bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interactive Communication in High-technology Home Care: Videophones for Pediatric Ventilatory Care
Authors: Miyasaka Katsuyuki , Suzuki Yasuyuki , Sakai Hirokazu , Kondo Yoichi 
Published: August 2004

Objective. To develop and to assess the clinical impact of a near-television quality home digital videophone system (Integrated Services Digital Network [ISDN] 64, 320 × 200 resolutions, 10 to 12 frames per second), which would provide respiratory care specialists’ resources to primary care physicians and their pediatric patients receiving home respiratory care.
Method. A prospective study comparing the preceding 6 months and following 6 months of implementation of a videophone system on seven pediatric home respiratory care patients (group I) and a prospective analytical study of three patients (group II) being introduced to home ventilatory care were carried out. Clinical effectiveness and time-saving benefits were studied.
Results. There were large reductions in the number of house calls by the physicians (from 5 to 0), unscheduled hospital visits by patients (from 24 to 5), and hospital admission days (from 22 to 10), with a fivefold increase in phone calls (from 11 to 58) in group I. This reduced the net number of hours spent by both patients and physicians in unscheduled medical care by 95 hours for the patients and 51.2 hours for the physicians. A total of 45 videophone calls, of which 27 were related to mechanical concerns and 18 to medical concerns, were made in group II. There were 7 mechanical and 10 medical problems of clinical significance, but all were directly handled by physicians by videophone. The majority (35 of 45) of videophone calls were made in the first 3-month period, indicating a decrease in nonspecific concerns after this period. The specifications of the system we used were found acceptable by both patients and health care professionals. The system seemed to be useful in effectively using the time of specialists and in relieving the anxieties of families. No deleterious effects were noted. The current initial cost is substantial but rapidly falling. The running cost is similar to a regular telephone bill when one ISDN 64 line is used.
Conclusions. The videophone system using ISDN 64 can now be considered a practical and effective tool to recruit specialist resources into home care and to improve the quality of pediatric home ventilatory care. This study encourages the use of videophones to help establish designated home care support systems that may extend beyond national borders and time zones. home care, videophone, telemedicine, Integrated Services Digital Network.
Partial Liquid Ventilation in Critically Ill Infants Receiving Extracorporeal Life Support
Authors: Greenspan Jay S. , Fox William W. , Rubenstein S. David , Wolfson Marla R. , Spinner Susan S. , Shaffer Thomas H. ,   Philadelphia Liquid Ventilation Consortium
Published: August 2004

Objectives. To demonstrate that a period of partial liquid ventilation (PLV) with perflubron improves pulmonary function, without adverse events, in a select group of critically ill infants receiving extracorporeal life support (ECLS) with a high likelihood of mortality.
Methods. This was an open-label, noncontrolled, phase I and II trial of PLV in two infants with congenital diaphragmatic hernia and four infants with acute respiratory distress syndrome (ARDS) who were failing to improve while receiving ECLS. PLV was performed by instilling and maintaining a functional residual capacity of sterile perflubron for 4 to 96 hours.
Results. Four infants were successfully weaned off ECLS for at least 3 days, and two infants (both with ARDS) are long-term survivors after PLV. All infants demonstrated lung recruitment and improved lung compliance, and there were no adverse events related to PLV.
Conclusions. The study suggests that perflubron PLV is safe, improves lung function, and recruits lung volume in critically ill infants receiving ECLS. PLV therapy for infants with ARDS seems to have a great deal of promise. Based on this and other phase I and II trials, studies of PLV on selected full-term infants before ECLS have been initiated. congenital diaphragmatic hernia, acute respiratory distress syndrome, partial liquid ventilation, extracorporeal life support.
Environmental Risk Factors Associated With Pediatric Idiopathic Pulmonary Hemorrhage and Hemosiderosis in a Cleveland Community
Authors: Montaña Eduardo , Etzel Ruth A. , Allan Terrance , Horgan Timothy E. , Dearborn Dorr G. 
Published: August 2004

Background. Unexplained pulmonary hemorrhage and hemosiderosis are rarely seen in infancy. A geographic cluster of 10 infants with this illness was identified in a large pediatric referral hospital in Cleveland, Ohio, during the period of January 1993 through December 1994. One infant died of severe respiratory failure.
Methods. A case-control study was conducted. Three control infants were matched by age with each case infant. All study infants’ guardians were interviewed. Questions were asked about child care practices and home conditions for the period before case infants’ illnesses. All infants’ records were reviewed, their homes were visited, and a structural and environmental survey was conducted.
Results. All 10 case infants were black, and 9 were male, whereas 50.0% of control infants were male, and 83.3% were black. The case infants’ mean age was 10.2 weeks (range, 6 weeks to 6 months). Matched analysis demonstrated that case infants’ homes were more likely to have had water damage preceding the pulmonary hemorrhage event (odds ratio, 16.25; 95% confidence interval, 2.55 to ∞). Case infants were also more likely to have had close relatives with pulmonary hemorrhage (odds ratio, 33.14; 95% confidence interval, 5.10 to ∞). In addition, 50.0% of case infants experienced recurrent pulmonary hemorrhaging after returning to their homes.
Conclusion. The results of this investigation of a cluster of infants with massive, acute pulmonary hemorrhage and hemosiderosis suggest that the affected infants may have been exposed to contaminants in their homes. Epidemiologic clues, such as water damage in the case infants’ homes, suggest that environmental risk factors may contribute to pulmonary hemorrhage. pulmonary hemorrhage, hemosiderosis, infancy, indoor air pollution, pesticides, volatile organic compounds, cholinesterase.
Primary Care Pediatrics in Italy: Eighteen Years of Clinical Care, Research, and Teaching Under a National Health Service System
Authors: del Torso Stefano , Bussi Roberto , DeWitt Thomas G. 
Published: August 2004

This article reviews how Italian National Health Service (NHS) pediatricians have tried to fulfill the obligations of modern primary care providers in a managed care environment, with special reference to the experience of the Veneto region in Italy and compares this situation with the present changes of the health system in the United States.
Italian NHS primary care pediatricians work independently in their offices, providing acute and chronic patients to all children 0 to 14 years old: NHS primary care physicians, including 7000 pediatricians, contract directly with the government for the care of patients through a capitated reimbursement system.
Twenty-nine independent associations of community pediatricians have been formed with the primary goal to pursue research and education in primary care pediatrics, in addition to traditional care. Several multicenter collaborative research studies at the national level have been organized and four university residency programs are training their residents in community-based pediatricians’ offices also, giving priority to activities specific to ambulatory practice and follow the suggestion of an Italian work group on ambulatory pediatric training.
The NHS has allowed the Italian pediatrician to focus on patient care and education rather than business. Computerization has been applied to the practice of medicine through the development of electronic medical records, particularly in the Veneto region. This technology allows combining effective clinical care with outcome researches and facilitates continuing medical education and residents’ training programs.
Italian primary care NHS pediatricians have tried to identify and address patient’s needs as well as the needs of a primary care provider in a managed care system. Recent and possible future modifications in the health system in the United States and in Italy need to be examined to learn from similarities and differences. primary care, network research, managed care, national health care, education.
Children and Adult Perceptions of Childhood Asthma
Authors: Guyatt Gordon H. , Juniper Elizabeth F. , Griffith Lauren E. , Feeny David H. , Ferrie Penelope J. 
Published: August 2004

Objective. To explore children's and parents' assessment of children's asthma.
Design. Prospective 2-month cohort study in which children and parents were reviewed at baseline and 1-month intervals.
Setting. Mid-sized, English-speaking, industrial community serving an urban and regional rural population.
Patients or Participants. Fifty-two children, 7 to 17 years old, with a wide range of asthma severity, and their parents.
Interventions. We offered patients with inadequately controlled asthma additional inhaled steroid.
Main Outcome Measures. Children and parents provided global ratings of change in childhood symptoms and children completed spirometry and the Paediatric Asthma Quality of Life Questionnaire at clinic visits. Patients recorded peak flow rates, symptoms, and medication use in a daily diary. The diary symptom report, medication use, and spirometry were combined to form an asthma control score.
Results. In children younger than 11, children's global rating of change in symptoms correlated strongly with changes in quality of life (0.54 to .67) but not with measures of airway caliber or asthma control, while parents' global ratings did not correlate with children's quality of life but showed moderate correlations with airway caliber (0.29 to .48) and asthma control (0.50). In children over the age of 11, correlations with all clinical variables were higher for their own than their parents' global ratings.
Conclusions. In children under 11, clinicians can gain complementary information from questioning children and parents. For children over 11, parents can provide little if any information beyond that obtained through questioning the child.
Prevention of Pediatric Drowning and Near-drowning: A Survey of Members of the American Academy of Pediatrics
Authors: O'Flaherty Jennifer E. , Pirie Phyllis L. 
Published: August 2004

Objective. To assess pediatricians' knowledge about the epidemiology of childhood drowning, their opinions and current practices regarding its prevention, and their interest in taking on more responsibility for its prevention.Design. A self-administered questionnaire was mailed to 800 pediatricians in the United States, randomly selected from the American Academy of Pediatrics' approximately 18 000 full fellows.Results. A total of 560 completed surveys were returned, a response rate of 70.1%. Although 85% of respondents believe it is the responsibility of pediatricians to become involved in community and/or legislative efforts to prevent childhood drowning, only 4.1% were involved in such efforts. Only a minority of respondents provided written materials and anticipatory guidance on drowning prevention to their patients. Women were more likely than men to discuss drowning prevention with their patients. Younger physicians were more likely than older physicians to discuss drowning prevention with their patients. Physicians who received formal education on drowning prevention during their pediatric residency training were more likely to provide written materials and anticipatory guidance on drowning prevention to their patients. However, only 17.9% of respondents received formal education on drowning prevention during their pediatric residency training. Seventy-four percent of all respondents felt that further education on the prevention of childhood drowning and near-drowning would be useful to them.Conclusion. Although drowning is the second leading cause of death by unintentional injury in the pediatric population (aged 0 to 19 years), most pediatricians do not routinely provide information to their patients, or to their patients' parents, on drowning prevention.Implication. Pediatricians have been effective child advocates in many areas of injury prevention. If the prevention of drowning is made a priority in pediatric practice, many more children's lives will be saved.
Long-term Appearance of Lacerations Repaired Using a Tissue Adhesive
Authors: Simon Harold K. , McLario David J. , Bruns Thomas B. , Zempsky William T. , Wood Robert J. , Sullivan Kevin M. 
Published: August 2004

Background. Histoacryl Blue (HAB), a tissue adhesive, has been shown to decrease laceration repair time, cause less pain to the child, eliminate the need for suture removal, and result in a similar short-term cosmetic outcome compared with conventional suturing. Reports suggest that poor correlation can exist between the short-term and long-term cosmetic outcomes for lacerations repaired by conventional suturing. Therefore, this study compares the long-term cosmetic outcome of HAB to conventional suturing for laceration repair in children.
Design. Prospective, randomized clinical trial.
Participants. Children presenting an urban pediatric emergency department for laceration repair between October 1994 and February 1995 were eligible. Patients less than 1 or more than 18 years old, those with lacerations more than 5 cm in length, or in areas of high tension or mobility were excluded.
Interventions. After routine wound management, including subcutaneous closure when deemed necessary, patients were randomized to receive skin sutures or HAB for cutaneous closure. Photographs taken at the 2-month and 1-year follow-up visits were evaluated for cosmetic appearance by two plastic surgeons blinded to the method of repair.
Results. Sixty-one children were enrolled: HAB (N = 30), suture (N = 31). Thirty HAB and 25 sutured patients were assessed at 2 months, while 17 HAB and 15 sutured patients were reevaluated at 1 year. Patients that followed-up at 2 months and 1 year were comparable to those with no follow-up in: treatment group (HAB vs suture), demographics, wound characteristics, and initial parental satisfaction. The two plastic surgeons graded the cosmetic appearance of the wounds repaired by HAB to be comparable to those repaired by conventional suturing at both the 2-month and 1-year follow-up.
Conclusions. The use of HAB is an ideal alternative to conventional suturing for the cutaneous closure of low tension lacerations in children with a long-term cosmetic outcome comparable to conventional suturing.
Therapy for Children With Invasive Pneumococcal Infections
Authors:   Committee on Infectious Diseases
Published: August 2004

This Policy Statement was retired May 2009.
This statement provides guidelines for therapy of children with serious infections possibly caused by Streptococcus pneumoniae. Resistance of invasive pneumococcal strains to penicillin, cefotaxime, and ceftriaxone has increased over the past few years. Reports of failures of cefotaxime or ceftriaxone in the treatment of children with meningitis caused by resistant S pneumoniae necessitates a revision of Academy recommendations. For nonmeningeal infections, modifications of the initial therapy need to be considered only for patients who are critically ill and those who have a severe underlying or potentially immunocompromising condition or patients from whom a highly resistant strain is isolated. Because vancomycin is the only antibiotic to which all S pneumoniaestrains are susceptible, its use should be restricted to minimize the emergence of vancomycin-resistant organisms. Patients with probable aseptic (viral) meningitis should not be treated with vancomycin. These recommendations are subject to change as new information becomes available.
Twenty Years of Outpatient Respiratory Syncytial Virus Infection: A Framework for Vaccine Efficacy Trials
Authors: Fisher Randall G. , Gruber William C. , Edwards Kathryn M. , Reed George W. , Tollefson Sharon J. , Thompson Juliette M. , Wright Peter F. 
Published: August 2004

Background. Respiratory syncytial virus (RSV) is the most important viral respiratory pathogen of infancy and childhood. Much has been written about inpatients with severe disease. Inpatients, however, represent only a minority of RSV-infected children. We studied the characteristics of symptomatic outpatient RSV infection in healthy children to gain a better understanding of RSV disease and to provide a background for the testing of intervention strategies in children without high-risk conditions.
Methods. A total of 1113 children were followed during 20 consecutive RSV seasons. Signs and symptoms of respiratory infection were monitored. Cultures were obtained for febrile upper respiratory infection, acute otitis media, and lower respiratory infection (LRI). Rates of febrile upper respiratory infection, acute otitis media, LRI, and hospitalization were calculated. Given those rates, numbers of children needed to demonstrate efficacy of a vaccine product were calculated.
Results. Mild disease from RSV infection lacked some of the classic features of RSV infection seen in hospitalized children. Involvement of the lower respiratory tract was, however, noted to be much higher in RSV infection than it was in infection with other viral respiratory pathogens. LRI was, therefore, considered the best candidate endpoint for vaccine trials. A product with 60% efficacy could be proven, with a power of 0.8, to be efficacious with as few as 1500 infants.
Conclusions. RSV infection is common and often involves the lower respiratory tract, even in outpatients. Our 20-year study of RSV infection provides a basis for calculation of sample sizes to be used in trials of vaccine candidates. respiratory syncytial virus, outpatient, epidemiology, vaccine, bronchiolitis.
Pediatric Injury Resulting From Family Violence
Authors: Christian Cindy W. , Scribano Philip , Seidl Toni , Pinto-Martin Jennifer A. 
Published: August 2004

Objective. Children who live in violent households are at risk for emotional and physical injury. Although recent research has addressed the emotional impact of witnessing family violence, no study has addressed the inadvertent physical injuries that result to children who witness family violence. The objective of this study was to describe the causes, types, and patterns of pediatric injuries resulting from family violence.
Methods. We reviewed the medical records of 139 children who presented to the emergency department with injuries resulting from domestic violence for demographic information, mechanism of injury, type, location, and severity of injury, treatment, and disposition.
Results. Children who were injured during domestic violence ranged in age from 2 weeks to 17 years. Although the mean age of the children identified was 5 years, 48% of the children were younger than 2 years. Although the most common dyad involved in the fight was the mother and father (57% of cases), extended family members and nonrelated adults were involved in almost one third of the cases. The most common mechanism of injury was a direct hit (36%). Of the injured children who were younger than 2 years, 59% were injured while being held by parents. Thirty-nine percent of the children were injured during attempts to intervene in fights. The majority of injuries were to the head (25%), face (19%), and eyes (18%). Young children sustained more head and facial injuries than older children, who had disproportionately more extremity trauma. Medical intervention was indicated in 43% of patients, of which 9% required hospital admission and 2% required surgical or intensive care intervention. Of the 91% of children discharged from the emergency department, 73% returned home, and 27% went to alternative homes.
Conclusions. Children sustain a wide range of physical injuries from family violence. Because the majority of injuries are minor, specific inquiry into the causes of all pediatric injuries may help further identify children living among family violence. domestic violence, child abuse, family violence, physical injury.
Australian Collaborative Trial of Antenatal Thyrotropin-Releasing Hormone: Adverse Effects at 12-Month Follow-up
Authors: Crowther Caroline Anne , Hiller Janet Esther , Haslam Ross Roger , Robinson Jeffrey Samuel ,   the ACTOBAT Study Group
Published: August 2004

Objective. The Australian Collaborative Trial of Antenatal Thyrotropin-Releasing Hormone (ACTOBAT) assessed the efficacy of 200 μg of thyrotropin-releasing hormone (TRH) in combination with glucocorticoids in the prevention of neonatal lung disease.1 This paper reports the 12-month follow-up of the infants from the trial completed in 1994.
Design. This was a double-blinded randomized controlled trial.
Setting. Women were recruited from level 3 perinatal centers throughout Australia.
Participants. Mothers who had not withdrawn from treatment and whose infants were discharged alive (1262 infants). Extensive efforts were made to trace this entire cohort.
Outcome Measures. A questionnaire was mailed to parents for self-completion immediately before their baby's/babies' first birthday. The questionnaire included a checklist to assess sensory, motor, language, and social development, and use of health services.
Results.  Milestone scores were developed from items on the follow-up form. Treatment with TRH was associated with an increased risk of motor delay, social delay, fine motor delay, sensory impairment, and early language impairment. No differences were seen between treatment and placebo groups for motor impairment.
Multivariate analyses were performed, adjusting for chronological age, duration of gestation at randomization, time from randomization to delivery, parity, history of perinatal death, history of preterm rupture of the membranes, infant sex, singleton or twin status, maternal age, and maternal blood pressure (systolic and diastolic) at randomization. For the total cohort (N = 1022), treatment with TRH was associated with motor delay (odds ratio [OR], 1.51; 95% confidence interval [CI] 1.11 to 2.05); social delay (OR 1.40; 95% CI 1.01 to 1.95); sensory impairment (OR, 2.00; 95% CI 1.06 to 3.74); severe impairment (OR, 1.75; 95% CI 1.07 to 2.87); and a trend toward motor impairment (OR, 1.50; 95% CI .97 to 2.33), early language impairment (OR, 1.27, 95% CI .90 to 1.79), and fine motor delay (OR, 1.15; 95% CI .83 to 1.60).
There were no differences between the treatment groups in hospital admissions (OR, 1.08; 95% CI .83 to 1.42), doctors' visits (general practitioner OR adj, 1.09; 95% CI .79 to 1.50 or specialist OR adj 1.15; 95% CI .87 to 1.49), respiratory symptoms (OR adj, 1.16; 95% CI .88 to 1.53), or behavioral disturbances (OR adj, .93; 95% CI .71 to 1.21).
Conclusions. Because antenatal administration of TRH is associated with small, consistent deficits in major milestone achievements at 12 months of age, it is essential that additional planned trials make provision for long-term follow-up. Antenatal TRH should only be used in the context of a clinical trial.