bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Evaluation of a Method for Evaluating Pediatric Residents' Knowledge and Skill in Performing Physical Examinations of the Ankle and Knee
Authors: Hergenroeder Albert C. , Laufman Larry , Chorley Joseph N. , Fetterhoff Amy C. 
Published: August 2004

Background.
Pediatric residents need the knowledge and physical examination skills to evaluate common musculoskeletal injuries. The ankle and the knee are the 2 most common sites of musculoskeletal injury in young athletes. Methods for evaluating pediatric residents' knowledge and skills in examining the ankle and knee are needed.

Objectives.
1) To describe the development of a method for evaluating pediatric residents' knowledge and skill in performing physical examinations of the ankle and knee, and 2) to report the reliability of this method.

Methods.
A written test and a Clinical Skills Assessment Examination (CSAE) with a rating index were developed by the investigators to evaluate pediatric residents' knowledge and skills in examining the ankle and knee. Fifty-eight pediatric residents completed the written test and examined the ankle and knee of one standardized patient at the beginning of a required 1-month adolescent medicine rotation. Forty-eight residents repeated the evaluation at the end of the month. The investigators rated the residents' performance of the CSAE and then assessed interrater reliability using Cronbach's α. Test–retest correlation was calculated to assess the reliability of the written test.

Results.
Test–retest correlation for the written test was 0.72, establishing its reliability. Interrater reliability for rating the CSAE of the ankle and knee was 0.98 and 0.90, respectively.

Conclusion.
Pediatric residents' knowledge and skills in examining the ankle and knee can be reliably evaluated using the written test and CSAE described in this article. These could be used to assess the effectiveness of current curricula in improving pediatric residents' knowledge and skill in evaluating ankle and knee complaints and to assist in the design of future curricula. musculoskeletal, evaluation methods, resident curriculum.
Pediatric Residents' Performance of Ankle and Knee Examinations After an Educational Intervention
Authors: Hergenroeder Albert C. , Chorley Joseph N. , Laufman Larry , Fetterhoff Amy C. 
Published: August 2004

Background.
Pediatric residents have the need for additional training in the care of common musculoskeletal injuries.

Objectives.
To implement and evaluate the effects of a teaching intervention on pediatric residents' knowledge and skills in performing the physical examination of the ankle and knee.

Study Design.
Prospective, intervention, single-sample study design.

Methods.
Pediatric residents (n = 58) on a 1-month adolescent medicine rotation received a teaching intervention after a baseline evaluation of their knowledge and skills. The teaching intervention was designed to improve their knowledge about and skills in performing physical examinations of the ankle and knee. The intervention included watching a videotape, followed by observation of the attending physician demonstrating the techniques on a standardized patient, followed by correct demonstration of the techniques by the resident. The residents' knowledge and skills were assessed at the end of the rotation and 9 months later. Knowledge was assessed using a written examination. Skills assessment was performed using a Clinical Skills Assessment Examination.

Results.
At baseline, the residents performed 37% of the ankle and 18% of the knee physical examination techniques correctly. At 1 and 9 months, the residents' knowledge of ankle and knee examinations was greater than at baseline. The residents performed 77% of the techniques correctly at 1 month and 67% at 9 months. The residents performed 55% of the knee examination techniques correctly at 1 month and 47% at 9 months. The teaching intervention was rated highly by the residents.

Conclusions.
The residents' performance of ankle and knee examinations was suboptimal at baseline and improved significantly after the teaching intervention. Observed improvements persisted for a mean of 35 weeks. The teaching intervention described in this study could meet the need for improved ankle and knee examination skills, the 2 most common sites of skeletal injury in young athletes. The teaching model is novel in that it couples videotape and skills-based teaching methods with reliable evaluation methods. This model teaching method could be adapted for use in other pediatric residency training programs and other content areas. musculoskeletal, physical examination, resident curriculum.
Methemoglobinemia and Consumption of Vegetables in Infants
Authors: Sanchez-Echaniz Jesus , Benito-Fernández Javier , Mintegui-Raso Santiago 
Published: August 2004

Objective.
To assess clinical and epidemiologic data of 7 infants diagnosed with acquired methemoglobinemia at the pediatric emergency department between 1993 and 1998. All cases were attributed to the consumption of mixed vegetables.

Methods.
Medical records were reviewed to collect anamnestic data; history of food ingestion; and results of physical examination, pulse oximetry, gasometry, cooximetry, urinalysis, and outcome. Local health authorities provided information on nitrate concentration in running water and in vegetables of common consumption in the area.

Results.
The mean age of the patients was 8.14 months (range: 7–13). None of the infants was undernourished, had diarrhea, or was given any drug. Drinking water showed a nitrate concentration of 3 to 6 ppm. All were fed homemade purée of mixed vegetables, prepared in advance and kept in the refrigerator for 12 to 27 hours. Silver beets were a common ingredient. No case showed metabolic acidosis. Methemoglobin level ranged between 10% and 58%. Three cases had nitrituria. Silver beets in our area were the vegetables with the highest nitrate concentration (mean: 3200 mg/kg).

Conclusions.
Consumption of silver beets and incorrect storage of homemade purées of mixed vegetables were potential causes of methemoglobinemia in this series. The disease may occur in children older than 6 months of age. Nitrituria in a cyanotic infant may suggest the diagnosis of methemoglobinemia. methemoglobinemia, nitrates, nitrites, food analysis, infant food, food preservation.
Examination of State Regulations Regarding Infants and Sleep in Licensed Child Care Centers and Family Child Care Settings
Authors: Moon Rachel Y. , Biliter Wendy M. , Croskell Sarah E. 
Published: August 2004

Background.Twenty percent of sudden infant death syndrome (SIDS) occurs in child care settings. Although the incidence of SIDS in the United States has decreased with increased awareness of the risks of prone infant sleeping, smoke exposure, soft bedding, and unsafe sleep environments, avoidance of these risk factors is not universally practiced in child care settings. Advocacy through state child care regulatory agencies and legislative bodies may be effective in more widespread awareness and avoidance of risk factors.Objective.To determine what individual state regulations for licensed child care centers and family child care settings exist regarding: 1) sleep positions for infants under 6 months old, 2) crib safety, 3) bedding safety, and 4) smoking in the facilities.Design.A descriptive survey of regulations for licensed child care centers and family child care settings in the 50 states and the District of Columbia.Results.Fifteen states use regulations adopted before publication of the first policy statement of the American Academy of Pediatrics on infant sleep position and SIDS in 1992. Six states require child care centers to place infants nonprone. Sixty-three percent of states require cribs in child care centers to meet at least 1 safety standard, and 45.1% require this in family child care homes. Six states have provisions limiting the use of soft bedding in child care centers, and 4 have such bans for family child care homes. Seventy-one percent of states prohibit smoking in child care centers during hours of operation; 17% of states have similar requirements for family child care homes.Conclusions.Many states use child care regulations that were written before the initial policy statements of the American Academy of Pediatrics regarding safe sleep environments for infants. Even those more recently adopted regulations do not adequately address sleep safety for infants. Pediatricians need to become more proactive in promoting safety regulations in child care. Adoption of new regulations can aid in education of child care providers and, thus, improve the safety for infants in child care.
Early Childhood Otitis Media in Relation to Children's Attention-Related Behavior in the First Six Years of Life
Authors: Minter Karin R. , Roberts Joanne E. , Hooper Stephen R. , Burchinal Margaret R. , Zeisel Susan A. 
Published: August 2004

Objective.This study examined whether otitis media with effusion (OME) and associated hearing loss during the first 4 years of life were related to the ratings of parents, teachers, and clinicians of children's attention and behavior in the first 6 years of life.Methods.In a prospective study, 85 black children were recruited from community-based child care programs when they were between 6 and 12 months old. OME and hearing status were monitored repeatedly from 6 months to 4 years old. Measures of attention and behavior were collected from parents, teachers, and clinicians when the children were infants, preschoolers, and first graders.Results.On average, children experienced either bilateral or unilateral OME 30% of the time and hearing loss 19.9% of the time between 6 months and 4 years old. Descriptive and inferential analyses revealed no significant associations between OME or hearing loss and the measures of attention or behavior completed by parents, teachers, and clinicians.Conclusions.In this sample of children, there was no relationship between amount of early childhood OME or hearing loss and measures of attention or behavior in the first 6 years of life as reported by parents, teachers, and clinicians. otitis media, hearing, attention, behavior.
Effects of Contingent Television on Physical Activity and Television Viewing in Obese Children
Authors: Faith Myles S. , Berman Nathaniel , Heo Moonseong , Pietrobelli Angelo , Gallagher Dympna , Epstein Leonard H. , Eiden Mark T. , Allison David B. 
Published: August 2004

Objective.Elevated television (TV) viewing and physical inactivity promote obesity in children. Thus, changes in physical activity and sedentary behavior seem critical to treating childhood obesity.Present Study.Using a randomized, 2-arm design, this pilot study tested the effects of contingent TV on physical activity and TV viewing in 10 obese children. TV viewing was contingent on pedaling a stationary cycle ergometer for experimental participants but was not contingent on pedaling for control participants. The study was conducted over 12 weeks, including a 2-week baseline period.Results.Multivariate analyses indicated that the intervention significantly increased pedaling and reduced TV-viewing time. During the treatment phase, the experimental group pedaled 64.4 minutes per week on average, compared with 8.3 minutes by controls. The experimental group watched 1.6 hours of TV per week on average, compared with 21.0 hours per week on average by controls during this phase. Secondary analyses indicated that the experimental group showed significantly greater reductions in total body fat and percent leg fat. Total pedaling time during intervention correlated with greater reductions in percent body fat (r = −0.68).Conclusions.Contingencies in the home environment can be arranged to modify physical activity and TV viewing and may have a role in treating childhood obesity. Contingent TV may be one method to help achieve this goal.
The Association Between Childhood Depression and Adulthood Body Mass Index
Authors: Pine Daniel S. , Goldstein Rise B. , Wolk Susan , Weissman Myrna M. 
Published: August 2004

Objective.
Stress in childhood relates to both childhood depression and elevated adult body mass index (BMI), a measure of relative overweight. However, there are limited data on the association between major depression in childhood and BMI in adulthood. The current study examines this association.

Method.
Children 6 to 17 years old with major depression (n = 90) or no psychiatric disorder (n = 87) were identified at Columbia Presbyterian Medical Center and followed up 10 to 15 years later. Psychiatric status at intake and follow-up was assessed via standardized psychiatric interviews. BMI during adulthood was recorded so that the association between depression and BMI could be considered over time.

Results.
Participants with childhood major depression had a BMI of 26.1 ± 5.2 as adults, compared with a BMI of 24.2 ± 4.1 in healthy comparisons (t175 = 2.7). This association could not be explained by a number of potentially confounding factors, including age, gender, cigarette or alcohol use, social class, and pregnancy or medication history. Although poverty during adulthood also predicted adult BMI, both the association between poverty and adult BMI (t152 = 2.9), as well as between childhood depression and adult BMI (t152 = 2.2) were significant in a multivariate model. Finally, duration of depression between childhood and adulthood also emerged as a predictor of adult BMI.

Conclusions.
Depression during childhood is positively associated with BMI during adulthood. This association cannot be explained by various potential confounding variables and may develop over time as children pass into their adult years. body mass index, depression, children, adolescents.
Cardiovascular Effects of Hydrocortisone in Preterm Infants With Pressor-Resistant Hypotension
Authors: Seri Istvan , Tan Rosemarie , Evans Jaquelyn 
Published: August 2004

Objective.To study the cardiovascular effects of hydrocortisone in preterm infants with hypotension unresponsive to volume and pressor administration.Study Design.Retrospective review of the cardiovascular response to 23 courses of hydrocortisone administration during the first day of treatment in 21 preterm infants (gestational age: 26.9 ± 3.9 weeks; postnatal age: 11.3 ± 13.1 days). Hydrocortisone (2 mg/kg/d in 16 patients and 3–6 mg/kg/d in 5 patients) was administered when dopamine (22.2 ± 11 μg/kg/min, range: 8–60) alone (n = 16) or in combination with dobutamine (8.4 ± 4.9 μg/kg/min, range: 5–20,n = 7) and/or epinephrine (0.38 ± 0.56 μg/kg/min, range: 0.01–1.2, n = 4) failed to normalize blood pressure.Results.Mean blood pressure increased from 29.3 ± 4.1 to 34.1 ± 5.2, 38.0 ± 8.0, and 41.8 ± 6.6 mm Hg by 2, 4, and 6 hours of hydrocortisone administration, respectively, and remained stable thereafter. Urine output increased despite a decrease in fluid administration during the first day of hydrocortisone treatment. The dose of dopamine and the number of patients receiving dobutamine and/or epinephrine also decreased during the same period. Eighteen of the 21 patients survived.Conclusions.Preterm infants with volume- and pressor-resistant hypotension respond to hydrocortisone with rapid normalization of the cardiovascular status and sustained decreases in volume and pressor requirement.
Developmental Follow-Up of Breastfed Term and Near-Term Infants With Marked Hyperbilirubinemia
Authors: Harris Mary Catherine , Bernbaum Judy C. , Polin Jessica R. , Zimmerman Robert , Polin Richard A. 
Published: August 2004

Objective.In recent years, the increased prevalence of breastfeeding in conjunction with early discharge practices has increased the risk for marked hyperbilirubinemia in neonates. This has resulted in the potential for bilirubin brain injury in affected infants. The purpose of this study was to identify all infants ≥36 weeks' gestational age with bilirubin levels &gt;25 mg/dL and evaluate them for early and late evidence of bilirubin brain injury.Methods.We reviewed the charts of all infants (from 1993–1996) ≥36 weeks' gestational age who were readmitted to the hospital during the first week of life with bilirubin levels &gt;25 mg/dL. Readmission records were reviewed for early signs of bilirubin encephalopathy. Magnetic resonance imaging (MRIs) and Brainstem auditory-evoked responses (BAERs) were reviewed for evidence of bilirubin toxicity. At follow-up, study infants had a complete neurodevelopmental examination, repeat MRIs, and behavioral hearing evaluations.Results.From 1993 to 1996, we identified 6 term and near-term infants readmitted to the hospital within the first week of life with peak bilirubin values ranging from 26.4 mg/dL (451 μmol/L) to 36.9 mg/dL (631 μmol/L). Five of 6 infants had bilirubin values &gt;30 mg/dL (513 μmol/L). All were exclusively breastfed or fed a combination of breast and bottle feedings. Five of 6 infants presented with abnormal neurologic signs. Four infants had initial MRIs, 3 of whom had increased signal intensity in the basal ganglia consistent with kernicterus. Two infants had abnormal BAERs; both also had abnormal MRIs. Five of 6 infants received exchange transfusions and all were treated with phototherapy and intravenous fluids. Follow-up examinations between 3 months and 2 years showed resolution of clinical signs in all but 1 infant. Four infants had a subsequent normal MRI and 1 had residual hearing impairment. One infant demonstrated severely abnormal developmental evaluations, as well as both an abnormal initial MRI and BAERs. Follow-up MRI showed evidence of encephalomalacia with changes not characteristic of kernicterus.Conclusions.We observed transient neurologic abnormalities in 5 of 6 infants readmitted to the hospital during the first week of life with marked hyperbilirubinemia. The abnormalities resolved following aggressive management using hydration, phototherapy, and exchange transfusion and may not correlate with long-term prognosis. Less aggressive therapy may be associated with residual neurologic abnormalities. We speculate that inadequate establishment of breastfeeding coupled with early discharge practices may play a role in the development of marked hyperbilirubinemia in these infants.
Improving the Delivery of Adolescent Clinical Preventive Services Through Skills-Based Training
Authors: Lustig Julie L. , Ozer Elizabeth M. , Adams Sally H. , Wibbelsman Charles J. , Fuster C. Daniel , Bonar Robert W. , Irwin Charles E. 
Published: August 2004

Objective.To examine the efficacy of skills-based training workshops on primary care providers' screening and counseling practices with adolescents during routine outpatient well visits.Design.Sixty-three primary care providers in outpatient pediatric departments within a managed health care organization participated in two 4-hour workshops on clinical preventive services for adolescents. The workshops focused on adolescent health, confidentiality, screening, and anticipatory guidance/brief counseling for 5 risk behaviors including: helmet and seatbelt use, tobacco use, alcohol use, and sexual behavior. A pre/posttest design was used to assess clinicians' screening and counseling practices during the pretraining and posttraining periods. Independent adolescent reports of clinicians' practices were obtained from 2 samples of 14- to 16-year-old adolescents immediately after their routine well visit in the outpatient clinics. One sample of adolescents reported during a pretraining period and a separate sample reported during a period after the training.Results.Adolescent reports indicated that after the training workshops, the average percentage of adolescents screened by their primary care providers increased significantly for seatbelt use (from mean 38% to 56%), helmet use (from mean 27% to 45%), tobacco use (from mean 64% to 76%), alcohol use (from mean 59% to 76%), and sexual behavior (from mean 61% to 75%). Additionally, the average percentage of adolescents offered brief counseling by their clinicians increased significantly after training in the areas of seatbelt use (from mean 36% to 51%), helmet use (from mean 25% to 43%), and sexual behavior (from mean 42% to 58%). Improvement after the training in brief counseling for tobacco use was marginally significant (from mean 60% to 69%) and for alcohol use was not significant, although there was an increase. Clinicians also significantly increased their discussion of the limits of confidentiality with their adolescent patients after the training workshops (from mean 32% to 45%).Conclusions.This study offers strong support for the efficacy of skills-based training for primary care providers as a method for increasing screening and counseling practices with adolescents. The present findings suggest that with appropriate skills-based training, practicing clinicians can implement several of the national guidelines that direct them to provide preventive services for multiple behaviors in a routine outpatient visit. Screening and counseling in these visits are important in the early identification, detection, and prevention of behaviors associated with the primary adolescent morbidities and mortalities. Thus, enhancing the delivery of clinical preventive services is an important step in the prevention of untoward health outcomes for youth.
Closed-Loop Controlled Inspired Oxygen Concentration for Mechanically Ventilated Very Low Birth Weight Infants With Frequent Episodes of Hypoxemia
Authors: Claure Nelson , Gerhardt Tilo , Everett Ruth , Musante Gabriel , Herrera Carmen , Bancalari Eduardo 
Published: August 2004

Background.
Mechanically ventilated very low birth weight infants often present with frequent episodes of hypoxemia, and maintaining arterial oxygen saturation by pulse oximetry (Spo2) within a normal range by manual fraction of inspired oxygen (Fio2) adjustments is difficult and time consuming.

Objectives.
An algorithm for closed-loop Fio2 control (cFio2) to maintain Spo2 within a target range was compared with continuous manual Fio2(mFio2) adjustments by a nurse in a group of ventilated infants who presented with frequent episodes of hypoxemia.

Results.
Fourteen infants (birth weight: 712 ± 142 g; gestational age: 25 ± 1.6 weeks; age: 26 ± 11 days; synchronized intermittent mandatory ventilation rate: 24 ± 10 b/m; peak inspiratory pressure: 17.5 ± 2.0 cmH2O; positive end-expiratory pressure: 4.3 ± 0.5 cmH2O) were studied for 2 hours on each mode in random sequence. Both modes aimed to maintain Spo2 between 88% and 96%.
There were 15 ± 7 and 16 ± 6 hypoxemic episodes/hour (Spo2 &lt;88%, &gt;5 s) during mFio2 and cFio2, respectively; episode duration was 41 ± 23 and 32 ± 15 s, totaling 19 ± 16% and 17 ± 12% of recording time. There were 13 ± 10 and 10 ± 8 hyperoxemic episodes/hour (Spo2&gt;96%, &gt;5 s) during mFio2 and cFio2,respectively; episode duration was 27 ± 15 and 24 ± 19 s, totaling 15 ± 14% and 10 ± 9% of recording time. Mean Spo2 and Fio2 levels were similar during both modes. The nurse made 29 ± 17 adjustments/hour during mFio2. There was a significant increase in the duration of normoxemia (Spo2 between 88%–96%) during cFio2 (75 ± 13 vs 66 ± 14% of recording time).

Conclusion.
In this group of infants, cFio2 was at least as effective as a fully dedicated nurse in maintaining Spo2 within the target range, and it may be more effective than a nurse working under routine conditions. We speculate that during long-term use, cFio2 may save nursing time and reduce the risks of morbidity associated with supplemental oxygen and episodes of hypo- and hyperoxemia.