bluuebunny/crossref_metadata_2025_split huggingface dataset:
Parent and Physician Perceptions Regarding Preventability of Pediatric Readmissions
Authors: Amin Dipti , Ford Ronald , Ghazarian Sharon R. , Love Benjamin , Cheng Tina L. 
Published: February 2016

OBJECTIVE:
To assess the causes and preventability of pediatric readmissions from the perspectives of parents and their physicians to guide future interventions.

METHODS:
Parent interview, physician survey, and medical record review were completed for children who were readmitted to a pediatric hospitalist service within 30 days of an index admission. Questions were asked about Health Belief Model constructs (perceived severity, susceptibility or preventability of admission, and perceived barriers), discharge readiness, and follow-up plans. Parent and physician perceptions about reasons for readmissions were examined, and responses to open-ended questions were coded.

RESULTS:
60 parent–physician pairs completed the study. The mean age of the patients was 6.43 (SD 6.42) years; 45% (n = 27) had a chronic disease, and 47% (n = 28) of patients were readmitted with the same or similar condition as in the previous hospitalization. At readmission, parents were more likely than physicians to think that the condition was serious (parent 98%, physician 76%; P &lt; .001) and that the readmission could have been prevented (parent 59%, physician 36%; P = .04). Most parents (63%) and physicians (65%) thought it was likely that the child may have future hospitalizations. Opportunities to prevent readmission included need for parent education, improving medication access and adherence, and need for coordination of follow-up care.

CONCLUSIONS:
Many parents and physicians thought the readmission was preventable, and the majority of both thought that the patient was susceptible to another hospitalization. Parents and physicians suggest opportunities to improve care processes during hospitalization and in services provided after discharge to reduce readmissions.
Complications of Deep Sedation for Individual Procedures (Lumbar Puncture Alone) Versus Combined Procedures (Lumbar Puncture and Bone Marrow Aspirate) in Pediatric Oncology Patients
Authors: Patel Meral M. , Kamat Pradip P. , McCracken Courtney E. , Simon Harold K. 
Published: February 2016

BACKGROUND AND OBJECTIVES:Pediatric oncology patients frequently undergo procedural sedation. The goal of this study was to determine the safety of combining procedures into a single sedation encounter and to assess if the magnitude of any complication is significant enough to justify separate sedation encounters for multiple procedures.METHODS:This retrospective review included pediatric oncology patients sedated for lumbar puncture alone or combined procedures (lumbar puncture and bone marrow aspirate) from January 2012 to January 2014. Demographic characteristics, medication dosing, procedural success, sedation duration, and adverse events (AEs) with associated required interventions were recorded. Sedation-related complications were separated into serious adverse events (SAEs) and AEs. Data were analyzed by using multivariable modeling.RESULTS:Data from 972 sedation encounters involving 96 patients, each having 1 to 28 encounters (mean ± SD, 10 ± 5), were reviewed. Ninety percent were individual procedures and 10% were combined procedures. Overall, there were few SAEs, and airway obstruction was the most common SAE. Combined procedures required 0.31 mg/kg more propofol (P &lt; .001) and took 1.4 times longer (P &lt; .001) than individual procedures. In addition, when adjusting for possible confounding factors, the odds of having an SAE were 4.8 (95% confidence interval, 1.37–16.65); P = .014) times higher for combined procedures. All SAEs and AEs were manageable by the sedation team.CONCLUSIONS:Combining procedures was associated with higher propofol doses, prolonged duration, and a small increase in likelihood of SAEs compared with individual procedures. All AEs fell within the scope of management by the sedation team. Balancing the increased, but manageable, risks versus the advantages of family/patient convenience, enhanced resource utilization, and minimization of potential neurotoxicity from anesthetics supports combining procedures when possible.
Validation of Procedural Codes to Identify Infants Evaluated for Serious Bacterial Infection
Authors: Biondi Eric A. , McCulloh Russell J. , Leyenaar JoAnna K. , Shin Carmen , Van Wie Nikole , Montalbano Amanda , Williams Derek J. 
Published: February 2016

OBJECTIVE:
To validate a novel coding method using Current Procedural Terminology, Fourth Edition (CPT-4) codes for identifying infants who underwent a full evaluation for serious bacterial infection (SBI).

METHODS:
We performed a multicenter, retrospective examination to determine the accuracy of a combination of CPT-4 codes for blood, cerebrospinal fluid (CSF), and urine cultures to identify previously healthy infants ≤90 days old admitted to a general care floor and fully evaluated for SBI. Full SBI evaluation was defined as blood, CSF, and urine cultures performed during the emergency department encounter or corresponding hospitalization. Cases were defined as infants who had codes for blood, CSF, and urine cultures (87040, 87070, and either 87086 or 87088), and these were compared with all other encounters. We validated these findings by comparing medical record documentation of blood, CSF, and urine cultures to the corresponding CPT-4 codes, with calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS:
We identified 8548 qualifying encounters, and 347 (4%) had a combination of CPT-4 codes 87040, 87070, and either 87086 or 87088. This combination had a sensitivity of 100% (95% confidence interval, 98.9–100) and specificity of 98.2% (95% confidence interval, 97.3–98.8) for identifying infants who underwent full SBI evaluation for an unknown source.

CONCLUSIONS:
CPT-4 codes provide an accurate means to identify infants who underwent complete SBI evaluation.
Description and Evaluation of an Educational Intervention on Health Care Costs and Value
Authors: Jonas Jennifer A. , Ronan Jeanine C. , Petrie Ian , Fieldston Evan S. 
Published: February 2016

OBJECTIVE:
There is growing consensus that to ensure that health care dollars are spent efficiently, physicians need more training in how to provide high-value, cost-conscious care. Thus, in fiscal year 2014, The Children’s Hospital of Philadelphia piloted a 9-part curriculum on health care costs and value for faculty in the Division of General Pediatrics. This study uses baseline and postintervention surveys to gauge knowledge, perceptions, and views on these issues and to assess the efficacy of the pilot curriculum.

METHODS:
Faculty completed surveys about their knowledge and perceptions about health care costs and value and their views on the role physicians should play in containing costs and promoting value. Baseline and postintervention responses were compared and analyzed on the basis of how many of the sessions respondents attended.

RESULTS:
Sixty-two faculty members completed the baseline survey (71% response rate), and 45 faculty members completed the postintervention survey (63% response rate). Reported knowledge of health care costs and value increased significantly in the postintervention survey (P = .04 and P &lt; .001). Odds of being knowledgeable about costs and value were 2.42 (confidence interval: 1.05–5.58) and 6.22 times greater (confidence interval: 2.29–16.90), respectively, postintervention. Reported knowledge of health care costs and value increased with number of sessions attended (P = .01 and P &lt; .001).

CONCLUSIONS:
The pilot curriculum appeared to successfully introduce physicians to concepts around health care costs and value and initiated important discussions about the role physicians can play in containing costs and promoting value. Additional education, increased cost transparency, and more decision support tools are needed to help physicians translate knowledge into practice.
Diagnosis of Autism Spectrum Disorder by Developmental-Behavioral Pediatricians in Academic Centers: A DBPNet Study
Authors: Hansen Robin L. , Blum Nathan J. , Gaham Amy , Shults Justine ,   on behalf of the DBPNet Steering Committee
Published: February 2016

OBJECTIVES:
To describe the clinical practices of physicians in the Developmental-Behavioral Pediatrics Network (DBPNet) to (1) diagnose autism spectrum disorders (ASDs), identify comorbidities, and evaluate etiology and (2) compare actual practice to established guidelines.

METHODS:
A total of 56 developmental-behavioral pediatricians completed encounter forms, including demographic/clinical information, for up to 10 consecutive new-patient visits given a diagnosis of ASD. Data were summarized by using descriptive statistics. Analysis of the statistical significance of differences between sites (n = 10) used general estimating equations and mixed-effects logistic regression to adjust for clustering by clinician within site.

RESULTS:
A total of 284 ASD forms were submitted. Most assessments (56%) were completed in 1 visit (27.5% in 2 visits, 8.6% in 3 visits). Use of the Childhood Autism Rating Scale, Autism Diagnostic Observation Schedule, or Screening Tool for Autism in Toddlers and Young Children varied across sites from 28.6% to 100% of encounters (P &lt; .001). A developmental assessment was reviewed/completed at 87.7% of encounters (range: 77.8%–100%; P = .061), parent behavior rating scales were reviewed/completed at 65.9% (range: 35.7%–91.4%; P = .19), and teacher behavior rating scales were reviewed/completed at 38.4% (range: 15%–69.2%; P = .19). Only 17.3% (95% confidence interval: 12.8%–21.7%) of evaluations were completed by an interdisciplinary team. A majority (71%) of patients had at least 1 comorbid diagnosis (31% had at least 2 and 12% at had least 3). Etiologic evaluations were primarily genetic (karyotype: 49%; microarray: 69.7%; fragile X: 71.5%).

CONCLUSIONS:
Despite site variability, the majority of diagnostic evaluations for ASD within DBPNet were completed by developmental-behavioral pediatricians without an interdisciplinary team and included a developmental assessment, ASD-specific assessment tools, and parent behavior rating scales. These findings document the multiple components of assessment used by DBPNet physicians and where they align with existing guidelines.
Pattern of Diagnosis and Co-occurring Symptoms in Adopted Children With Autism Spectrum Disorder
Authors: Ezell Jordan , Shui Amy , Sanders Kevin , Veenstra-VanderWeele Jeremy 
Published: February 2016

OBJECTIVES:
To determine whether adopted children with autism spectrum disorder (ASD) differ from the general ASD population in terms of diagnosis, internalizing and externalizing behaviors, sleep problems, and medications.

METHODS:
We studied 163 adoptees in the Autism Speaks Autism Treatment Network (ATN) in comparison with 5624 nonadopted ATN participants (aged 1.5–17.6 years; mean [SD] = 6.2 [3.4] years). Gender, age, race, ethnicity, IQ, and categorical Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ASD diagnosis were tested for differences by group (adopted versus nonadopted) by using independent-samples t tests for continuous variables and Fisher’s exact tests for categorical variables. Logistic or linear regression models were used to examine the association between adoption status and several outcome variables, after controlling for covariates.

RESULTS:
After controlling for demographics and diagnosis, there were significant differences in group characteristics, including greater propensity for externalizing behavior (P &lt; .001), internalizing behavior (P = .001), and sleep problems (P &lt; .001) in the adopted population. Adoptees were also prescribed psychotropic medications (P &lt; .001) more often than the nonadoptees. Adoptees received a diagnosis of pervasive developmental disorder–not otherwise specified significantly more frequently than controls (odds ratio = 1.8; CI = 1.3–2.5; P &lt; .001), despite no significant difference in symptoms on standardized measures.

CONCLUSIONS:
These results suggest that the population of adopted children with ASD differs from the general ASD population both with regard to diagnostic subtype and co-occurring behavioral problems. Future research should evaluate the contributions of specific factors associated with adoption such as biological family history, pregnancy history, early childhood experience, and age at adoption.
Assessment and Treatment of Anxiety in Youth With Autism Spectrum Disorders
Authors: Vasa Roma A. , Mazurek Micah O. , Mahajan Rajneesh , Bennett Amanda E. , Bernal Maria Pilar , Nozzolillo Alixandra A. , Arnold L. Eugene , Coury Daniel L. 
Published: February 2016

OBJECTIVES:Anxiety is one of the most prevalent co-occurring symptoms in youth with autism spectrum disorder (ASD). The assessment and treatment recommendations proposed here are intended to help primary care providers with the assessment and treatment of anxiety in ASD.METHODS:The Autism Speaks Autism Treatment Network/Autism Intervention Research on Physical Health Anxiety Workgroup, a multidisciplinary team of clinicians and researchers with expertise in ASD, developed the clinical recommendations. The recommendations were based on available scientific evidence regarding anxiety treatments, both in youth with ASD and typically developing youth, and clinical consensus of the workgroup where data were lacking.RESULTS:Assessment of anxiety requires a systematic approach to evaluating symptoms and potential contributing factors across various developmental levels. Treatment recommendations include psychoeducation, coordination of care, and modified cognitive-behavioral therapy, particularly for children and adolescents with high-functioning ASD. Due to the limited evidence base in ASD, medications for anxiety should be prescribed cautiously with close monitoring of potential benefits and side effects.CONCLUSIONS:Assessment and treatment of clinical anxiety in youth with ASD require a standardized approach to improve outcomes for youth with ASD. Although this approach provides a framework for clinicians, clinical judgment is recommended when making decisions about individual patients.
Irritability and Problem Behavior in Autism Spectrum Disorder: A Practice Pathway for Pediatric Primary Care
Authors: McGuire Kelly , Fung Lawrence K. , Hagopian Louis , Vasa Roma A. , Mahajan Rajneesh , Bernal Pilar , Silberman Anna E. , Wolfe Audrey , Coury Daniel L. , Hardan Antonio Y. , Veenstra-VanderWeele Jeremy , Whitaker Agnes H. 
Published: February 2016

OBJECTIVE:
Pediatric primary care providers (PCPs) caring for patients with autism spectrum disorder (ASD) often encounter irritability (vocal or motoric outbursts expressive of anger, frustration, or distress) and problem behavior (directed acts of aggression toward other people, self, or property). The Autism Intervention Research Network on Physical Health and Autism Speaks Autism Treatment Network charged a multidisciplinary workgroup with developing a practice pathway to assist PCPs in the evaluation and treatment of irritability and problem behavior (I/PB).

METHODS:
The workgroup reviewed the literature on the evaluation and treatment of contributory factors for I/PB in ASD. The workgroup then achieved consensus on the content and sequence of each step in the pathway.

RESULTS:
The practice pathway is designed to help the PCP generate individualized treatment plans based on contributing factors identified in each patient. These factors may include medical conditions, which the PCP is in a key position to address; functional communication challenges that can be addressed at school or at home; psychosocial stressors that may be ameliorated; inadvertent reinforcement of I/PB; and co-occurring psychiatric conditions that can be treated. The pathway provides guidance on psychotropic medication use, when indicated, within an individualized treatment plan. In addition to guidance on assessment, referral, and initial treatment, the pathway includes monitoring of treatment response and periodic reassessment.

CONCLUSIONS:
The pediatric PCP caring for the patient with ASD is in a unique position to help generate an individualized treatment plan that targets factors contributing to I/PB and to implement this plan in collaboration with parents, schools, and other providers.
Improving Access to Care at Autism Treatment Centers: A System Analysis Approach
Authors: Austin June , Manning-Courtney Patricia , Johnson Meghan L. , Weber Rachel , Johnson Heather , Murray Donna , Ratliff-Schaub Karen , Tadlock Abbey Marquette , Murray Mark 
Published: February 2016

OBJECTIVE:
The prevalence of autism spectrum disorder is steadily increasing and placing more demands on already overburdened diagnostic and treatment systems. A thoughtful, systematic reorganization of autism service delivery may reduce delays and better meet the growing need.

METHODS:
Two clinical centers in the Autism Intervention Research Network on Physical Health, Cincinnati Children’s Hospital Medical Center (CCHMC) and Nationwide Children’s Hospital (NCH), undertook a year-long access improvement project to reduce delays to care by using system analysis to identify sources of delay and to target changes by using a set of defined access principles. Although both sites addressed access, they focused on slightly different targets (reducing number of patients with autism spectrum disorders waiting for follow-up appointments at NCH and reducing delay to new diagnosis at CCHMC).

RESULTS:
Both sites achieved dramatic improvements in their complex, multidisciplinary systems. A 94% reduction in number of patients on the waitlist from 99 to 6 patients and a 22% reduction in median delay for a new ongoing care appointment were realized at NCH. A 94% reduction in third next available appointment for new physician visits for children 3 to 5 years old was realized at CCHMC.

CONCLUSIONS:
This article demonstrates that 2 different clinical systems improved access to care for autism diagnosis and follow-up care by identifying sources of delay and using targeted changes based on a set of access change principles. With appropriate guidance and data analysis, improvements in access can be made.
Telehealth and Autism: Treating Challenging Behavior at Lower Cost
Authors: Lindgren Scott , Wacker David , Suess Alyssa , Schieltz Kelly , Pelzel Kelly , Kopelman Todd , Lee John , Romani Patrick , Waldron Debra 
Published: February 2016

OBJECTIVE:
To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA).

METHODS:
We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment.

RESULTS:
All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was &gt;90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy.

CONCLUSIONS:
This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet.
Differences in Perceived Need for Medical, Therapeutic, and Family Support Services Among Children With ASD
Authors: Benevides Teal W. , Carretta Henry J. , Mandell David S. 
Published: February 2016

OBJECTIVE:
Identifying racial and ethnic differences in perceived need for treatment among families of children with autism spectrum disorder (ASD) will improve understanding of disparities in care seeking. We described racial and ethnic differences in perceived need for services that children with ASD and their families frequently use.

METHODS:
We conducted bivariate analyses of racial and ethnic categories and perceived need for 6 common services used by children with ASD as found in the 2005 to 2006 (n = 2123) and the 2009 to 2010 (n = 3055) National Survey of Children With Special Health Care Needs data sets. Multivariate logistic regressions within concatenated data sets were conducted to examine associations between racial and ethnic category and perceived service needs while controlling for predisposing, enabling, and child factors.

RESULTS:
Compared with caregivers of white non-Hispanic children with ASD, caregivers of Hispanic children reported less need for prescription medications in adjusted multivariate analyses. Caregivers of black non-Hispanic children with ASD reported less need for prescription medications and for child and family mental health services than caregivers of white non-Hispanic children. Both English-speaking Hispanic caregivers and black non-Hispanic caregivers reported greater need for occupational, speech, and physical therapy than white non-Hispanic caregivers. No racial or ethnic differences were found in perceived need for specialty medical care or respite care.

CONCLUSIONS:
Caregivers of children with ASD from different racial and ethnic backgrounds may differentially perceive need for different types of care. Their perceptions may in turn affect how they prioritize and seek care, independent of their child’s specific needs.
Spoilage potential of a novel group of bacteria isolated from dairy products
Authors: Tsôeu L. Ingrid , Jooste Piet J. , Charimba George , Hugo Celia J. 
Published: February 2016

Cold-tolerant bacteria, also known as psychrotrophic bacteria, are notorious contaminants of milk in the refrigerated dairy food chain. These organisms, especially the pseudomonads, may produce heat-resistant enzymes that are responsible for the breakdown of proteins and lipids in milk and dairy products. Such reactions result in a variety of defects in the raw or unprocessed milk that may affect the suitability of such milk for further processing. The enzymes produced may cause defects in long-life dairy products such as cheese, butter and long-life milk. In the present study, a range of 18 yellow pigmented psychrotrophic bacteria, collectively known as flavobacteria, were isolated from local dairy products. One aim of this study was to identify these bacteria to species level using molecular techniques. A second aim was to determine the spoilage potential of these organisms based on profiles generated by the BIOLOG system (that may relate to hydrolytic enzymes produced). Of the 18 isolates, 14 belonged to the genus Chryseobacterium while 4 were identified as Empedobacter isolates. The most active spoilage organisms in this group were shown to be C. bovis, C. shigense and E. brevis. These findings illustrate that enzymatically catalysed defects in dairy products should not be attributed solely to acknowledged psychrotrophic bacteria such as the pseudomonads, but that flavobacterial species may also be actively involved.