preventive care as well as for containing costs.
The transformation of the nation's current medical care system into a true health care system will require innovative strategies designed to merge the existing fragmented array of services into coordinated and comprehensive systems for delivering primary and preventive health care services in community settings. The community-Oriented Primary Care concept successfully blends these functions and has achieved measurable results in reducing health care costs and improving access to preventive services for identified populations. There is flexibility in existing funding sources to promote preventive services in various public and private health care settings and to assist in the transformation from a disease-oriented medical care system to one focused on health.
Hospitals' Responses to Universal Infant Hepatitis B Vaccination Recommendations
Authors: Hurie Marjorie B. , Saari Thomas N. , Proctor Mary E. , Davis Jeffrey P. 
Published: December 2021

Objective. To assess the extent to which hospitals in a midwestern state with low acute hepatitis B virus (HBV) morbidity offered hepatitis B (Hep B) vaccine to all infants, whether offering infants Hep B vaccine was associated with hospital geographic location or size, as measured by the number of births, and how hospital staff resolved key programmatic issues.
Methods. The managers of hospital newborn nurseries (N = 110) were surveyed by mail. The written response rate was 72%; all of the nonresponders were interviewed by telephone. The outcome measured was the number of hospitals offering Hep B vaccine to all infants by geographic region and hospital size.
Results. Sixty-five percent of the hospitals routinely offered Hep B vaccine to all infants; these hospitals accounted for 80% of reported Wisconsin births. In univariate analysis, the decision to offer infants Hep B vaccine was associated with both hospital size and hospital location. After controlling for size, hospitals in the northeastern region were eight times more likely (relative risk, 8.21; 95% confidence interval, 1.30, 51.79) to offer infants Hep B vaccine than hospitals in the southeastern (referent) region. Regional differences in reported rates of acute HBV infection do not explain this finding, because morbidity in the northeastern region (1 per 100 000) is among the lowest in Wisconsin. Although more than 80% of hospitals with Hep B vaccination programs required written informed consent for vaccination, had standing orders for administering Hep B vaccine to infants whose mothers' hepatitis B surface antigen (HBsAg) test results were known, and had mechanisms to notify the infants' physicians that the infants had been vaccinated, only 38% had standing orders for testing mothers whose HBsAg test results were unknown.
Conclusions. Hospitals are not necessarily deterred from implementing infant Hep B vaccination programs by low community HBV morbidity. Hospitals should develop policies to assure that parturient women with unknown HBsAg status are screened and their infants are appropriately treated.
Analysis of Homeopathic Treatment of Childhood Diarrhea
Authors: Sampson Wallace , London William 
Published: December 2021

The article entitled "Treatment of Acute Childhood Diarrhea With Homeopathic Medicine: A Randomized Clinical Dual in Nicaragua" by Jacobs et al (Pediatrics. 1994;93:719-725) reported a study of the efficacy of homeopathy in the treatment of acute childhood diarrhea. Children with diarrhea were entered into the study if the diarrhea was not severe (type C severe diarrhea patients were sent to a hospital). Oral rehydration therapy was begun, and subjects were randomly assigned to receive either homeopathic preparations or placebos. The preparations were determined by a computerized therapeutic scheme. This scheme depended on a family observer's answers to questions from an "experienced homeopathic practitioner." The article purports to show a statistically significant difference favoring the treatment group over the controls. The report has faults of 1) purpose, 2) method, 3) diagnosis and treatment selection, 4) results interpretation, and 5) authors' editorial comments. The reported difference between treatment and control groups are of dubious significance. This article argues that the study's conclusion that homeopathy is effective for childhood diarrhea is unwarranted.
Homeopaths claim that homeopathy is an "alternative" medical system. The authors justify their research in the hope that homeopathy would have public health importance. If true, one would presume the system to be equal to or better than oral rehydration therapy. Therefore, even if it were positive, this study would not prove homeopathy to be an alternative to the standard treatment of childhood diarrhea.
METHODS
Government agencies do not routinely assay homeopathic products. Homeopathic products have been found to be adulterated with active material.1-3
Universal Access to Good-quality Education and Care of Children From Birth to 5 Years
Authors:   COMMITTEE ON EARLY CHILDHOOD, ADOPTION AND DEPENDENT CARE
Published: December 2021

CHILDREN IN EARLY CARE AND EDUCATION PROGRAMS
All families with children need child care at one time or another, and increasingly, parents seek child care so they can work outside of the home. During the past two decades, the proportion of mothers of young children entering the labor force nearly doubled, reaching 68% in 1992, with a concomitant dramatic increase in the number of children younger than 5 years who receive some form of out-of-home child care. Currently, about 80% of children entering school have had regular care in either child care centers (nonresidential settings that provide care and education for any number of children), nursery schools or preschools, their own homes, the homes of relatives, or, most frequently, family day cane homes (the homes of the care givers in which care and education are provided for either a small [1 to 6] or large [7 to 12] number of children). The types of child care arrangements and the extent to which they are used vary according to the child's age and the income, education, and employment status of the parents. Older preschool children, children whose mothers have more than high school educations, and children whose families' incomes are higher are more likely to be enrolled in center-based care. Unemployed parents also tend to use care in centers rather than cane in the child's or another family's home, presumably because subsidized center-based child care programs are available for them. Overall, however, poor families are less likely to make use of preschool programs for their 3- to 4-year-old children than are more affluent families.
Postdischarge Utilization of Medical Services by High-risk Infants: Experience in a Large Managed Care Organization
Authors: Cavalier Stevan , Escobar Gabriel J. , Fernbach Stephen A. , Quesenberry Charles P. , Chellino Marie 
Published: December 2021

Background. Infants discharged from intensive care nurseries are a high-risk infant (HRI) population known to have increased utilization of medical services. Most studies tracking HRIs have been based on data obtained from individual chart review or direct patient contact. Given the high cost of such studies, it is desirable to develop less costly methods to track such infants.
Objectives. Our goals were: (1) to identify an HRI cohort at two neonatal intensive care units; (2) to identify a control group of infants not meeting HRI criteria; and (3) to measure outpatient and inpatient utilization in both cohorts using computerized files in a managed care organization.
Methods. Using California Children's Services criteria as our starting point, we established an HRI definition. From a 1-year birth cohort of 7579 infants at two facilities, we identified 250 infants meeting the HRI definition at two neonatal intensive care units during 1990. We then matched the HRIs with a cohort of 896 randomly selected control newborns (those not meeting the HRI definition). Using organizational computer files and state of California death certificate tapes, we followed these infants until February 28, 1992. We measured the number of hospitalizations, total number of hospital days, and total number of outpatient visits and expressed these outcomes as rates per person-year. We also measured postdischarge mortality.
Results. The rate of hospitalization in the HRI group was 6.07 times (95% confidence interval [CI], 4.74-7.77) that in the control group. The utilization of hospital days by the HRI population (hospital days per 1000 person-months) was 13.24 times higher (95% CI, 11.00-16.04). The outpatient visit rate was 1.40 times higher (95% CI, 1.36-1.45) in the HRI population.
Conclusion. Our findings in a large managed care organization corroborate previous studies showing that hospitalization rates are significantly higher among HRIs. In our study population, outpatient utilization was significantly higher as well. Our study also demonstrates the feasibility of using computerized files to study outcomes in selected pediatric populations. These methods can be used for epidemiologic studies, interventional trials, and planning for resource allocation.
DELAYS BY HMO LEAVING PATIENTS HAUNTED BY BILLS
Authors: L. J. F. 
Published: December 2021

The Health Insurance Plan (HIP) of Greater New York, the state's largest and oldest health maintenance organization (HMO), routinely fails to pay millions of dollars of its members' medical bills each year, leaving subscribers either to cover the bills themselves or to fight collection agencies and lawsuits from doctors demanding overdue payments.
The company hangs on to millions of dollars it invests to improve its bottom line. It pays no penalties because regulators have been lax in policing HMOS.
What's more, as HIP's record for paying claims deteriorated over the last few years, its record for collecting premiums improved, leaving the company with a growing pool of cash. Having this stockpile of money—even temporarily—is a great advantage to HIP, because the company's financial health is heavily dependent on investment income.
If an insurance company slows down claims payment by one day, they have a tremendous profit advantage because of the interest they make on the money. . .All of these skims come out to be a significant amount.
PERSISTENT INCREASE IN PLASMA AND URINARY LEUKOTRIENES AFTER ACUTE ASTHMA
Authors: Joos Thad H. 
Published: December 2021

Purpose of the Study. With the role of leukotrienes in the inflammatory cycle of asthma well accepted, the present study set out to measure various leukotriene levels in asthmatic children during and 1 month after an acute asthmatic attack.
Methods. Plasma and urinary leukotrienes were evaluated using a high-performance liquid chromatography/radioimmunoassay in 10 children 5-10 years of age with acute asthma as documented by peak expiratory flow rates at the onset of an episode and 1 month after when their peak expiratory flow rates returned to normal. The children were all from atopic backgrounds and three were on long-term inhaled anti-inflammatory therapy. They were matched by age-appropriate normal children who had the same plasma and urinary determinations performed.
Results. Plasma concentrations of both leukotrines B4 and E4 were significantly increased during the acute phase but also 1 month later when compared with the normals. The urinary levels of leukotrine E4 were the most strikingly elevated initially and at the 1-month follow-up.
Reviewer's Comments. Physicians caring for the diabetic patient have the hemoglobin A-1-C determination as a gauge of diabetic control to supplement daily glucose readings. Urinary leukotrine E4 levels or similar markers may well provide the physician with useful data as to the state of the inflammatory process in the asthmatic's lung. An extension of the project for a longer time period would be most interesting especially if the urinary levels continued to be reliable. This noninvasive source of information certainly is preferable to endotracheal biopsy or bronchoalveolar lavage, two current choices.
Air Pollution and Sudden Infant Death Syndrome
Authors: Koehler Steven A. 
Published: December 2021

This letter is in response to the article by Knöbel et al entitled, "Sudden Infant Death Syndrome in Relation to Weather and Optimetrically Measured Air Pollution in Taiwan" in the December issue of Pediatrics (1995;96:1106-1110).
The findings of this article are brought into question because the article suffers from several serious methodological and epidemiologic problems that greatly affect the validity of the results. Before proceeding, and because none was provided, a clear definition of sudden infant death syndrome (SIDS) needs to be given.
Asthma: Too Much Diagnosis and Too Much Medicine
Authors: Giannini Allan V. 
Published: December 2021

Asthma is the diagnosis for the teenage athlete with exerciseinduced wheezing, the adult aspirin-sensitive patient on steroids, the toddler who wheezes with every upper respiratory infection, and the college student who returns home and wheezes around her cats. These conditions are not the same. The pathophysiologies differ as well as the outcomes. They only share a common symptom: wheezing.
We try to be aware of medical diagnoses that present with wheezing such as gastroesophageal reflux, sinusitis, and foreign bodies in the airways.