bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatricians' Awareness of and Attitudes About Four Clinical Practice Guidelines
Authors: Christakis Dimitri A. , Rivara Frederick P. 
Published: August 2004

Background. The increasing complexity of medical care and a desire to increase quality and control costs have led to growing use of clinical practice guidelines (CPGs). It is unclear how helpful these guidelines are to the practitioners expected to use them. We surveyed pediatricians about their knowledge and impressions of four well-publicized CPGs: the American Academy of Pediatrics' “Practice Parameter for Hyperbilirubinemia in Newborns” (hyperbilirubinemia), “A Guideline for the Management of Febrile Infants” (fever), the Agency for Health Care Policy and Research's “Guideline for Otitis Media With Effusion” (otitis), and the US Preventive Services Task Force Guide to Clinical Preventive Services (preventive care).Objectives. 1) What percentage of practicing pediatricians are aware of these guidelines? 2) How helpful do they find them? 3) What are practitioners' perceived limitations of these guidelines? 4) Have these guidelines affected provider behavior? 5) Are there features of a provider's training or practice that are associated with changing practice as a result of guidelines?Design. A national survey of 600 pediatricians selected at random from the American Medical Association master file.Results. A total of 300 of 555 eligible participants (54%) returned surveys. Of the respondents, 66% were aware of the hyperbilirubinemia guideline, 64% of the fever guideline, 50% of the otitis guideline, but only 16% knew of the preventive care guidelines. Mean helpfulness scores (1 to 10 scale, where 1 = “not at all helpful” and 10 = “extremely helpful”) ranged from 3.67 to 6.67 for the different guidelines. In terms of limitations, 15% to 33% of respondents reported that CPGs were “too cookbook,” 6% to 19% reported that they were “too time-consuming,” and 4% to 16% reported that they were “too cumbersome.” Additional reported limitations were believing that a guideline left no room for personal experience and judgment, concern of increased liability risk, and poor parental acceptance of CPG recommendations. The proportions reporting change in management as a result of a CPG were 28% for the hyperbilirubinemia guideline, 36% for the fever guideline, 19% for the preventive care guidelines, and 28% for the otitis guideline. Mean helpfulness scores reported by nonuniversity-affiliated physicians were significantly higher than those reported by university-affiliated physicians. In a regression model of respondents aware of a particular guideline, more recent graduation from medical school and increased helpfulness scores were associated with guideline-related behavior change.Conclusion. In their present form, CPGs are not perceived as very helpful by most practitioners. More recent medical school graduates and nonuniversity-affiliated physicians are more likely to find them helpful and more likely to change their behavior because of them.
Impact of Education for Physicians on Patient Outcomes
Authors: Clark Noreen M. , Gong Molly , Schork M. Anthony , Evans David , Roloff Dietrich , Hurwitz Martin , Maiman Lois , Mellins Robert B. 
Published: August 2004

Objectives. This study was conducted to assess the impact of an interactive seminar based on self-regulation theory on 1) the treatment practices and communications and education behavior of physicians, 2) the health status and medical care utilization of their pediatric patients with asthma, and 3) the satisfaction with care of the subjects' parents.
Methods. A total of 74 general practice pediatricians were assigned to either a program or a control group in a randomized controlled study. Data were collected from physicians at baseline, and 69 (93%) provided follow-up data 5 months after the program. Data were also collected from 637 of their patients at baseline, and in a 22-month window after the intervention, 472 (74%) of this number provided follow-up data.
Results. After the seminar, physicians in the program group were more likely than were control group physicians to address patients' fears about medicines, review written instructions, provide a sequence of educational messages, write down how to adjust the medicines at home when symptoms change, and report that they spent less time with their patients. Parents of the children treated by program physicians were significantly more likely than were control group parents to report that the physician had been reassuring, described as a goal that the child be fully active, and gave information to relieve specific worries. After a visit with the physician, these parents were also more likely to report that they knew how to make management decisions at home. After the intervention compared to controls, patients of physicians in the program group were more likely to have received a prescription for inhaled antiinflammatory medicine and to have been asked by the physician to demonstrate how to use a metered-dose inhaler. After the intervention, children seen by program physicians made significantly fewer nonemergency office visits and visits for follow-up of an episode of symptoms; however, there were no differences in emergency department visits and hospitalizations. Among children who were placed on inhaled corticosteroids during this study, however, children treated by physicians who had received education had significantly fewer symptoms and fewer follow-up office visits, nonemergency physician office visits, emergency department visits, and hospitalizations.
Conclusions. The interactive seminar based on theories of self-regulation led to patient–physician encounters that were of shorter duration, had significant impact on the prescribing and communications behavior of physicians, led to more favorable patient responses to physicians' actions, and led to reductions in health care utilization.
Health and Developmental Outcomes at 18 Months in Very Preterm Infants With Bronchopulmonary Dysplasia
Authors: Grégoire Marie-Claude , Lefebvre Francine , Glorieux Jacqueline 
Published: August 2004

Objective. To determine whether very preterm infants who are oxygen-dependent at 28 days of life but not at 36 weeks' gestational age are at high risk of morbidities at 18 months.Population. A total of 217 infants born in a tertiary care center at 24 to 28 weeks' gestation in 1987 to 1992, classified into three groups: neonatal comparison group, O2 &lt;28 days of life (n = 76); bronchopulmonary dysplasia (BPD)-1, O2 ≥28 days but not at 36 weeks' gestational age (n = 48); and BPD-2, O2 ≥36 weeks (n = 93).Outcome Measures. Growth, persistent respiratory problems (asthma, tracheostomy, home oxygen therapy), surgery, hospitalizations, and neurodevelopmental impairments.Results. Among the three groups, no differences were found in weight, height, head circumference, or total number of days of rehospitalizations for any causes, or in rate of rehospitalizations to the intensive care unit, persistent respiratory problems, cerebral palsy, or sensory impairment. Children with BPD-2 needed more hernia repairs compared with the other two groups (comparison group: 12% vs BPD-1: 10% vs BPD-2: 30%), had more days of readmissions for respiratory problems (comparison group: 2.0 vs BPD-1: 2.0 vs BPD-2 6.3 [BPD-1 vs BPD-2]), had a lower mean developmental quotient (comparison group: 97.4 ± 15.0 vs BPD-1: 97.9 ± 11.6 vs BPD-2: 90.7 ± 19.3). Intraparenchymal cerebral lesions, high family adversity, and prolonged ventilation were the most important factors influencing the developmental outcome.Conclusion. Children with BPD-1 are similar in all respect at 18 months to children in the comparison group. Children with BPD-2 are similar to the other groups at 18 months in growth, general health, and neurologic outcome but differ in having a higher number of days of rehospitalizations for respiratory causes, more hernia repairs, and more developmental delays.
Cystatin C—A New Marker of Glomerular Filtration Rate in Children Independent of Age and Height
Authors: Bökenkamp Arend , Domanetzki Michael , Zinck Raymund , Schumann Gerhard , Byrd Dennis , Brodehl Johannes 
Published: August 2004

Objectives. Serum creatinine is the most common endogenous marker of renal function. The proportionality between creatinine production and muscle mass requires adjustment for height and body composition. The low molecular weight protein cystatin C is produced by all nucleated cells and eliminated by glomerular filtration. Therefore, cystatin C was studied as an alternative marker of glomerular filtration rate (GFR) in children.Methods. Cystatin C and creatinine were measured in sera from inulin clearance (CIn) examinations performed in 184 children aged 0.24 to 17.96 years. CIn ranged from 7 to 209 mL/min/1.73 m2 (median, 77).Results. The reciprocal of cystatin C correlated better with CIn (r = 0.88) than the reciprocal of creatinine (r = 0.72). Stepwise regression analysis identified no covariates for the correlation between cystatin C and CIn, whereas height was a covariate for creatinine. Using an estimate of GFR from serum creatinine and height, correlation with CIn was similar to cystatin C, but female gender and dystrophy were associated with an overestimation of GFR. Diagnostic accuracy in the identification of reduced GFR measured as area under the receiver-operating characteristic plot was 0.970 ± 0.135 (mean ± SE) for cystatin C and 0.894 ± 0.131 for creatinine (NS). A cutoff cystatin C concentration of 1.39 mg/L had 90% sensitivity and 86% specificity for detecting abnormal GFR.Conclusion. Unlike creatinine, serum cystatin C reflects renal function in children independent of age, gender, height, and body composition.
Venipuncture Is More Effective and Less Painful Than Heel Lancing for Blood Tests in Neonates
Authors: Larsson Björn A. , Tannfeldt Gunnilla , Lagercrantz Hugo , Olsson Gunnar L. 
Published: August 2004

Objective. Heel lancing has hitherto been the method of choice for screening tests of inborn errors of metabolism in neonates. Eutectic mixture of local anesthetic has little, if any, analgesic effect when applied to the heel of pre- and full-term infants. Today there seems to be no practical method that effectively alleviates the pain caused by heel lancing. The aim of this study was to investigate whether other methods, such as venipuncture of the dorsal side of the hand, are less painful and more efficient than heel lancing in neonates.Methods. One hundred twenty healthy, full-term infants who underwent testing for phenylketonuria (PKU) were included in the study. They were randomized into three groups: a venipuncture group (VP) (n = 50), a heel-lance group with a small lancet (SL) (n = 50), or a large lancet (LL) (n = 20). Pain reactions were assessed by the Neonatal Facial Coding System (NFCS). The latency and duration of the first cry as well as the total screaming time was analyzed. The efficacy of the method was assessed by the time taken to complete the PKU test and number of times the skin had to be punctured.Results. Nociceptive response. The NFCS scores after the first skin puncture were: VP, 247; SL, 333; and LL, 460. The NFCS scores were significantly lower in the VP than in the groups subjected to heel lancing. During the first 60 seconds after skin puncture, 44% of the infants cried in the VP group, compared with 72% and 85% in the SL and LL groups, respectively.Efficacy. A successful PKU test with only one skin puncture was performed in 86% of the VP group, but in only 19% in the SL group and 40% in the LL group. The total time needed to obtain the PKU blood sample was 191 seconds (median) in the VP group, 419 seconds in the SL group, and 279 seconds in the LL group.Conclusion. Venipuncture is more effective and less painful than heel lancing for blood tests in neonates.
Developmental Changes in Energy Expenditure and Physical Activity in Children: Evidence for a Decline in Physical Activity in Girls Before Puberty
Authors: Goran Michael I. , Gower Barbara A. , Nagy Tim R. , Johnson Rachel K. 
Published: August 2004

Objective. To examine individual changes in energy expenditure and physical activity during prepubertal growth in boys and girls.
Methods. Total energy expenditure (TEE), resting energy expenditure, physical activity-related energy expenditure, reported physical activity, and fat and fat-free mass were measured three times over 5 years in 11 boys (5.3 ± 0.9 years at baseline) and 11 girls (5.5 ± 0.9 years at baseline).
Results. Four-year increases in fat (∼6 kg) and fat-free mass (∼10 kg) and resting energy expenditure (∼200 kcal/day) were similar in boys and girls. In boys, TEE increased at each measurement year, whereas in girls, there was an initial increase from age 5.5 (1365 ± 330 kcal/day) to age 6.5 (1815 ± 392 kcal/day); however, by age 9.5, TEE was reduced significantly (1608 ± 284 kcal/day) with no change in energy intake. The gender difference in TEE changes over time was explained by a 50% reduction in physical activity (kcal/day and hours/week) in girls between the ages of 6.5 and 9.5.
Conclusions. These data suggest a gender dimorphism in the developmental changes in energy expenditure before adolescence, with a conservation of energy use in girls achieved through a marked reduction in physical activity.
Low Serum Thyroxine on Initial Newborn Screening Is Associated With Intraventricular Hemorrhage and Death in Very Low Birth Weight Infants
Authors: Paul David A. , Leef Kathleen H. , Stefano John L. , Bartoshesky Louis 
Published: August 2004

Transient hypothyroxinemia (TH) of prematurity has been correlated with poor neurodevelopmental outcome. However, the relationship between thyroid function and neonatal mortality and brain injury has not been described.
Objective. To investigate the relationship between thyroid function and neonatal outcome.
Methods. Review of infants weighing &lt;1500 grams admitted to a single level III newborn intensive care unit (n = 342). Serum total T4 values of initial newborn screening of infants dying before hospital discharge were compared with those of surviving infants. Total T4values from infants with and without intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) also were compared.
Results. T4 values strongly correlated with gestational age (r = .56). Overall, 289 (85%) of 342 infants had TH. None of the infants had true congenital hypothyroidism. T4 values of infants with cystic PVL (n = 15) were not statistically different from those for infants who did not develop cystic PVL. Infants with IVH (n = 58) had a lower T4 value than did infants who did not develop IVH (5.4 ± 3.4 μg/dL vs 7.8 ± 3.6 μg/dL). Infants who died before hospital discharge (n = 24) had a lower T4 value than did infants discharged to home (3.4 ± 2.2 vs 7.9 ± 3.7 μg/dL). After controlling for potential confounding variables, T4 value remained associated with an increased odds of IVH (odds ratio: 1.2; 95% confidence interval: 1.05 to 1.4) and mortality (odds ratio: 2.3; 95% confidence interval 1.6 to 3.4).
Conclusions. In our population of very low birth weight infants, TH has an incidence of 85%. Very low T4 values on initial newborn screening are associated with increased odds of death and IVH. Additional investigation is needed to determine whether low serum thyroxine level contributes to IVH and neonatal death or whether it is simply an associated factor.
School-age Follow-up of Prophylactic Versus Rescue Surfactant Trial: Pulmonary, Neurodevelopmental, and Educational Outcomes
Authors: Sinkin Robert A. , Kramer Bonnie M. , Merzbach Joan L. , Myers Gary J. , Brooks John G. , Palumbo Donna R. , Cox Christopher , Kendig James W. , Mercier Charles E. , Phelps Dale L. 
Published: August 2004

Background. Exogenous surfactant replacement has improved survival and reduced pulmonary complications of prematurity. Improved early outcomes for infants of &lt;30 weeks' gestation treated with a strategy of prophylactic versus rescue surfactant, if needed, were demonstrated in a multicenter, randomized trial conducted between 1985 and 1988. We reevaluated a subset of survivors from this trial to determine the pulmonary and neurodevelopmental outcomes at school age.Methods. At 4.5 to 8 years of age, all survivors from one of the three centers were located, and 96% were evaluated. The original randomization included stratification by center and followed an intention-to-treat methodology in assessing the efficacy of prophylactic versus rescue treatment with surfactant. The follow-up test battery included a health-assessment questionnaire, spirometry, 88% saturation test, neurologic examination, and the McCarthy Scales of Children's Abilities (MSCA) and the Conners' Parent Rating Scale–48. Educational achievement was determined by school class placement and teachers' reports of achievement.Results. Of the 192 children originally enrolled, 154 survived. Evaluations were performed on 148 of these infants. An abnormal pulmonary history was found in 45 (30%) of the children: 16 (22%) in the prophylactic group and 29 (39%) in the rescue group. Formal pulmonary function was evaluated in 81 children; 29 (78%) in the prophylactic group and 33 (75%) in the rescue group were considered abnormal. No significant differences were found between the two groups on either cognitive or motor subscales of the MSCA, the Conners' Parent Rating Scale–48, the neurologic examination, the education services received in school, or the teacher ratings of below-average academic performance. Intelligence scores measured on the MSCA were low–normal for both groups. Some level of educational assistance was being provided to 72 (49%) of the cohort studied, and both groups had below average educational performance and increased needs for educational assistance.Conclusions. Prophylactic surfactant administration to infants of &lt;30 weeks' gestation was associated with fewer long-term clinical pulmonary complications than assignment to rescue administration. Formal pulmonary testing at school age did not reveal significant differences between treatment groups in those infants who could be tested. There also were no group differences found on neurologic, cognitive, behavioral, or educational assessments at school age.
Cat Scratch Disease Presenting With Peripheral Facial Nerve Paralysis
Authors: Walter Robert S. , Eppes Stephen C. 
Published: August 2004

Acquired peripheral facial nerve paralysis is a relatively common disorder that affects both children and adults. The most frequent nontrauma-related etiologies in otherwise neurologically intact patients are idiopathic (Bell's palsy) and infectious, which includes otitis media, herpes zoster, Lyme disease, herpes simplex virus, Epstein–Barr virus, and Mycoplasma pneumoniae.1
Cat scratch disease (CSD) is typically a subacute, regional lymphadenitis caused by Bartonella henselae that is seen in children and young adults. CSD most often has a benign, self-limited course. However, 11% of CSD patients may present atypically, most commonly with Perinaud's oculoglandular syndrome or acute encephalopathy.6
We present a child with the first reported case of acute facial nerve paralysis in serologically proven CSD with typical lymphadenitis.
Pitfalls in the Diagnosis of Ventricular Shunt Dysfunction: Radiology Reports and Ventricular Size
Authors: Iskandar Bermans J. , McLaughlin Colleen , Mapstone Timothy B. , Grabb Paul A. , Oakes W. Jerry 
Published: August 2004

Introduction. The diagnosis of shunt malfunction can be difficult even for the experienced clinician and may lead to disastrous circumstances when misinterpreted. Less experienced physicians may rely more on radiographic reports as a primary diagnostic modality. In this study, we evaluated the reliability of using these reports without accurate clinical assessment.
Methods. All shunt revisions seen at Children's Hospital (Birmingham, AL) between January 1996 and August 1996 were reviewed, excluding patients with brain tumors, supratentorial extraaxial fluid collections, and infections. Sixty-eight patients underwent 100 operations for shunt malfunction. All patients had evidence of shunt blockage, disconnection, catheter malposition, or valve pressure incompatibility. The prospective radiographic interpretation of preoperative computed tomography and magnetic resonance imaging scans was reviewed in each case.
Results. Twenty-four percent of the reports made no mention of shunt malfunction. In this group, the ventricular system was described as “unchanged,” “stable,” “normal,” “unremarkable,” “small,” “smaller,” “slit,” “negative,” and “no hydrocephalus,” with no other comment to support a diagnosis of shunt malfunction. An additional 9% of reports contained the same terms, while also hinting at some other clinical or radiographic data that suggest the possibility of shunt failure (eg, a shunt disconnection seen on plain radiographs), despite the scan findings. In all patients in this group, symptoms improved after surgery.
Conclusion. We conclude that as many as one third of patients presenting with shunt malfunction will not have the diagnosis of shunt malfunction supported by a prospective radiologic interpretation of brain imaging. Although the neurosurgical community can assess the clinical situation to determine the need for surgery, other clinicians can be easily reassured by a radiographic report that does not mention or diagnose shunt malfunction. Today, more than ever, nonneurosurgeons are being called on to evaluate complex clinical situations and may rely on radiographic reports.
Facilities and Equipment for the Care of Pediatric Patients in a Community Hospital
Authors:   Committee on Hospital Care
Published: August 2004

This Clinical Report was revised. See https://doi.org/10.1542/peds.2020-0204.
Most children requiring hospitalization are admitted to community hospitals that vary significantly in their pediatric resources. The intent of this statement is to provide guidelines for furnishing and equipping a pediatric area in a community hospital.
Pediatric Cardiac Surgery: The Effect of Hospital and Surgeon Volume on In-hospital Mortality
Authors: Hannan Edward L. , Racz Michael , Kavey Rae-Ellen , Quaegebeur Jan M. , Williams Roberta 
Published: August 2004

Objective. To examine the relationship between annual provider (hospital and surgeon) volume of pediatric cardiac surgery and in-hospital mortality.
Design. Population-based retrospective cohort study using a clinical database.
Setting. The 16 acute care hospitals in New York with certificate of need approval to perform pediatric cardiac surgery.
Patients. All children undergoing congenital heart surgery in New York from 1992 to 1995.
Main Outcome Measures. Risk-adjusted mortality rates for various hospital and surgeon volume ranges. Adjustments were made for severity of illness using logistic regression.
Results. A total of 7169 cases were analyzed. After controlling for severity of preprocedural illness using clinical risk factors, hospitals with annual pediatric cardiac surgery volumes of fewer than 100 had significantly higher mortality rates (8.26%) than hospitals with volumes of 100 or more (5.95%), and surgeons with annual volumes of fewer than 75 had significantly higher mortality rates (8.77%) than surgeons with annual volumes of 75 or more (5.90%).
Conclusions. Both hospital volume and surgeon volume are significantly associated with in-hospital mortality, and these differences persist for both high-complexity and low-complexity pediatric cardiac procedures.