bluuebunny/crossref_metadata_2025_split huggingface dataset:
Parental Preferences for Primary and Specialty Care Collaboration in the Management of Teenagers With Congenital Heart Disease
Authors: Miller Marlene R. , Forrest Christopher B. , Kan Jean S. 
Published: August 2004

Objectives.We examined parental preferences for locus of service delivery for their teenager's congenital heart disease (CHD) and the influence of disease severity, sociodemographic factors, and insurance on these preferences.Methods.A consecutive sample of parents of teenagers followed in a pediatric cardiology clinic completed a mailed questionnaire. Disease severity was classified as low (≤1 cardiovascular procedure), moderate (&gt;1 cardiovascular procedure), and high (cyanosis or single ventricle physiology).Results.Eighty-six of 148 parents responded (58%): 40, low severity; 36, moderate severity; and 10, high severity of illness. Parents preferred using primary care providers (PCPs) as a point of first contact for all 11 of 11 general health concerns and 5 of 7 potential cardiovascular-related concerns: chest pain (52%), syncope (73%), seeming seriously ill (79%), sports physical examination (79%), and endocarditis prophylactic antibiotics (94%). Increasing disease severity was significantly associated with preferring cardiologists for 6 of 7 cardiovascular-related concerns. Overall, 58% of parents viewed their care as a PCP–cardiologist comanagement model versus a cardiologist-dominated model. Lower family income (odds ratio [OR]: 1.5; confidence interval [CI]: 1.0–2.2) and severity of illness (OR: 2.1; CI: 1.0–4.4) were associated with a comanagement model of health care versus a cardiologist-dominated model.Conclusions.This study suggests that the majority of parents of teenagers with CHD prefer to use their teenager's PCP for all routine health care needs and many cardiovascular health needs. Severity of illness and family income are positively associated with greater preference for cardiologist care.
High-Versus Low-Threshold Surfactant Retreatment For Neonatal Respiratory Distress Syndrome
Authors: Kattwinkel John , Bloom Barry T. , Delmore Paula , Glick Christina , Brown David , Lopez Suzanne , Willett Lynne , Egan Edmund A. , Conaway Mark , Patrie James 
Published: August 2004

Surfactant therapy has become an effective standard therapy for infants with respiratory distress syndrome (RDS). The first dose may be given either as prophylaxis immediately after delivery, or as rescue after an infant has developed RDS. Second and subsequent doses are currently recommended by the manufacturers to be administered at minimal levels of respiratory support.Purpose. This study compared the relative efficacy of administering second and subsequent doses of Infasurf surfactant at a low threshold (Fio2 &gt;30%, still requiring endotracheal intubation) versus a high threshold (Fio2 &gt;40%, mean airway pressure &gt;7 cm H2O) of respiratory support.Methods. A total of 2484 neonates received a first dose of surfactant; 1267 reached conventional retreatment criteria and were randomized to be retreated according to low- or high-threshold criteria. They were then retreated at a minimum of 6-hour intervals each time they reached their assigned threshold until receiving a maximum of 4 total doses. Subjects were stratified by whether they received their first dose by prophylaxis or rescue and by whether their lung disease was considered complicated (evidence of perinatal compromise or sepsis) or uncomplicated.Results. Among the patients randomized, 33% of prophylaxis and 23% of rescue subjects met criteria for the complicated stratum. Although infants allocated to the high-threshold strategy were receiving slightly more oxygen at 72 hours, there was no difference in the number receiving mechanical ventilation at 72 hours or in the secondary respiratory outcomes (requirement for supplemental oxygen or mechanical ventilation at 28 days, supplemental oxygen at 36 weeks' postconceptional age, inspired oxygen concentration &gt;60% at any time). However, there was a significantly higher mortality for infants with complicated RDS who had received retreatment according to the high-threshold strategy.Conclusions. We conclude that equal efficacy can be realized by delaying surfactant retreatment of infants with uncomplicated RDS until they have reached a higher level of respiratory support than is the current standard. We speculate that this would result in a substantial cost-saving from less utilization of drug. Conversely, we believe that infants with complicated RDS should continue to be treated by the low-threshold retreatment strategy, which is currently recommended by the manufacturers of the commercially available surfactants.
Sudden Infant Death Syndrome in Child Care Settings
Authors: Moon Rachel Y. , Patel Kantilal M. , Shaefer Sarah J. McDermott 
Published: August 2004

Background.The incidence of sudden infant death syndrome (SIDS) in the United States has decreased with decreased prone sleeping. Extrapolating from Census Bureau data, ∼7% of SIDS should occur in organized child care settings (ie, child care centers or family child care homes). However, 2 states have reported higher rates of SIDS in child care.Objectives.To determine the percentage of SIDS deaths occurring in child care settings, and to ascertain associated factors.Design.A retrospective study of SIDS deaths from January 1995 through June 1997 was conducted. Data were abstracted from SIDS databases in 11 states. Characteristics of SIDS cases occurring in child care settings, including sleep position, were compared with those occurring in the care of parents. Univariate and multiple logistic regression analyses were performed.Results.A total of 1916 SIDS cases were analyzed for this study. Of these deaths, 20.4% occurred in child care settings. Compared with deaths in the care of parents, those occurring in child care settings were more likely to occur on weekdays between 8:00am and 4:00 pm; infants were older; not black; and their mothers were more educated. Infants in child care were more likely to be found prone in univariate analysis, but the association was not significant in multiple logistic regression analysis. However, in multiple regression analysis, infants in child care were more likely to be last placed prone or found prone, when the usual sleep position was side or supine.Conclusion.A large proportion (20.4%) of SIDS cases occur in child care settings. Factors associated with SIDS in child care settings include older age, race, and highly educated parents. Previous studies have reported that unaccustomed prone sleeping puts infants at high risk for SIDS; this characteristic was found to be associated with SIDS in child care and may partly explain the high proportion of SIDS cases in child care settings. Parents must discuss sleep position with any caretakers of their infants. In addition, further efforts to educate child care providers about the importance of supine sleep for infants must be ongoing.
Pediatric Residency Education
Authors: Mulvey Holly J. , Ogle-Jewett Ethan A. B. , Cheng Tina L. , Johnson Robert L. 
Published: August 2004

Objective.
On February 1, 1997, new pediatric Residency Review Committee guidelines became effective. Eighteen months later, pediatric residency program directors were queried regarding the implementation of these guidelines. Because both the challenge to implement these guidelines and the opportunities to shape pediatric graduate medical education rest with the program directors, obtaining the feedback and suggestions from this group is seen as the keystone of future planning endeavors.

Methods.
A 20-question multiple-choice/opened-ended questionnaire was sent to the 201 members of the Association of Pediatric Program Directors in 2 mailings in August and September 1998.

Results.
A final response rate of 70% was achieved. Very few program directors reported difficulties in instituting the new residency review committee requirements. The exceptions to this pattern were those requirements pertaining to limitations on time spent in intensive care experience and in the neonatal intensive care unit, wherein 34% of the respondents identified barriers. Although the majority of respondents regarded these requirements as very good or sufficient, some program directors expressed concern regarding insufficient amounts of time available for preparation in intensive care (18%), neonatal intensive care unit (22%), behavioral/developmental pediatrics (16%), and in adolescent medicine (13%). In general, programs have been more successful in defining new competencies than in developing curricula to teach them. The majority of respondents also indicated that their residents' exposure was excellent or satisfactory in all 6 of the following practice settings: private office-based practice for continuity clinic, private office-based practice for outpatient rotation, predominately managed care practice, community clinics for continuity clinic, community clinics for outpatient rotation, and hospital-based practice for continuity clinic. They also indicated that they had no serious concerns about the types of career development assistance offered to residents and the types of follow-up tracking of residents.

Conclusion.
The findings from this survey have reaffirmed the merit of the current system of pediatric residency education. They have also revealed the commitment of program directors to address the complex issues generated by the evolution of health care delivery, and thereby contribute to the optimal provision of pediatric health care now and in the future.
The Value of First-Day Bilirubin Measurement in Predicting the Development of Significant Hyperbilirubinemia in Healthy Term Newborns
Authors: Alpay Faruk , Sarici S. Ümit , Tosuncuk H. Deniz , Serdar Muhittin A. , Inanç Neriman , Gökçay Erdal 
Published: August 2004

Objective.The recognition, follow-up, and early treatment of neonatal jaundice has become more difficult, since the earlier discharge of newborns from hospitals has become common practice. This prospective study was undertaken to identify the newborns at risk for developing significant hyperbilirubinemia later during the first days of life by measuring the serum bilirubin levels of the first 5 days of life to determine the critical predictive serum bilirubin value on the first day of life.Methodology.A total of 498 healthy term newborns were followed with daily serum total bilirubin measurements for the first 5 days of life, and cases with serum bilirubin levels of ≥17 mg/dL after 24 hours of life were defined to have significant hyperbilirubinemia.Results.No newborns had a serum total bilirubin level of ≥17 mg/dL in the first 72 hours of life. Sixty of 498 cases (12.05%) had significant hyperbilirubinemia after 72 hours of life, and these cases had significantly higher bilirubin levels than those who did not develop significant hyperbilirubinemia on each of the first 5 days' measurements. Of the 206 newborns who had a serum bilirubin level of ≥6 mg/dL in the first 24 hours, 54 (26.21%) developed significant hyperbilirubinemia, whereas only 6 of the 292 newborns (2.05%) who had a serum bilirubin level of &lt;6 mg/dL on the first day developed significant hyperbilirubinemia. A mean serum bilirubin level of ≥6 mg/dL on the first day had the highest sensitivity (90%). At this critical serum bilirubin value, the negative predictive value was very high (97.9%) and the positive predictive value was fairly low (26.2%). Furthermore, because no cases with a serum bilirubin level of &lt;6 mg/dL in the first 24 hours of life required a subsequent phototherapy treatment and because all of those infants requiring a phototherapy treatment with serum bilirubin levels of ≥20 mg/dL were just among the cases whose first-day bilirubin levels were ≥6 mg/dL, the critical bilirubin level of 6 mg/dL on the first day made it possible, with the highest (100%) sensitivity and negative predictive value, to definitely predict all of the infants who would have a bilirubin level of &gt;20 mg/dL, requiring a phototherapy treatment later during the first days of life.Conclusions.A serum bilirubin measurement and the use of the critical bilirubin level of 6 mg/dL in the first 24 hours of life will predict nearly all of the term newborns who will have significant hyperbilirubinemia and will determine all those who will require a phototherapy treatment later during the first days of life.
Depressive Symptoms and Cigarette Smoking Predict Development and Persistence of Sleep Problems in US Adolescents
Authors: Patten Christi A. , Choi Won S. , Gillin J. Christian , Pierce John P. 
Published: August 2004

Objective.
To evaluate factors related to the development and persistence of adolescent sleep problems.

Methods.
In this longitudinal, population-based study, the Teenage Attitudes and Practices Survey was administered by telephone to 7960 adolescents (3921 girls and 4039 boys) 12 to 18 years old in 1989 and at follow-up in 1993. Sleep problems at both time points were assessed using a single item on the Teenage Attitudes and Practices Survey. Those who responded that they “often or sometimes” had trouble going to sleep or staying asleep during the past 12 months were categorized as reporting sleep problems, whereas those who responded “often” were categorized as having frequent sleep problems. Multiple logistic regression analyses were used to identify baseline characteristics predictive of the development and persistence of sleep problems or frequent sleep problems, respectively, from baseline to follow-up.

Results.
Of the 4866 adolescents without sleep problems at baseline, 28% developed sleep problems by 1993, and 9% developed frequent sleep problems. Of the 3094 adolescents who reported sleep problems at baseline, 52% reported sleep problems in 1993, and 21% reported frequent sleep problems. Female sex and notable depressive symptoms were associated with the development and persistence of sleep problems and frequent sleep problems at follow-up. Cigarette smoking status showed a dose–response relationship with development of sleep problems and frequent sleep problems, and with persistence of frequent sleep problems at follow-up.

Conclusion.
The reduction of depressive symptoms and cigarette smoking among adolescents are important factors to consider in prevention and treatment efforts focused on adolescent sleep problems.
Immunization Entry at the Point of Service Improves Quality, Saves Time, and Is Well-Accepted
Authors: Adams William G. , Conners William P. , Mann Adriana M. , Palfrey Sean 
Published: August 2004

Objective.
Computer-based immunization tracking is a routine part of many pediatric practices; however, data quality is inconsistent and entry often relies on dedicated data entry personnel and is time-consuming, expensive, or difficult. The purpose of this study was to evaluate data quality, nursing satisfaction, and reduction in documentation burden after the introduction of a point-of-service immunization entry system in an inner-city pediatric primary care center.

Design.
Prospective preintervention and postintervention study.

Methods.
Visit records from all pediatric nonurgent care visits for patients &lt;5 years old were collected during a 2-week period before (preintervention) and after (postintervention) the introduction of a computer-based immunization entry system. Nurses used software designed to allow rapid entry during immunization preparation followed by printing 2 adhesive labels for documentation. Satisfaction was evaluated using an 8-question survey administered 3 months after the intervention.

Results.
One hundred forty-seven (63.6%) of 231 preintervention and 132 (51.4%) of 257 postintervention children received at least 1 immunization (immunized) during the study visit. Gender and mean age were similar for immunized children in the 2 groups. In the preintervention group, 56 (37.9%) of 147 immunized children had at least 1 dose missing (a total of 128 of 343 doses administered) from the immunization tracking database compared with none in the postintervention group. Medical record review showed that 92.6% of preintervention and 91.4% of postintervention children were on-schedule after the study visit. However, missing data lead to the misclassification of preintervention children—only 68.4% were reported by the database to be on-schedule. All 9 nurses reported using the program all the time to enter immunizations, 89% said that the program required somewhat or a lot less time, and 100% strongly recommended continued use of the program. All 9 nurses also reported that they would be somewhat or very unenthusiastic about the system if labels were not available. During the 12 months after introduction of the system, 8273 forms containing immunization information were printed, preventing nurses from having to write &gt;101 000 dates.

Conclusions.
Immunization entry by nurses at the time of immunization preparation improves the quality of tracking data, reduces misclassification of immunization needs, saves time, and can be well-accepted. It is likely that poor data quality in some tracking systems has led to falsely low immunization coverage estimates. Systems such as the one in this study can improve quality and should be integrated into routine clinical practice.
Stimulant Treatment in Maryland Public Schools
Authors: Safer Daniel J. , Malever Michael 
Published: August 2004

Objective.A statewide school survey was performed to provide naturalistic data on the prevalence of medication administered to Maryland public school students for the treatment of attention deficit hyperactivity disorder (ADHD) to clarify the concern of some state legislators about stimulant treatment for youths.Methods.In April 1998, school nurses supervised a survey of all Maryland public school students medicated during school hours for ADHD. The data collected on these students included: type of medication administered, gender, school level, race/ethnicity, special education and Section 504 status, and the specialist of the prescriber.Results.Of the 816 465 students surveyed, 20 050 (2.46%) received methylphenidate and 3721 (0.46%) received other medications for ADHD. Other major findings were: 1) methylphenidate constituted 84% of all the medication administered for ADHD; 2) the male:female ratio of the medication's recipients was 3.5:1 and 4.3:1 in elementary and secondary school, respectively; 3) black and Hispanic students received methylphenidate at approximately half the rate of their white counterparts; 4) 45% of all students receiving methylphenidate had special education status and an additional 8% had Section 504 status; and 5) nurse practitioners were the prescribers of 3% of the methylphenidate prescribed to Maryland students.Conclusions.This large, population-based, point prevalence study of medication administered to students for ADHD adds new and updated findings on prevalence variations, rates for minority and special education/Section 504 students, and specialty prescriber rates.
Vitamin A Status and Postnatal Dexamethasone Treatment in Bronchopulmonary Dysplasia
Authors: Shenai Jayant P. , Mellen Beverly G. , Chytil Frank 
Published: August 2004

Objective.Vitamin A (retinol) plays an important role in epithelial regeneration during recovery from lung injury in bronchopulmonary dysplasia (BPD). Dexamethasone is used in the postnatal treatment of very low birth weight (VLBW) neonates with BPD. To test the hypothesis that the vitamin A status is critical for the beneficial pulmonary response to dexamethasone, we performed a prospective cohort study in which we characterized the changes in plasma concentrations of vitamin A and retinol-binding protein (RBP) in response to dexamethasone, and correlated these changes with the pulmonary outcome.Methods.VLBW neonates (birth weight &lt;1350 g, gestational age &lt;31 weeks, postnatal age &gt;10 days), who had presumptive diagnosis of severe BPD and need for high ventilatory support (fraction of inspired oxygen ≥.6, mean airway pressure ≥7 cm H2O), were treated with a seven-day course of dexamethasone (.5 mg/kg/d × 2 days, .25 mg/kg/d × 2 days, .1 mg/kg/d × 3 days). Plasma concentrations of vitamin A and RBP were determined sequentially at baseline, and during and after dexamethasone treatment. Pulmonary response to dexamethasone was graded daily using a composite ventilation score. The changes in plasma vitamin A and RBP concentrations were compared between infants with a positive (beneficial) pulmonary response to dexamethasone and those with a negative response.Results.Among 23 infants studied, 13 showed a positive pulmonary response to dexamethasone, as indicated by successful weaning from supplemental oxygen and mechanical ventilation, whereas 10 showed a negative response. A significant, yet short-term, increase in plasma concentrations of both vitamin A and RBP was observed in most infants treated with dexamethasone. The plasma vitamin A and RBP responses to dexamethasone tended to be higher in infants with a positive pulmonary response than in those with a negative response. Accounting for gender, a vitamin A response with each 10.0 μg/dL increment in plasma vitamin A concentration was associated with a 60% increase in the odds favoring a positive pulmonary response to dexamethasone.Conclusion.Postnatal dexamethasone treatment in VLBW neonates with BPD induces a significant, yet short-term, increase in plasma concentrations of both vitamin A and RBP. This increase probably results from endogenous mobilization of vitamin A from the liver. Our data suggest that the beneficial pulmonary response to dexamethasone in infants with BPD is influenced, at least in part, by the vitamin A status, and that gender plays a role in this response.vitamin A, dexamethasone, bronchopulmonary dysplasia.