bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation and Treatment Strategies in Patients with Schizophrenia and Comorbid Depression
Authors: McRenolds Deana , Mehta Palav , Nasrallah Henry A. 
Published: August 2014

CME Educational Objectives1.Understand depression in relation to negative symptoms in schizophrenia and be able to understand the risk of suicide in patients with schizophrenia.2.Understand the pharmacotherapies that have been studied to better treat depression in patients with schizophrenia.3.Explore the efficacy of pharmacotherapy and psychotherapy combination therapy.In addition to the main clinical features of schizophrenia, such as positive symptoms, negative deficits, and neurocognitive dysfunction, mood symptoms are quite common as well. Depressive symptoms are often manifested by patients and are believed to be due to multiple causes including genetic/biological, comorbid depression, stressful lifestyle, and even posttraumatic stress disorder (PTSD) triggered by the life-threatening nature of a psychotic episode.
Lessons from Placebo Arm Wrestle in Clinical Research
Authors: Nayak Devdutt , Chowdhury Noshin 
Published: August 2014

In the last half-century, randomized, placebo-controlled, double-blind design has become the norm for clinical trials and has created a windfall for the drug manufacturers. It has also created extra headaches for the statisticians measuring study outcomes. When compared with the placebo pill, there has been a steady decline in the effectiveness of new agents during last 25 years, whereas placebo responsiveness has increased in studies lasting less than 8 weeks. Placebo effect rates have risen approximately 7% per decade during the last 30 years, and more recent trials have shown an approximate 1.6-fold greater risk for placebo effects. There is a high, unpredictable, and heterogeneous responsiveness in many psychiatric conditions. True placebo effects can only be separated from non-specific treatment effects if a no-treatment control group is included; however, such trials are rarely performed in psychiatric conditions for ethical reasons.
In clinical practice, the positive-care effect can increase the magnitude of placebo component of the pharmacodynamic response of the drug. It is difficult to apply a placebo condition to psychotherapy as the therapist knows what “brand” of therapy is given, and some of the essential ingredients (ie, hope, belief, expectations, healing ritual, and emotionally charged interaction with an expert) are also common to placebo condition. It has been shown that the therapeutic relationship itself can produce benefits in psychotherapy, independent of the specific techniques employed. Experimental conditions affect both the subjects and the researchers in different and unpredictable ways. Blinded, randomized, controlled trials may be impartial and truth-seeking, but they are still vulnerable to measurement and reporting bias, and some scholars are in favor of replacing them with well-designed observational studies because their results do not overestimate the magnitude of therapeutic effect as once thought.
Elements of an Ideal Statutory Scheme for Mental Health Civil Commitment
Authors: Stettin Brian , Lamb Richard , Frese Fred 
Published: August 2014

Watching a loved one fall into the grip of severe mental illness can be painful and terrifying in equal measure. And yet sometimes, to the chagrin and astonishment of those who want to help the ill person find a way back to the life he once had, pleas to seek treatment are met with emphatic insistence that everything is fine. At some point, when things become unbearable for the concerned observer, a call will be made to police or a local mental health facility. It is at this moment that the situation becomes not merely a health emergency, but also a legal matter.
This leads to a critical question: what exactly are the societal imperatives activated by a psychiatric crisis? This is a major question that states have had to grapple with in crafting their laws on involuntary treatment. Laws must also address the circumstances that typically follow a diagnosis of severe mental illness, such as how long and under what criteria the person should be held by a court of law for continued inpatient treatment against his wishes, whether the state should require him to adhere to a prescribed treatment plan, and how far into relapse a person must fall before he is involuntarily re-hospitalized.
Maternal Immunization: An Update for Pediatricians
Authors: Munoz Flor M. 
Published: August 2014

CME Educational Objectives

1.
Discuss the current recommendations for vaccination during pregnancy in the United States.

2.
Determine the benefits of maternal immunization for the newborn and infant.

3.
Outline future developments for maternal vaccination and potential benefits for the fetus and newborn.

The immunization of women during pregnancy can protect both the mother and her infant against serious infectious diseases. The prevention of infection through maternal immunization reduces the risk of exposure to the baby, results in higher concentrations of transplacentally transferred pathogen-specific maternal antibodies to the newborn, and provides protection to the infant during a period of vulnerability. The benefits of vaccinating pregnant women outweigh any theoretic risk when there is a risk of exposure to an infectious disease that threatens the mother or the newborn’s health.
Toxoids and inactivated virus or bacterial vaccines are safe and cause no harm to the mother or fetus. Live vaccines, viral or bacterial, are contraindicated during pregnancy as a precaution because of the theoretic risk of infection of the fetus. However, there has been no evidence to date of direct fetal injury after the administration of live viral vaccines to pregnant women. The administration of immune globulin preparations to pregnant women results in no known risks to the fetus.
In the United States, vaccines recommended in pregnancy include the seasonal influenza vaccine, tetanus toxoid, and the pertussis vaccine as a combined tetanus-diphtheria toxoid and acellular pertussis vaccine (Tdap). Pregnant women who travel or who have unavoidable exposures to vaccine-preventable diseases should be immunized. Breast-feeding is not a contraindication to the vaccination of mothers with inactivated and most live vaccines. Women who are not immune to rubella should be immunized after delivery. Similarly, the influenza and Tdap vaccinations may be administered postpartum in women who were not vaccinated during pregnancy.
Adult Immunization and Its Impact on Children
Authors: Boyle Daniel P. , Flaherty John P. 
Published: August 2014

CME Educational Objectives

1.
Review the incidence of selected vaccine-preventable diseases in the adult population.

2.
Determine current adult vaccination rates.

3.
Analyze the impact that failure to immunize adults may have on child contacts.

The prevention of illness through vaccination is one of the most essential services pediatricians provide to their patients. However, the importance of adult vaccination and its impact on the health of children are often overlooked. There remains a large portion of adults in the United States who are not compliant with the Advisory Committee on Immunization Practices immunization schedule. These people provide a potential reservoir for the spread of vaccine-preventable illness to children and adolescents. There are numerous contributing factors to the lack of immunization. Pediatricians, along with adult health care providers, can serve an important role by educating parents, guardians, and adult contacts of children on the importance of receiving the recommended adult vaccinations and the role of vaccines in preventing the spread of disease to the pediatric population.
Prevention of Meningococcal Infections in the First 2 Years of Life
Authors: Woods Charles R. 
Published: August 2014

CME Educational Objectives

1.
Review the current epidemiology of meningococcal disease in children.

2.
Discuss the history of meningococcal vaccine development and the unique challenges posed by developing a vaccine against this microbe.

3.
Determine vaccine recommendations as well as potential roadblocks to routine vaccination of young children.

The spectrum of disease caused by
Neisseria meningitidis
includes bacteremia, fulminant sepsis (meningococcemia), meningitis, and pneumonia. The incidence of meningococcal infection has long been higher in infancy than adolescents or adults older than 65 years (a third group with an increased risk based on age). Five meningococcal serogroups (A, B, C, Y, and W135) cause the great majority of human disease. Serogroup B strains cause about two-thirds of disease in children younger than 6 years. For this reason, new meningococcal vaccine formulations have been developed and evaluated in children younger than 2 years.

Of four meningococcal vaccines currently licensed in the United States, two conjugate products, (MenACWY-D [Menactra], Sanofi Pasteur; HibMenCY-TT [MenHibrix], GlaxoSmithKline), are recommended for infants and toddlers younger than 2 years who have an increased risk for invasive meningococcal disease. High-risk conditions are complement deficiencies, community outbreaks, functional or anatomic asplenia, and travel to high-risk areas in which serogroup A infection is prevalent. Recommendations vary by age, dosing, and indication between these two products. Both licensed products are immunogenic and have side-effect profiles that are considered safe for use. In most cases, concomitant use with other recommended childhood vaccines does not interfere with responses to these vaccines.

As of yet, there has not been universal adoption of this immunization in the infant population by parents or providers. Factors that weigh against the implementation of a national routine infant program include the prevention of only 40 to 50 meningococcal cases, two to four deaths per year, and a relatively low case fatality among infants. Some argue that costs should not be considered a barrier because infant deaths and morbidity would be prevented. The availability of a serogroup B vaccine would improve impact and cost-effectiveness of a routine infant meningococcal vaccine program. Debate over the implementation of routine infant meningococcal vaccination in the United States is ongoing. This review focuses on vaccines for the prevention of
N. meningitidis
infection in infants and young toddlers in the first 2 years of life.
Strategies and Suggestions for a Healthy Toddler Diet
Authors: Schwartz Sally , Benuck Irwin 
Published: August 2014

Nutritional challenges for toddlers are common because their eating behaviors are inconsistent; they may eat more or less than requirements meal to meal and day to day. To help reduce parental stress, it’s essential to discuss with parents/caregivers their expectations on how and what they think their toddler should be eating. It is important to remember that toddlers are not little adults; portion sizes are often distorted (too large), and portions should reflect the individual child’s age and development. Parents/caregivers can help with new food acceptance by modeling good mealtime behaviors such as limiting high-energy, low-nutritional food and drinks, eating healthy foods along with their children together at the table with the television shut off, and eating appropriate portion sizes.
Pediatricians should inform concerned parents/caregivers that toddlers commonly do not accept new foods; foods may need to be introduced repeatedly, up to 10 to 15 times before a child will eat them. To adhere to National Heart, Lung, and Blood Institute (NHLBI) guidelines, parents and caregivers should focus on providing balanced meals that offer a variety of foods, with at least three to four food groups for meals and one to two food groups for snacks, always including familiar foods along with new foods.
It is important to reassure families that adherence to NHLBI guidelines for toddlers may be difficult at first, but with the proper education, planning ahead for meal/snack times, and education of all providers caring for the toddler (including nannies, daycares, and family members), it can be done successfully. Improving the nutrition and health of their young toddler will help prevent risk factors for the development of cardiovascular disease.

CME Educational Objectives

1.
Delineate what comprises a healthy toddler diet.

2.
Discuss strategies for meal planning for toddlers.

3.
Develop a clear understanding of the varying fat content of milk products.
The Most Important Meal of the Day: Why Children Skip Breakfast and What Can Be Done About It
Authors: Jackson Lisa Wilhelm 
Published: August 2014

We all experience that morning rush to get somewhere — to work, to school, or to complete a number of important errands before we reach those final destinations. Many adults skip meals for a variety of reasons. Children and teenagers are no different.
Eating behaviors can promote or diminish healthy nutrition. A child consuming breakfast with family members on a regular basis is ideal but not always realistic. More and more children have two working parents who are rushing out to work in the morning, have limited income or a lack of healthy options at home, or possess a lack of education on the benefits of breakfast. Evidence shows that breakfast consumption reduces weight gain by improving satiety and decreasing binge eating later in the day. High-fiber cereals (ie, >2 g per serving) and whole-grain products improve satiety and decrease binge eating at lunch or after school. The total dietary fiber intake should equal age plus 5 g for young children and up to 14 g/1,000 calories for adolescents.
In the National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study, 2,379 white and black females aged 9 to 19 years were followed on an annual basis. The more frequently breakfast was consumed was associated with a higher calcium and fiber intake and, consequently, a lower body mass index. This article focuses on the NHLBI guidelines for cardiovascular risk reduction in children and adolescents, including practical suggestions about breakfast meal planning and food choices. These recommendations offer real-time dietary suggestions and practical advice for patients’ families.

CME Educational Objectives

1.
Discuss the important effects skipping meals can have on the overall long-term well-being of a child.

2.
Identify strategies parents can use to promote a consistent adequate breakfast meal.

3.
Provide specific ideas for a breakfast meal that match differing family lifestyles.
Childhood Obstructive Sleep Apnea Syndrome: A Review of the 2012 American Academy of Pediatrics Guidelines
Authors: Trosman Irina 
Published: August 2014

CME Educational Objectives

1.
Review new 2012 American Academy of Pediatrics guidelines for the diagnosis and management of childhood obstructive sleep apnea syndrome (OSA).

2.
Outline the differences between the previous 2002 guidelines and the most recent guidelines.

3.
Highlight controversies and challenges in the diagnosis and management of pediatric OSA.

On a busy day at the pediatric office, child health care practitioners may see children of different ages present with symptoms such as inattentiveness, hyperactivity, aggression, behavioral problems, excessive sleepiness, difficulty waking up in the morning, learning problems, frequent awakening at night, restless sleep, morning headaches, and nocturnal enuresis. Children with these symptoms may be underweight or morbidly obese; healthy; or suffering from asthma, seasonal allergies, or other ailments. What they will likely have in common is a fairly well-known and yet under-recognized condition — obstructive sleep apnea syndrome (OSA).
The American Academy of Pediatrics first published “Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome” in 2002. However, with the increase in obstructive sleep apnea syndrome research, they revised these guidelines in 2012. These new guidelines evaluate obstructive sleep apnea syndrome diagnostic techniques, describe available treatment options, and provide follow-up recommendations. This article explores those revisions.
Just a Scary Dream? A Brief Review of Sleep Terrors, Nightmares, and Rapid Eye Movement Sleep Behavior Disorder
Authors: Haupt Mark , Sheldon Stephen H. , Loghmanee Darius 
Published: August 2014

CME Educational Objectives

1.
Recognize the signs and symptoms of parasomnias in children.

2.
Develop a clinical framework to evaluate common parasomnias in children.

3.
Distinguish the unique features of sleep terrors, nightmares, and rapid eye movement sleep behavior disorder (RBD).

The clinical spectrum of sleep disorders in children is broad, ranging from primary snoring and obstructive sleep apnea (OSA) syndrome to complex sleep-related behaviors and movement disorders. Although snoring and OSA typically receive significant attention and discussion, other biologically based sleep disorders are as common, if not more common, in children. A general pediatrician is frequently presented with the complaint of sleep talking, sleep walking, or abnormal movements during sleep. Even more alarming is the presentation of the child suddenly and explosively screaming during sleep. Such complaints fall under the category of parasomnias. Exclusive to sleep and wake-to-sleep transitions, these parasomnias include arousals with abnormal motor, behavioral, autonomic, or sensory symptoms. Parasomnias can be noticeably dissimilar in clinical manifestations, but most share biologic characteristics. Three parasomnias associated with loud vocalizations associated with sleep that can present to general practitioners include sleep terrors, nightmares, and rapid eye movement sleep behavior disorder (RBD). Although usually benign, these sleep disorders can be disruptive and even potentially dangerous to the patient and can often be threatening to quality of life. In this article, we describe the clinical features of some of these disorders and how to differentiate between their alarming presentations.
Diagnosis and Treatment of Adolescent Idiopathic Scoliosis
Authors: Burton Monique S. 
Published: August 2014

CME Educational Objectives

1.
Define scoliosis, including the three major types of scoliosis and the age breakdown for idiopathic scoliosis.

2.
Utilize an algorithm for scoliosis screening and the appropriate use of imaging modalities.

3.
Understand the appropriate management for adolescent idiopathic scoliosis, including indications for bracing and referral for surgery.

Scoliosis is defined as a lateral curvature of the spine greater than 10 degrees on radiography that is typically associated with trunk rotation. The three major types of scoliosis are congenital, idiopathic, and neuromuscular. Idiopathic scoliosis is divided into three subcategories based on the age of onset. Infantile idiopathic scoliosis affects patients younger than 3 years, juvenile idiopathic scoliosis appears in children between 3 and 10 years, and adolescent idiopathic scoliosis (AIS) occurs in skeletally immature patients older than 10 years.
AIS is the most common form of idiopathic scoliosis. Approximately 2% to 4% of children aged 10 to 16 years have some degree of spinal curvature. Although some researchers view routine screening for AIS as controversial, well-child examinations and sports physicals are an optimal time to evaluate for AIS in the clinical setting.
In 2008, the American Academy of Orthopaedic Surgeons, the Scoliosis Research Society, the Pediatric Orthopaedic Society of North America, and the American Academy of Pediatrics convened a task force to review the issues related to scoliosis screening and issued an information statement concluding that although screening has limitations, the potential benefits that patients with idiopathic scoliosis receive from early treatment can be substantial. Recommendations are now that females are screened twice, at age 10 and 12 years, and males once at age 13 or 14 years. Screening during routine well-child examinations and/or school-based evaluations will help identify patients who need ongoing monitoring. The evaluation of curvatures in conjunction with the level of skeletal maturity will help to guide the management of the curvature.
Skeletal Trauma in Child Abuse
Authors: Swoboda Sara L. , Feldman Kenneth W. 
Published: August 2014

CME Educational Objectives

1.
Understand the key history elements and risk factors that raise suspicion for non-accidental trauma.

2.
Identify which fractures and injury patterns are concerning for nonaccidental trauma.

3.
Discuss mandatory reporter regulations regarding suspected child abuse.

Fractures and other skeletal injuries are common in childhood. Most are the result of falls, motor vehicle accidents, and other forms of accidental trauma. However, skeletal trauma is present in a significant number of abused children. Age and developmental abilities are key components in raising clinical suspicion for child abuse. Children who are unable to provide their own history because of age or developmental delay require increased attention. Younger children are more likely to have abusive fractures, whereas accidental fractures increase with age and developmental abilities. The consequences of missing abuse are high because children returned to their homes without intervention are likely to face further abuse and have an increased mortality risk. Because of the potentially high cost of undiagnosed child abuse, diagnosis of a skeletal injury is incomplete without diagnosing its etiology. All health providers for children should be able to recognize patterns of skeletal injury secondary to abusive trauma and understand the process for initiating Child Protective Services (CPS) investigations when necessary. Although they can occur accidentally, fractures in nonmobile children should always increase the clinician’s concern for abusive trauma. In light of the significant consequences for children when abuse is missed by a primary care provider, abuse should be on the differential diagnosis for all presenting childhood injuries.
Febrile Seizures
Authors: Patterson Janet L. , Carapetian Stephanie A. , Hageman Joseph R. , Kelley Kent R. 
Published: August 2014

CME Educational Objectives

1.
Discuss the classification, epidemiology, and pathophysiology of febrile seizures in children.

2.
Review the evaluation, management, and prognosis of febrile seizures.

3.
Understand the long-term outcomes and implications for follow-up management and parental education of febrile seizures.

Febrile seizures are the most common form of childhood seizures, affecting 2% to 5% of children. They are considered benign and self-limiting; however, a febrile seizure is a terrifying event for most parents, and is one of the most common causes of trips to the emergency room.
A febrile seizure is “an event in infancy or childhood, usually occurring between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause.” This definition excludes seizures with fever in children who have had a prior afebrile seizure. In 2011, The American Academy of Pediatrics (AAP) published a clinical practice guideline defining a febrile seizure as “a seizure accompanied by fever (temperature ≥ 100.4°F or 38°C by any method), without central nervous system infection, that occurs in infants and children 6 through 60 months of age.” Febrile seizures are further classified as simple or complex. This article reviews the evaluation, management, and prognosis of simple and complex seizures, including febrile status epilepticus.