bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physicians’ Experience With Allegations of Medical Malpractice in the Neonatal Intensive Care Unit
Authors: Meadow William , Bell Anthony , Lantos John 
Published: August 2004

Objective. To assess the personal experience of all practitioners of neonatal intensive care unit (NICU) medicine in the United States with the medical malpractice system; in particular, to assess the circumstances of malpractice allegations in which they themselves had personal experience, and to extrapolate from their individual experiences to the field of neonatology in general.
Design. Written survey of all MDs practicing NICU medicine in the US.
Participants. Two thousand four hundred ninety-eight NICU physicians as determined from three sources: a) the American Board of Medical Specialists; b) the American Academy of Pediatrics Section of Neonatal/Perinatal Medicine; and c) a listing of neonatologists provided by Ross Laboratories.
Main Outcome Measures. Responses to survey questions.
Results. We received 1813 responses, representing ∼75% of all physicians practicing NICU medicine in the US. Overall, 43% of respondents had experienced at least one claim of malpractice against them. The probability of a malpractice allegation increased with years in practice, from ∼20% for NICU physicians in practice ≤5 years (65/337), to ∼60% for NICU physicians in practice &gt;15 years (276/469). Men and women were equally likely to have been sued, accounting for years in practice. Physicians practicing in community NICUs were more likely to be sued than those in university settings. On a scale of 1 to 4 (4 being most reasonable) the median assessment of the reasonableness of malpractice allegations was 1, mean 1.2. On a scale of 1 to 4 (4 being the highest) the median assessment of effectiveness of the current system in identifying true malpractice was 1, mean 1.4. The respondents believed that approximately 80% of malpractice allegations were inappropriate; conversely, they believed that approximately 80% of true medical malpractice escaped detection. On a scale of 1 to 4 (4 being the highest), the median assessment of the detrimental effect of the present malpractice system on health care was 4, mean 3.4.
Conclusions. Most NICU physicians will be sued if they practice long enough. In this context, efforts to use malpractice claims to seek out evildoers (such as underlie the National Practitioners Data Bank) appear ill-conceived. Similarly, exhortations for physicians to become either more educated or more sensitive are unlikely to reduce malpractice claims. Our data suggest that malpractice in the NICU appears to function more like a lottery than like a mechanism for either quality assurance or just retribution. medical malpractice, NICU, standard of care, neonatologists.
Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?
Authors: Quayle Kimberly S. , Jaffe David M. , Kuppermann Nathan , Kaufman Bruce A. , Lee Benjamin C. P. , Park T. S. , McAlister William H. 
Published: August 2004

Objective. Despite the frequent occurrence of head injury in children, there is no agreement about clinical screening criteria that indicate the need for imaging studies. This study was undertaken to provide information relevant to the choice of imaging modalities in children with acute head trauma.Methodology. A prospective cohort of 322 children seeking care consecutively in an urban pediatric emergency department for nontrivial head injury was assembled. Skull radiographs, head computed tomography, and data forms including mechanism of injury, symptoms, and physical findings were completed for each child.Results. Intracranial injury occurred in 27 children (8%), whereas 50 (16%) had skull fractures. Of those with intracranial injury, 16 (59%) had normal mental status and no focal abnormalities, and 1 of those 16 required surgery for evacuation of an epidural hematoma. Six (38%) of the 16 were younger than 1 year, 5 of whom had scalp contusion or hematoma without other symptoms. Findings not significantly associated with intracranial injury were scalp contusion, laceration, hematoma, abrasion, headache, vomiting, seizure, drowsiness, amnesia, and loss of consciousness for less than 5 minutes. Findings associated with intracranial injury were skull fracture, signs of a basilar skull fracture, loss of consciousness for more than 5 minutes, altered mental status, and focal neurologic abnormality.Conclusions. Intracranial injury may occur with few or subtle signs and symptoms, especially in infants younger than 1 year. The relative risk for intracranial injury is increased almost fourfold in the presence of a skull fracture, although the absence of a skull fracture does not rule out intracranial injury. The significance of nonsurgical intracranial injury in neurologically normal children needs further study. brain injuries, head injuries, skull fractures, computed tomo-graphy, radiography.
Efficacy of Bidirectional Fiber-optic Phototherapy for Neonatal Hyperbilirubinemia
Authors: Tan K. L. 
Published: August 2004

Objective. To evaluate the efficacy of fiber-optic phototherapy using the standard Ohmeda Biliblanket, a large version, double standard Biliblankets, and conventional phototherapy using daylight fluorescent lamps in full-term, healthy infants with nonhemolytic hyperbilirubinemia.Methods. Full-term, healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, &gt;255 μmol/L or 222 μmol/L at &lt;48 hours of age) were allocated randomly to one of four modes of phototherapy: standard fiber-optic mat (Ohmeda Biliblanket), a large version, double standard Biliblankets, and conventional phototherapy. Bilirubin levels were monitored every 12 hours. Exposure was stopped when bilirubin levels were less than 185 μmol/L, the minimum duration being 24 hours.Results. A total of 171 infants were studied; 42 were exposed to standard fiber-optic phototherapy, 43 to large fiber-optic phototherapy, 42 to double–fiber-optic phototherapy, and 44 to conventional phototherapy. Durations of exposure were 87.05 ± 6.09 (SEM), 82.57 ± 5.84, 64.85 ± 5.43, and 62.61 ± 3.74 hours, respectively; the 24-hour decline rates were 10.26% ± 1.84%, 14.50% ± 1.53%, 21.82% ± 1.71%, and 19.00% ± 1.65%, respectively; the overall decline rates over the whole exposure period were 0.47% ± 0.03%, 0.52% ± 0.04%, 0.71% ± 0.05%, and 0.75% ± 0.04% per hour, respectively. The efficacy of double–fiber-optic phototherapy and conventional phototherapy was similar and significantly better than that of the large fiber-optic mat and the standard fiber-optic mat in duration, 24-hour decline rate, and overall decline rate. The large mat was slightly better than the standard-size mat with regard to 24-hour decline rate and overall decline rate, but this difference was not significant. Failure of phototherapy occurred only in the large fiber-optic mat group (3 of 43) and the standard fiber-optic mat group (4 of 42); none occurred in the other two groups, but differences not statistically significant. The nursing personnel were more comfortable with single fiber-optic phototherapy, which caused no initial disturbance to the swaddled infants as did conventional phototherapy, but found double–fiber-optic phototherapy difficult to use.Conclusion. For efficacy of fiber-optic phototherapy in full-term infants to be comparable to that of our conventional phototherapy, the light dose of the standard mats needs to be doubled. fiber-optic phototherapy, neonatal hyperbilirubinemia, efficacy.
Childhood Poisoning Involving Transdermal Nicotine Patches
Authors: Woolf Alan , Burkhart Keith , Caraccio Thomas , Litovitz Toby 
Published: August 2004

Objective. To describe the circumstances, medical complications, and outcomes of children exposed to a transdermal nicotine patch (TNP).
Design. Prospective case series; postmarketing surveillance study over a 24-month period.
Setting. Thirty-four United States poison centers.
Patients. Children 0 to 15 years old exposed to a TNP.
Interventions. None.
Outcome Measures. Exposure circumstances, symptoms and signs of toxicity, complications, disposition, and hospital length of stay.
Results. Reports were received concerning 36 exposures to TNP in children younger than 16 years old (mean: 3 years old). Eighteen of these TNP exposures were dermal; 18 additional children had bitten, chewed, or swallowed part of a patch. All four commercial brands of TNP were represented; no brand was associated with more symptoms or an increased severity of illness. Fourteen children (39%) developed symptoms, including gastrointestinal distress (nausea, vomiting, diarrhea, abdominal pain), weakness, dizziness, or localized rashes. Occurrence of symptoms after a dermal exposure to a TNP was associated with an estimated nicotine dose ≥.10 mg (≥.01 mg/kg body weight). Ten children were seen in the emergency department; two were admitted overnight. All recovered fully.
Conclusions. In this series, unintentional exposures to TNPs among young children usually involved used patches, were transient (&lt;20 minutes duration), and required only skin decontamination and supportive care. Continued monitoring of inadvertent childhood exposures to TNPs is recommended to confirm these observations. nicotine, poisoning, transdermal nicotine patch, overdose, pediatric poisoning, intoxication.
Parent and Physician Response to Children’s Cholesterol Values of 200 mg/dL or Greater: The Child and Adolescent Trial for Cardiovascular Health Experiment
Authors: Nader Philip R. , Yang Minhua , Luepker Russell V. , Parcel Guy S. , Pirie Phyllis , Feldman Henry A. , Stone Elaine J. , Webber Larry S. 
Published: August 2004

Objective. To determine parental actions and concerns and physician responses to parental notification that a child’s cholesterol value was 200 mg/dL or greater, a value recommended by the National Cholesterol Education Program to warrant physician follow-up and evaluation.Methodology. A telephone survey of parents (n = 784) and physicians (n = 117) was carried out after parental notification of a total blood cholesterol value obtained as part of measurement done while participating in the Child and Adolescent Trial for Cardiovascular Health in 96 schools located in California, Louisiana, Minnesota, and Texas.Results. Only 20% of parents contacted physicians. Factors associated with this action included whether the parent was notified once or twice, the level of the cholesterol, previous cholesterol testing in the parent, and medical insurance that covered the visit. Family history of cardiovascular disease, when other factors were considered, did not increase the likelihood that a physician contact would be made. After contact with the physician, 59% of physicians reported evaluating children for cholesterol; about half reported repeating the cholesterol determination.Conclusion. Parental knowledge of a child’s cholesterol value of 200 mg/dL or greater did not result in substantially further seeking of health care. children, elevated cholesterol, parental response, physician response.
Validity and Reliability of Clinical Signs in the Diagnosis of Dehydration in Children
Authors: Gorelick Marc H. , Shaw Kathy N. , Murphy Kathleen O. 
Published: August 2004

Objective. To determine the validity and reliability of various clinical findings in the diagnosis of dehydration in children.Design. Prospective cohort study.Setting. An urban pediatric hospital emergency department.Participants. One hundred eighty-six children ranging in age from 1 month to 5 years old with diarrhea, vomiting, or poor oral fluid intake, either admitted or followed as outpatients. Exclusion criteria included malnutrition, recent prior therapy at another facility, symptoms for longer than 5 days’ duration, and hyponatremia or hypernatremia.Methods. All children were evaluated for 10 clinical signs before treatment. The diagnostic standard for dehydration was fluid deficit as determined from serial weight gain after treatment.Main Results. Sixty-three children (34%) had dehydration, defined as a deficit of 5% or more of body weight. At this deficit, clinical signs were already apparent (median = 5). Individual findings had generally low sensitivity and high specificity, although parent report of decreased urine output was sensitive but not specific. The presence of any three or more signs had a sensitivity of 87% and specificity of 82% for detecting a deficit of 5% or more. A subset of four factors—capillary refill &gt;2 seconds, absent tears, dry mucous membranes, and ill general appearance—predicted dehydration as well as the entire set, with the presence of any two or more of these signs indicating a deficit of at least 5%. Interobserver reliability was good to excellent for all but one of the findings studied (quality of respirations).Conclusions. Conventionally used clinical signs of dehydration are valid and reliable; however, individual findings lack sensitivity. Diagnosis of clinically important dehydration should be based on the presence of at least three clinical findings. dehydration, capillary refill, clinical assessment, interobserver agreement.
Adverse Events Associated With Exchange Transfusion in Healthy and Ill Newborns
Authors: Jackson J. Craig 
Published: August 2004

Objective. To determine the incidence of adverse events attributable to exchange transfusion during the past 15 years and compare the incidence of severe complications between healthy and ill infants.Design. Medical records for the past 15 years from two teaching hospitals with neonatal intensive care units were reviewed. Those newborns who underwent exchange transfusions were classified as healthy or ill. Adverse events were analyzed to determine whether they were attributable to the procedure.Results. Of the 106 patients who underwent exchange transfusion, 81 were healthy and had no medical problems other than jaundice. The remaining 25 patients were classified as ill and had medical problems ranging from mild to severe. At least 2 (2%) of the 106 patients died of complications probably attributable to exchange transfusion. None of the 81 healthy infants died, but 1 had severe necrotizing enterocolitis requiring surgery. Of the 25 ill infants, at least 3 (12%) experienced severe complications (including 2 deaths) probably attributable to exchange transfusion. Serious complications from the most common adverse events, hypocalcemia and thrombocytopenia, were limited to the group of infants already ill with other medical problems.Conclusions. Because of the significantly greater rate of severe complications in ill infants, exchange transfusion should be delayed until the risk of bilirubin encephalopathy is as high as the risks of severe complications from the procedure itself (12%). These results do not support recommendations to use lower exchange levels in ill infants compared with healthy infants. exchange transfusion, whole-blood; adverse events, jaundice, neonatal; kernicterus, infant, newborn.
Intravenous Methohexital for Brief Sedation of Pediatric Oncology Outpatients: Physiologic and Behavioral Responses
Authors: Freyer David R. , Schwanda Allison E. , Sanfilippo Dominic J. , Hackbarth Richard M. , Hassan Nabil E. , Kopec John S. , Neirotti Maria Teresa 
Published: August 2004

Objective. In this successor to a preliminary retrospective study, we sought to confirm the apparent safety and efficacy of intravenous methohexital (MHX) for brief, unconscious sedation of pediatric hematology/oncology outpatients undergoing painful, invasive procedures.Methods. This prospective study was conducted in a children’s hospital-based hematology/oncology clinic. Following published monitoring guidelines for deep pediatric sedation, MHX (1.0 mg/kg) was administered immediately before each procedure, 1% xylocaine was given locally, and additional MHX was titrated to maintain minimal response to pain during the procedure. For each patient, the procedural and physiologic response data reported below were recorded from the onset of sedation through recovery. Behavioral distress responses were measured using a standardized pediatric observational tool (Procedure Behavioral Checklist).Results. Two hundred and thirty-three procedures were carried out in 76 patients ranging .1 to 19.6 years of age. The mean cumulative MHX dose/procedure was 4.6 ± 2.9 mg/kg. The mean lengths of time from initiation of sedation until completion of the invasive procedure, attainment of patient arousability, discontinuation of monitoring, and attainment of patient alertness were 8 ± 5, 19 ± 8, 19 ± 9, and 22 ± 9 minutes, respectively. Relative to presedation values, mean arterial pressure (MAP), heart rate, and respiratory rate showed maximum mean percent changes of −16.6, +17.8, and +13.4, respectively (all clinically insignificant). Complications among procedures were transient and included hiccoughs and myoclonus (each 10%); oropharyngeal secretions (6%); and pain at the injection site, emergence phenomena, and mild stridor (each ≤3%). Of two procedures (.9%) affected by transient upper airway obstruction associated with emesis or secretions, only one briefly needed mask ventilation. No procedures required intubation or early termination. In 49 additional procedures assessed for patient distress, observed pain responses were absent to mild in 45 (92%) and moderate in 4.Conclusion. MHX appropriately administered provides sedation which is effective, safe, well tolerated, and of short duration, making MHX attractive for use in pediatric oncology outpatients and other populations with similar sedation needs. methohexital, pain, procedures, quality of life, sedation.
Health Care Utilization and Cost Among Children With Asthma Who Were Enrolled in a Health Maintenance Organization
Authors: Lozano Paula , Fishman Paul , VonKorff Michael , Hecht Julia 
Published: August 2004

Objective. To measure the impact of asthma on the use and cost of health care by children in a managed care organization.Design. Population-based historical cohort study.Setting. A medium-sized staff model health maintenance organization in western Washington state.Subjects. All 71 818 children, between age 1 to 17 years, who were enrolled and used services during 1992.Outcome Measures. Children were identified with one or more asthma diagnoses during 1992 using automated encounter data. Nonurgent outpatient visits, pharmacy fills, urgent care visits, and hospital days, as well as associated costs were measured. All services were categorized as asthma care or nonasthma care. Multivariate regression analysis was used to compute marginal cost for asthma (difference in total cost between children with asthma and other children using services, adjusted for covariates).Results. Treated prevalence of asthma was 4.9%. Children with asthma incurred 88% more costs ($1060.32 vs $563.81/yr), filled 2.77 times as many prescriptions (11.59 vs 4.19/yr), made 65% more nonurgent outpatient visits (5.75 vs 3.48/yr), and had twice as many inpatient days (.23 vs .11/yr) compared with the general population of children using services. Asthma care represented 37% of all health care received by children with asthma, while the remaining 63% were for nonasthma services. Almost two-thirds of asthma-related costs were attributable to nonurgent outpatient care and prescriptions; only one third was attributable to urgent care and hospitalizations. Controlling for age, sex, and comorbidities, the marginal cost of asthma was $615.17/yr (95% confidence interval $502.73, $727.61), which includes asthma as well as nonasthma services. This marginal cost represents 58% of all health care costs for children with asthma.Conclusions. Children with asthma use significantly more health services (and incur significantly more costs) than other children using services, attributable largely to asthma care. The majority of all health care costs for children with asthma were for nonasthma services. Urgent care visits and hospitalizations are less important components of asthma costs in this managed care organization than has been found in other national studies.
The Associations of Suicide Attempts in Adolescents
Authors: Woods Elizabeth R. , Lin Yvonne G. , Middleman Amy , Beckford Patricia , Chase Louise , DuRant Robert H. 
Published: August 2004

Objective. Suicide completion has increased in the United States among 15- to 24-year-olds from 4.5 per 100 000 (1950) to 13.2 per 100 000 (1990). Suicide attempts have been found to be associated with depression, substance use, overall number of life stressors, gender, and impulsive behaviors. We hypothesized that suicide attempt is associated with many other health risk behaviors.Design. To evaluate this hypothesis, we analyzed the data from the 1993 Massachusetts Youth Risk Behavior Survey from a representative sample of students in grades 9 through 12 in public and private high schools. We examined the relationships between ever attempting suicide and engaging in other health risk or problem behaviors (eg, sexual activity, substance use, violence, and seat belt nonuse).Results. The 3054 students were distributed among the 9th to 12th grades; 50.7% were female, 77.7% white, 6.7% black, 5.9% Hispanic, 4.6% Asian, .8% Native American, and 4.4% other; and the mean age was 16 ± 1.2 years. Based on logistic regression analysis, ever attempting suicide was associated with physical fights in the past 12 months (odds ratio [OR] = 1.3[95% confidence interval (CI), 1.22–1.44]), regular cigarette use in the past 30 days (2.0[1.41–2.97]), female gender (3.2[2.21–4.71]), lack of seat belt use (1.3[1.21–1.34]), gun carrying in the past 30 days (1.4[1.12–1.70]), substance use before last sexual activity (1.4[1.09–1.84]), Native American or other (2.4[1.21–4.71]), and lifetime use of other drugs (1.2[1.04–1.40]). The full model correctly assigned 92% of the youth. There were small differences in models for males, females, and sexually active youth. Same gender sexual experiences for sexually active youth did not significantly improve the model (partial r = .0, OR = .87 [95% CI, .33–2.30]) and fewer (88%) of the youth were correctly assigned by the model.Conclusions. Ever attempting suicide is associated with other problem behaviors. This research proposes an empirical model of the relationship between suicide attempts and other health risk behaviors. Identifying which adolescents are at risk for suicide attempts from the presence of accompanying risk behaviors will help clinicians to evaluate suicide risk when other problem behaviors are identified, thus enabling the design of possible prevention strategies.
Clinicopathological Correlations in Postasphyxial Organ Damage: A Donor Organ Perspective
Authors: Barnett Christopher P. , Perlman Max , Ekert Paul G. 
Published: August 2004

Objectives. 1) To assess pathology in the heart, kidneys, lungs, liver, and intestine in babies dying of postasphyxial hypoxic ischemic encephalopathy (HIE), and their suitability for organ transplantation. 2) To analyze the correlation between in vivo clinical markers of collateral organ damage and autopsy findings.
Study Design. Retrospective cohort study of 58 infants who died of postasphyxial HIE and had autopsies during 1985 to 1994. Collateral organ damage was evaluated clinically and pathologically, and the results compared.
Results. Severe pathological changes were observed in 6% to 62% of the five organs studied; 59% of the four major organs had either minor or no pathology. The sensitivity of the clinical predictors ranged from 69% to 100%, and specificity from 50% to 97%.
Conclusions. The organs of newborns dying of severe HIE may be suitable for use as donor organs; predictions of their suitability were most accurate for liver, kidney, and lungs, and least accurate for the heart.