bluuebunny/crossref_metadata_2025_split huggingface dataset:
Addressing Transition to Adult Health Care for Adolescents With Special Health Care Needs
Authors: Scal Peter , Ireland Marjorie 
Published: June 2005

Objective. To determine the factors associated with addressing the transition from pediatric to adult-oriented health care among US adolescents with special health care needs.Methods. Data for 4332 adolescents, 14 to 17 years of age, from the 2000–2001 National Survey of Children With Special Health Care Needs were used. The adequacy of transition services was determined by parent self-report. Explanatory variables, including parental education, family poverty status, race/ethnicity, measures of the severity and complexity of conditions, health insurance status, having a personal doctor, and the quality of the parent's relationship with the adolescent's doctor, were entered into a regression model.Results. Overall, 50.2% of parents reported that they had discussed transition issues with their adolescent's doctor and 16.4% had discussed and developed a plan for addressing those needs. In a multivariate regression analysis, correlates of the adequacy of transition services included older age, female gender, complexity of health care needs, and higher quality of the parent-doctor relationship.Conclusions. Among adolescents with special health care needs, those who were older and those with more complicated needs were more likely to have addressed the transition from a pediatric to adult-oriented system of care. Furthermore, this analysis demonstrated a strong association between a high-quality parent-provider relationship and the extent to which transition issues were addressed. The importance of transition services for adolescents with less complex needs and the overall impact of health care transition services were not assessed in this study and remain important questions for future investigations.
Evaluation of a Unique, Nurse-Inserted, Peripherally Inserted Central Catheter Program
Authors: Gamulka Beth , Mendoza Cristina , Connolly Bairbre 
Published: June 2005

Background. Concerns regarding the safety and success of peripherally inserted central catheters (PICCs) placed at the bedside in the pediatric population initially precluded the development of a nurse-inserted PICC program at our pediatric center. Previously, all PICCs were inserted by interventional radiologists (IRs) with fluoroscopic guidance. A new nurse-inserted PICC program was initiated with collaboration between PICC nurses and IRs.
Methods. Three nurses participated in the project. Patients who met preestablished selection criteria were approached. All insertions were performed with sterile technique on the fluoroscopy table, with IRs available to support the PICC nurse. Veins were accessed visually or through palpation. Final tip position was confirmed in all cases with contrast material administration and fluoroscopy. Additional fluoroscopy was performed only if placement difficulties were encountered. All patients were monitored prospectively.
Results. Ninety-nine patients (age: 3–18 years; average age: 13.6 years) met the selection criteria. Two patients underwent primary insertion by an IR. The remaining 97 patients underwent an insertion attempt by a nurse. Sixty-nine PICCs (71.1%) were placed successfully by a nurse, 15 (15.5%) required minor assistance from an IR, and 13 (13.4%) were inserted by an IR after an unsuccessful nurse attempt. No insertion complications were noted. Insertion difficulties included difficulty advancing the catheter (19.6%), difficulty cannulating the vein (6.2%), and tip malposition (2.1%). Postinsertion complications occurred for 27.8% of PICCs, and 13.4% required removal before the end of therapy.
Conclusion. This novel, pediatric nurse-inserted PICC program has a good safety profile, high success rate, and low postprocedural complication rate.
Effects of Early Cholesterol Intake on Cholesterol Biosynthesis and Plasma Lipids Among Infants Until 18 Months of Age
Authors: Demmers Théa A. , Jones Peter J. H. , Wang Yanwen , Krug Susan , Creutzinger Vivian , Heubi James E. 
Published: June 2005

Background. The endogenous cholesterol fractional synthesis rate (FSR) is related inversely to infant dietary cholesterol at 4 months of age; however, it remains to be established whether this effect is permanent, possibly contributing to later hypercholesterolemia.Objective. To determine whether levels of dietary cholesterol in infancy induced changes in FSR and plasma lipid levels that persisted at 18 months.Methods. A prospective clinical trial was conducted with 47 infants, from their first week of life until 18 months of age, who received human milk (HM) until weaned (n = 15) or were randomized to receive modified cow's milk formula (MCF) with added cholesterol (n = 15) or cow's milk formula (CF) (n = 17) for 12 months. Cholesterol contents of HM, MCF, and CF were 120, 80, and 40 mg/L, respectively. FSR and plasma lipid levels were measured at 4 and 18 months.Results. At 4 months, total cholesterol and low-density lipoprotein cholesterol levels were higher for infants fed HM and MCF, compared with CF. High-density lipoprotein cholesterol levels were higher in the MCF group than in the HM and CF groups. FSR in the HM group (0.034 ± 0.005 pools per day) was lower than that in the CF group (0.052 ± 0.005 pools per day). There was no difference between the HM and MCF (0.047 ± 0.005 pools per day) groups or between the MCF and CF groups. At 18 months, there were no differences in FSRs or plasma lipid profiles between the groups.Conclusion. Although cholesterol intake before weaning affects FSRs and plasma lipid profiles at 4 months, these differences do not persist after weaning to an unrestricted diet at 18 months. This provides additional evidence that there is no imprinting of FSR in infancy with differing dietary levels of cholesterol.
Cardiac Changes Associated With Growth Hormone Therapy Among Children Treated With Anthracyclines
Authors: Lipshultz Steven E. , Vlach Sarah A. , Lipsitz Stuart R. , Sallan Stephen E. , Schwartz Marcy L. , Colan Steven D. 
Published: June 2005

Objective. The objective was to assess the cardiac effects of growth hormone (GH) therapy. Anthracycline-treated childhood cancer survivors frequently have reduced left ventricular (LV) wall thickness and contractility, and GH therapy may affect these factors.
Methods. We examined serial cardiac findings for 34 anthracycline-treated childhood cancer survivors with several years of GH therapy and baseline cardiac z scores similar to those of a comparison group (86 similar cancer survivors without GH therapy).
Results. LV contractility was decreased among GH-treated patients before, during, and after GH therapy (−1.08 SD below the age-adjusted population mean before therapy and −1.88 SD 4 years after therapy ceased, with each value depressed below normal). Contractility was higher in the control group than in the GH-treated group, with this difference being nearly significant. The GH-treated children had thinner LV walls before GH therapy (−1.38 SD). Wall thickness increased during GH therapy (from −1.38 SD to −1.09 SD after 3 years of GH therapy), but the effect was lost shortly after GH therapy ended and thickness diminished over time (−1.50 SD at 1 year after therapy and −1.96 SD at 4 years). During GH therapy, the wall thickness for the GH-treated group was greater than that for the control group; however, by 4 years after therapy, there was no difference between the GH-treated group and the control group.
Conclusions. GH therapy among anthracycline-treated survivors of childhood cancer increased LV wall thickness, but the effect was lost after therapy was discontinued. The therapy did not affect the progressive LV dysfunction.
Organizational Characteristics and Preventive Service Delivery in Private Practices: A Peek Inside the “Black Box” of Private Practices Caring for Children
Authors: Randolph Greg , Fried Bruce , Loeding Leslie , Margolis Peter , Lannon Carole 
Published: June 2005

Objective. Although privately owned practices provide the majority of primary care for children, little is known about the organizational characteristics of these practices or how these characteristics affect the quality of care for children. The purpose of this study was to describe selected organizational characteristics and preventive service delivery features that might affect the quality of primary care for children in private practices.Methods. A cross-sectional study of 44 private pediatric and family medicine practices in 2 regions of North Carolina was performed. Preventive service performance was assessed through chart abstraction for 60 randomly selected children between 24 and 30 months of age, for evaluation of immunizations and anemia, tuberculosis, and lead screening delivery by 2 years of age. Organizational characteristics were determined through surveys of all physicians and staff members. We used descriptive statistics and scatter plots to describe variations in organizational characteristics and preventive services.Results. Overall, practices demonstrated low levels of preventive service performance, with substantial variation among practices. Only 39% of children received 3 of the 4 recommended preventive services measured (practice range: 2–88%). Few practices demonstrated evidence of a systematic approach to prevention. For example, only 12 (27%) of the 44 practices used &gt;1 of 5 recommended preventive service delivery strategies. Furthermore, practices varied greatly with respect to many of the measured organizational characteristics, which were consistent with organizational stress in some cases. For example, turnover of clinicians and staff members was remarkably high, with practices losing an average of 27% of their clinicians every 4 years (range: 0–170%) and 39% of their office staff members every 2 years (range: 0–170%).Conclusions. Private practices caring for children in North Carolina demonstrated low overall performance for the 4 recommended preventive services examined, with large variations among practices. Few practices had evidence of comprehensive systems for prevention. There was also evidence of substantial variation in many organizational characteristics. Some organizational characteristics were at levels that might impede delivery of high-quality primary care for children. These findings suggest a growing need for research that examines the impact of organizational characteristics on the quality of care in private practices.
Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis
Authors: Avansino Jeffrey R. , Goldman Bryan , Sawin Robert S. , Flum David R. 
Published: June 2005

Objective. The optimal treatment of children with empyema remains controversial. The purpose of this review was to compare reported results of nonoperative and primary operative therapy for the treatment of pediatric empyema.Methods. A systematic comprehensive review of the scientific literature was conducted with the PubMed (National Library of Medicine) database for the period from 1981 to 2004. This reproducible search identified all publications dealing with treatment of empyema in the pediatric population (&lt;18 years of age). A meta-analysis was performed with studies with adequate data summaries for ≥1 of the outcomes of interest for both treatment groups.Results. Sixty-seven studies were reviewed. Data were aggregated from reports of children initially treated nonoperatively (3418 cases from 54 studies) and of children treated with a primary operative approach (363 cases from 25 studies). The populations were similar in age. Patients who underwent primary operative therapy had a lower aggregate in-hospital mortality rate (0% vs 3.3%), reintervention rate (2.5% vs 23.5%), length of stay (10.8 vs 20.0 days), duration of tube thoracostomy (4.4 vs 10.6 days), and duration of antibiotic therapy (12.8 vs 21.3 days), compared with patients who underwent nonoperative therapy. In 8 studies for which meta-analysis was possible, patients who received primary operative therapy were found to have a pooled relative risk of failure of 0.09, compared with those who did not. Meta-analysis could not be performed for any of the other outcome measures investigated in this review. Similar complication rates were observed for the 2 groups (5% vs 5.6%).Conclusions. These aggregate results suggest that primary operative therapy is associated with a lower in-hospital mortality rate, reintervention rate, length of stay, time with tube thoracostomy, and time of antibiotic therapy, compared with nonoperative treatment. The meta-analysis demonstrates a significantly reduced relative risk of failure among patients treated operatively.
Morphine Does Not Provide Adequate Analgesia for Acute Procedural Pain Among Preterm Neonates
Authors: Carbajal Ricardo , Lenclen Richard , Jugie Myriam , Paupe Alain , Barton Bruce A. , Anand Kanwaljeet J. S. 
Published: June 2005

Background. Morphine alleviates prolonged pain, reduces behavioral and hormonal stress responses induced by surgery among term neonates, and improves ventilator synchrony and sedation among ventilated preterm neonates, but its analgesic effects on the acute pain caused by invasive procedures remain unclear.Objective. To investigate the analgesic efficacy of intravenously administered morphine on heel stick-induced acute pain among preterm neonates.Design. This study was nested within a prospective, randomized, double-blind, multicenter, placebo-controlled trial (the NEOPAIN Trial).Setting. A tertiary-care NICU in a teaching hospital.Participants. Forty-two preterm neonates undergoing ventilation.Interventions. Neonates were randomized to either the morphine (loading dose of 100 μg/kg, followed by infusions of 10–30 μg/kg per hour according to gestation, N = 21) or placebo (5% dextrose infusions, N = 21) group. Pain responses to 3 heel sticks were evaluated, ie, before the loading dose (T1), 2 to 3 hours after the loading dose (T2), and 20 to 28 hours after the loading dose (T3).Main Outcomes Measures. Pain was assessed with the Douleur Aiguë Nouveau-né (DAN) scale (behavioral pain scale) and the Premature Infant Pain Profile (PIPP) (multidimensional pain scale); plasma morphine levels were measured at T3.Results. Infants in the placebo and morphine groups had similar gestational ages (mean ± SD: 27.2 ± 1.7 vs 27.3 ± 1.8 weeks) and birth weights (972 ± 270 vs 947 ± 269 g). Mean ± SD DAN pain scores at T1, T2, and T3 were 4.8 ± 4.0, 4.6 ± 2.9, and 4.7 ± 3.6, respectively, for the placebo group and 4.5 ± 3.8, 4.4 ± 3.7, and 3.1 ± 3.4 for the morphine group. The within-group factor (pain at T1, T2, and T3) was not statistically different over time. The between-group analysis (infants receiving placebo versus those receiving morphine) showed no significant differences. Mean ± SD PIPP pain scores at T1, T2, and T3 were 11.5 ± 4.8, 11.1 ± 3.7, and 9.1 ± 4.0, respectively, for the placebo group and 10.0 ± 3.6, 8.8 ± 4.9, and 7.8 ± 3.6 for the morphine group. The within-group factor was statistically different over time. The between-group analysis showed no significant differences. Mean ± SD plasma morphine levels at T3 were 0.44 ± 1.79 ng/mL and 63.36 ± 33.35 ng/mL for the placebo and morphine groups, respectively. There was no correlation between plasma morphine levels and pain scores at T3 (DAN, R = −0.05; PIPP, R = −0.02).Conclusions. Despite its routine use in the NICU, morphine given as a loading dose followed by continuous intravenous infusions does not appear to provide adequate analgesia for the acute pain caused by invasive procedures among ventilated preterm neonates.
Managed Care Organization Characteristics and Outpatient Specialty Care Use Among Children With Chronic Illness
Authors: Shenkman Elizabeth , Tian Lili , Nackashi John , Schatz Desmond 
Published: June 2005

Background. Limited information is available about managed care organization (MCO) characteristics that influence outpatient physician specialist use among children with chronic conditions.Objective. To examine the association between MCO characteristics and outpatient physician specialist use among children with chronic conditions who were receiving care in MCOs in which primary care providers (PCPs) served as gatekeepers for referrals and who were publicly insured.Design and Methods. A total of 2333 children who had been diagnosed with a chronic condition and had functional limitations, an increased need for or use of health care services beyond what children normally use, and/or dependence on medications or home medical equipment were included in the study. The odds of an outpatient physician specialist visit 1 year after study entry were examined as a function of child health and sociodemographic characteristics, MCO characteristics, the child’s prior specialty care use, and provider availability in the MCO service delivery area.Results. Children cared for in MCOs with lower percentages of PCPs paid on a fee-for-service basis (odds ratio: 0.95; 95% confidence interval: 0.92–0.98), with higher percentages of pediatricians in the PCP network (odds ratio: 1.17; 95% confidence interval: 1.07–1.29), and offering financial incentives for meeting quality of care standards (odds ratio: 1.71; 95% confidence interval: 1.28–2.29) had greater odds of outpatient physician specialist visits. Black children had odds of specialty care that were approximately one half those of white children. Children with prior physician specialist use were 52% more likely to have a physician specialist visit in the year after study entry. The children’s diagnoses and condition consequences were not related significantly to the odds of a specialty visit.Conclusions. Specific MCO characteristics were associated with greater specialty care use among a group of low-income children with chronic conditions. Such information should be used to improve the structure of managed care arrangements for these vulnerable children.
Pediatric Residents' Responses That Discourage Discussion of Psychosocial Problems in Primary Care
Authors: Wissow Lawrence S. , Larson Susan , Anderson Jada , Hadjiisky Elizabeth 
Published: June 2005

Objective. Studies spanning nearly 4 decades demonstrate that doctors ignore or dismiss many patient bids for discussion of psychosocial topics. We sought to understand characteristics of doctors, patients, and visits in which this occurs.Methods. Reanalysis of 167 audiotapes from 2 studies of parent-doctor communication in a pediatric residents' continuity clinic was performed. Tapes included visits by 100 mothers or female guardians to 55 residents who were the children's primary care providers. Coders identified mentions of psychosocial topics and noted the content and the doctor's response. Responses were classified with an adaptation of a previously described, psychoanalytically derived typology of avoidant or discouraging responses.Results. Discouraging responses occurred in 34 (77%) of 44 discussions that involved corporal punishment and 51 (34%) of 64 discussions that involved other psychosocial topics. The particular topic (parent/family versus routine parenting issue) and how the topic was framed (as a problem versus simply mentioned) were associated with doctors' discouraging responses (OR: 3.07; 95% confidence interval: 1.56–6.05; and OR: 7.57; 95% confidence interval: 3.50–16.44; respectively). Discouraging responses were not related to the doctor's gender, parent's ethnicity, length of the parent-doctor relationship, or doctor's overall interview style (patient-centeredness). Discouraging responses to routine problems tended to be dismissive, but 41% of discouraging responses to parent/family problems were failed attempts to provide advice.Conclusions. Discouraging responses seem to be related less to doctor or patient characteristics than to the type and acuity of the psychosocial topic. These responses may originate with doctors' discomfort with particular subject areas and thus might be approached with training that combines communication and emotion-handling skills with clinical tools such as Bright Futures in Practice: Mental Health or the International Classification of Diseases, 10th Revision, Primary Care.
Influence of Excess Adiposity on Exercise Fitness and Performance in Overweight Children and Adolescents
Authors: Norman Anne-Caroline , Drinkard Bart , McDuffie Jennifer R. , Ghorbani Samareh , Yanoff Lisa B. , Yanovski Jack A. 
Published: June 2005

Objective. Relatively little is known about how excess body mass affects adolescents' capacity to perform sustained exercise. We hypothesized that most of the difficulty that severely overweight adolescents have with sustained exercise occurs because the metabolic costs of moving excess mass result in use of a high proportion of their total oxygen reserve.Methods. We compared results from a maximal cycle ergometry fitness test in 129 severely overweight adolescents who had BMIs of 41.5 ± 9.7 kg/m2 and ages of 14.5 ± 1.8 years (range: 12.1–17.8 years) and 34 nonoverweight adolescents who had BMIs of 20.1 ± 2.9 kg/m2 and ages of 14.5 ± 1.5 years (range: 12.0–18.1 years). Oxygen uptake (V̇o2) was compared at 3 times: during a 4-minute period of unloaded cycling (ULV̇o2), at the lactate threshold estimated by gas exchange (LTV̇o2), and at maximal exertion (V̇o2 max). Heart rate was obtained at rest and at V̇o2 max. Participants also completed a 12-minute walk/run performance test to obtain distance traveled (D12) and heart rate.Results. Absolute LTV̇o2 and V̇o2 max and LTV̇o2 as a percentage of V̇o2 max were not different in overweight and nonoverweight adolescents during the cycle test. However, absolute ULV̇o2 was significantly greater in overweight adolescents: ULV̇o2 accounted for 35 ± 8% of V̇o2 max (and 63 ± 15% of LTV̇o2) in overweight adolescents but only 20 ± 5% of V̇o2 max (and 39 ± 12% of LTV̇o2) in nonoverweight adolescents. Resting heart rate before initiating the cycle test was significantly greater in overweight than nonoverweight adolescents (94 ± 14 vs 82 ± 15 beats per minute). However, maximal heart rate during the cycle test was significantly lower in overweight adolescents (186 ± 13 vs 196 ± 11 beats per minute). During the walk/run test, mean D12 was significantly shorter for overweight than for nonoverweight adolescents (1983 ± 323 vs 1159 ± 194 m). D12 was negatively related to BMI SDS (r = −0.81) and to ULV̇o2 (r = −0.98).Discussion. Overweight and nonoverweight adolescents had similar absolute V̇o2 at the lactate threshold and at maximal exertion, suggesting that overweight adolescents are more limited by the increased cardiorespiratory effort required to move their larger body mass through space than by cardiorespiratory deconditioning. The higher percentage of oxygen consumed during submaximal exercise indicates that overweight adolescents are burdened by the metabolic cost of their excess mass. Their greater oxygen demand during an unloaded task predicted poorer performance during sustained exercise. Exercise prescriptions for overweight adolescents should account for the limited exercise tolerance imposed by excess body mass, focusing on activities that keep demands below lactate threshold so that exercise can be sustained.