bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Helicobacter pylori Eradication on Gastroesophageal Reflux Symptoms and Epigastric Pain in Children and Adolescents
Authors: Levine Arie , Milo Tamir , Broide Efrat , Wine Eitan , Dalal Ilan , Boaz Mona , Avni Yona , Shirin Haim 
Published: August 2004

Objective. Conflicting reports have noted a possible association linking eradication of Helicobacter pylori with aggravation of gastroesophageal reflux (GER) disease. We prospectively evaluated the effect of eradication of H pylori on GER symptoms and epigastric pain and the association among these 3 parameters in a pediatric cohort.
Methods. Patients who were referred for gastroscopy were evaluated for frequency, severity, and nocturnal presence of symptoms related to GER as well as epigastric pain. Patients who were positive for H pylori received triple antibiotic therapy. The patients were followed for at least 6 months after therapy. Patients with successful eradication had symptoms compared with their pre-eradication state and were compared with a cohort of patients without H pylori or those with persistent H pylori.
Results. Of 119 children and adolescents who were recruited, 95 patients completed the study, with a mean follow-up of 11.2 months. The distribution of outcomes for each GER symptom (better, worse, unchanged) was similar before and after eradication and did not depend on prior H pylori status. Among patients with GER and epigastric pain, improvement in epigastric pain was significantly correlated with the improvement in GER symptoms but not with eradication of H pylori.
Conclusions. Eradication of H pylori is not associated with increased symptoms of GER in children and adolescents. Improvement in epigastric pain in children is significantly correlated with the improvement in GER symptoms but not with eradication of H pylori.
Neonatal Cerebral Infarction and Neuromotor Outcome at School Age
Authors: Mercuri Eugenio , Barnett Anna , Rutherford Mary , Guzzetta Andrea , Haataja Leena , Cioni Giovanni , Cowan Frances , Dubowitz Lilly 
Published: August 2004

Objective. The aim of this study was to assess neuromotor function at school age in children who had cerebral infarction on neonatal magnetic resonance imaging (MRI).
Design. Twenty-two children with evidence of cerebral infarction on neonatal brain MRI (18 with arterial infarction and 4 with border-zone lesions) were assessed at school age with a structured neurologic examination and the Movement Assessment Battery for Children, a battery of tests designed to assess motor function.
Results. Of the 22 children, 6 (30%) had hemiplegia and a further 7 (30%) showed some neuromotor abnormality such as asymmetry on the neurologic examination (n = 4) or poor scores on the neuromotor test without any sign of asymmetry (n = 3). The remaining 9 children had a normal motor outcome. Hemiplegia was found only in children who had concomitant involvement of hemisphere, internal capsule, and basal ganglia on brain MRI. Children with involvement of the internal capsule, associated either with basal ganglia or hemispheric lesions, did not show hemiplegia but still had motor difficulties.
Conclusions. Our results suggest that although hemiplegia occurs in a relatively small proportion of children with neonatal cerebral infarction, other signs of neuromotor impairment can be present, and these become more obvious at school age when a more specific assessment can be performed. These results also suggest that the involvement of the internal capsule on neonatal MRI can predict the presence of these abnormalities.
Paintball Injuries in Children: More Than Meets the Eye
Authors: Listman David A. 
Published: August 2004

Objective. To describe the increasing incidence of ocular injuries in the pediatric population caused by paintballs. The awareness of this trend will help the physician who treats the child to give appropriate care as well as educate physicians, who counsel children, about this growing mechanism of pediatric injuries.
Methods. Previously unpublished data from the US Consumer Product Safety Commission were analyzed to find the frequency of ocular injuries in children. A review of the English-language literature was also conducted to describe trends with regard to age, sex, location at the time of injury, use of eye protection, types of injuries sustained, and long-term visual outcome.
Results. The incidence of paintball eye injuries treated in emergency departments has risen from an estimated 545 in 1998 to &gt;1200 in 2000. The proportion of these injuries that occurred in the pediatric population may be well over 40%. These injuries are seen predominantly in boys, a growing proportion of whom are playing informally in unsupervised settings and not wearing eye protection. The cases previously reported include large numbers of hyphemas, retinal detachments, cataracts, corneal abrasions, vitreous hemorrhages, and commotio retina. Many of the patients in these cases sustained permanent visual impairment, with 43% having best vision at follow-up of 20/200 or worse.
Conclusions. Pediatric eye injuries caused by paintballs are an unrecognized cause of severe injury and permanent visual loss. The advances in eye protection for participants in “war games” have had little if any effect on the youngest population. Children and teens are unlikely to wear eye protection voluntarily when playing at undesignated or unsupervised locations. Changes should be made to restrict availability of these very dangerous but easily acquired guns and ammunition. Practitioners must counsel young people and their caregivers to avoid injuries by wearing appropriate eye protection. Parents should supervise the use of paintball equipment as they would other activities that involve high-speed projectiles.
Planning Adenotonsillectomy in Children With Obstructive Sleep Apnea: The Role of Overnight Oximetry
Authors: Nixon Gillian M. , Kermack Andrea S. , Davis G. Michael , Manoukian John J. , Brown Karen A. , Brouillette Robert T. 
Published: August 2004

Objective. Obstructive sleep apnea (OSA) in children is usually effectively treated by adenotonsillectomy (T&A). However, there may be a waiting list for T&A, and the procedure is associated with an increased risk of postoperative complications in children with OSA. Needed is a simple test that will facilitate logical prioritization of the T&A surgical list and help to predict children who are at highest risk of postoperative complications. The objective of this study was to develop and validate a severity scoring system for overnight oximetry and to evaluate the score as a tool to prioritize the T&A surgical list.Methods. This study comprised 3 phases. In phase 1, a severity score was developed by review of preoperative overnight oximetry in children who had urgent T&A in 1999–2000. In phase 2, the score was validated retrospectively in 155 children who had polysomnography (PSG) before T&A in 1992–1998. In a phase 3, a 12-month prospective evaluation of a protocol based on the score was conducted.Results. In phase 1, a 4-level severity score was developed on the basis of the number and the depth of desaturation events (normal to severely abnormal, categories 1–4). In phase 2, the McGill oximetry score correlated with severity of OSA by PSG criteria. In phase 3, a clinical management protocol was developed based on the score. Of 230 children tested, 179 (78%) had a normal/inconclusive oximetry (category 1) and went on to have PSG. Those with a positive oximetry (categories 2–4; 22%) had no additional sleep studies before T&A. Timing of T&A was based on oximetry score, leading to a significant reduction in waiting time for surgery for those with higher oximetry scores. Postoperative respiratory complications were more common with increasing oximetry score.Conclusions. Overnight pulse oximetry can be used to estimate the severity of OSA, to shorten the diagnostic and treatment process for those with more severe disease, and to aid clinicians in prioritization of T&A and planning perioperative care.
Identification and Recall of Children With Chronic Medical Conditions for Influenza Vaccination
Authors: Daley Matthew F. , Barrow Jennifer , Pearson Kellyn , Crane Lori A. , Gao Dexiang , Stevenson John M. , Berman Stephen , Kempe Allison 
Published: August 2004

Objectives. Despite long-standing recommendations to provide annual influenza vaccination to children with chronic medical conditions, immunization rates are &lt;10% in most primary care settings. Many obstacles impede implementation of these recommendations, including the challenge of identifying targeted children and the need to immunize yearly in a short time interval. The objective of this study was to assess the accuracy of billing data for identifying children who have high-risk conditions (HRCs) and need influenza vaccination and 2) to evaluate the efficacy of reminder/recall for children with HRCs.Methods. The study was conducted in 4 private pediatric practices in metropolitan Denver, Colorado, that share a computerized billing system and also participate in an immunization registry. For all children aged 6 to 72 months, registry records were linked with the billing database. Patients with ≥1 encounters for an HRC in the previous 24 months were selected, with HRCs identified from International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Using medical records as the “gold standard,” we reviewed 327 randomly selected records to determine the sensitivity, specificity, and accuracy of billing data for identifying HRCs. For children with an HRC, we then conducted a randomized, controlled trial of reminder/recall for influenza vaccination. The primary outcome of the recall trial was receipt of influenza vaccine.Results. Billing data had a sensitivity of 72% (95% confidence interval [CI]: 48%–95%), specificity of 95% (95% CI: 90%–100%), and overall accuracy of 90% (95% CI: 84%–96%) in determining which children had an HRC. Of the 17 273 patients aged 6 to 72 months, 2007 had ≥1 HRCs (12% overall; range: 9%–14% per practice). Asthma/reactive airways disease accounted for 87% of all HRCs. Reminder/recall significantly increased influenza immunization in children with HRCs, with a vaccination rate of 42% in those recalled, compared with 25% in control subjects. Recalled subjects were more likely to have an office visit (68% vs 60%) and less likely to have a missed opportunity to immunize (28% vs 37%) compared with control subjects.Conclusions. Diagnosis-based billing data accurately identified children who had HRCs and needed annual influenza vaccination, and registry-driven reminder/recall significantly increased influenza immunization in targeted children.
Reimbursement for Pediatric Diabetes Intensive Case Management: A Model for Chronic Diseases?
Authors: Beck Joni K. , Logan Kathy J. , Hamm Robert M. , Sproat Scott M. , Musser Kathleen M. , Everhart Patricia D. , McDermott Harrold M. , Copeland Kenneth C. 
Published: August 2004

Objective. Current reimbursement policies serve as potent disincentives for physicians who provide evaluation and management services exclusively. Such policies threaten nationwide availability of care for personnel-intensive services such as pediatric diabetes. This report describes an approach to improving reimbursement for highly specialized, comprehensive pediatric diabetes management through prospective contracting for services. The objective of this study was to determine whether pediatric diabetes intensive case management services are cost-effective to the payer, the patient, and a pediatric diabetes program.
Methods. A contract with a third-party payer was created to reimburse for 3 key pediatric diabetes intensive case management components: specialty education, 24/7 telephone access to an educator (and board-certified pediatric endocrinologist as needed), and quarterly educator assessments of self-management skills. Data were collected and analyzed for 15 months after signing the contract. Within the first 15 months after the contract was signed, 22 hospital admissions for diabetic ketoacidosis (DKA) occurred in 16 different patients. After hospitalizations for DKA, all 16 patients were offered participation in the program. All were followed during the subsequent 1 to 15 months of observation. Ten patients elected to participate, and 6 refused participation. Frequency of rehospitalization, emergency department visits, and costs were compared between the 2 groups.
Results. Among the 10 participating patients, there was only 1 subsequent DKA admission, whereas among the 6 who refused participation, 5 were rehospitalized for DKA on at least 1 occasion. The 10 patients who participated in the program had greater telephone contact with the team compared with those who did not (16 crisis-management calls vs 0). Costs (education, hospitalization, and emergency department visits) per participating patient were approximately $1350 less than those for nonparticipating patients. Differences between participating and nonparticipating groups included age (participants were of younger age), double-parent households (participants were more likely to be from double parent households), and number of medical visits kept (participants kept more follow-up visits). No differences in duration of diabetes, months followed in the program, sex, or ethnicity were observed.
Conclusions. Contracting with third-party payers for pediatric diabetes intensive case management services reduces costs by reducing emergency department and inpatient hospital utilizations, likely a result of intensive education and immediate access to the diabetes health care team for crisis management. Such strategies may prove to be cost saving not only for diabetes management but also for managing other costly and personnel-intensive chronic diseases.
Adenoviral Infections in Children: The Impact of Rapid Diagnosis
Authors: Rocholl Christian , Gerber Kris , Daly Judy , Pavia Andrew T. , Byington Carrie L. 
Published: August 2004

Background. Adenovirus (ADV) infections were difficult to diagnose in the past, and many infections were unrecognized. Direct fluorescent assay (DFA) for the rapid diagnosis of ADV infection, as part of a viral respiratory panel, became available at Primary Children’s Medical Center (Salt Lake City, UT) in December 2000.Objective. To describe children with ADV infection diagnosed by DFA and viral culture and document the impact of rapid ADV testing on patient care.Methods. DFA testing for respiratory viruses including ADV was performed on nasal wash specimens with parallel viral culture. Chart review was performed for all ADV-positive patients identified from microbiology records between December 2000 and May 2002.Results. Of 1901 patients positive for respiratory viruses, 143 (7.5%) were ADV-positive by DFA or culture. The mean age of ADV-positive children was 23 months; 90% were ≤60 months old. Eighty percent were previously healthy, and 56% required admission with a mean length of stay of 3.4 days. The most common diagnoses included fever (31%), bronchiolitis (24%), and pneumonia (14%). Other conditions included suspected Kawasaki disease (KD) and hepatitis. Forty-six percent of ADV-positive children were given antibiotics at presentation, but only 2 (1.4%) had documented bacterial infection (one had Escherichia coli urinary tract infection and one had Moraxella catarrhalis bacteremia). Thirty-six percent of children had a change in management based on positive ADV DFA. In children with suspected KD (n = 5), 100% had positive ADV DFA, and immune globulin was withheld in 4. One immunocompetent patient with fulminant liver failure received cidofovir treatment after a positive ADV DFA and recovered before liver transplant.Conclusions. ADV is a common infection in young children and often results in admission and unnecessary antibiotic therapy. Identifying ADV as the cause of illness can favorably impact care and in some instances may be life-saving. DFA testing for ADV should be considered for infants and children requiring admission for fever, respiratory illness, suspected KD, and hepatitis.
Maternal Depressive Symptoms and Adherence to Therapy in Inner-City Children With Asthma
Authors: Bartlett Susan J. , Krishnan Jerry A. , Riekert Kristin A. , Butz Arlene M. , Malveaux Floyd J. , Rand Cynthia S. 
Published: August 2004

Context. Little is known about how depressive symptoms in mothers affects illness management in inner-city children with asthma.
Objective. Our goal was to determine how maternal depressive symptoms influence child medication adherence, impact of the child’s asthma on the mother, and maternal attitudes and beliefs.
Methods. Baseline and 6-month surveys were administered to 177 mothers of young minority children with asthma in inner-city Baltimore, MD and Washington, DC. Medication adherence, disruptiveness of asthma, and select attitudes toward illness and asthma therapy were measured. Six-month data (N = 158) were used to prospectively evaluate long-term symptom control and emergency department use. Independent variables included asthma morbidity, age, depressive symptoms, and other psychosocial data.
Results. No difference in child asthma morbidity was observed between mothers high and low in depressive symptoms. However, mothers with high depressive symptoms reported significantly more problems with their child using inhalers properly (odds ratio [OR]: 5.0; 95% confidence interval [CI]: 1.3–18.9) and forgetting doses (OR: 4.2; 95% CI: 1.4–12.4). Depressive symptoms were also associated with greater emotional distress and interference with daily activities caused by the child’s asthma, along with less confidence in asthma medications, ability to control asthma symptoms, and self-efficacy to cope with acute asthma episodes. In addition, depressed mothers reported less understanding about their child’s medications and use (OR: 7.7; 95% CI: 1.7–35.9). Baseline asthma morbidity, maternal depression scores, and family income were independently associated with asthma symptoms 6 months later, whereas medication adherence was not predictive of subsequent asthma morbidity or emergency department use.
Conclusions. Maternal depressive symptoms were not associated with child asthma morbidity but were associated with a constellation of beliefs and attitudes that may significantly influence adherence to asthma medications and illness management. Identifying and addressing poor psychological adjustment in mothers is important when developing a child’s asthma treatment and may facilitate parent-provider communication, medication adherence, and asthma management among inner-city children.
Pediatricians’ Use of and Attitudes About Personal Digital Assistants
Authors: Carroll Aaron E. , Christakis Dimitri A. 
Published: August 2004

Background. Personal digital assistants (PDAs) are being increasingly used in medical practice. Although they have been touted as having the ability to improve efficiency and safety, little is known about pediatricians’ use of and attitudes about PDAs.
Objective. Our goals were to 1) determine the percentage of pediatricians using PDAs and computers, 2) determine perceived strengths and weaknesses of PDAs, and 3) explore characteristics associated with beliefs and use.
Design/Methods. Pediatricians (2130) were selected randomly from the American Medical Association Physician Masterfile of US-licensed physicians. All participants were mailed a survey along with a prepaid return envelope and a $1 incentive. Up to 3 mailings were sent per participant.
Results. Of eligible participants, 63.2% returned a survey. There were no significant differences between respondents and nonrespondents with respect to sex, type of practice, and present employment. Thirty-five percent of respondents currently use PDAs at work, and 40% currently use PDAs for personal use. Of those using PDAs, the most commonly used applications were for drug reference (80%), personal scheduling (67%), and medical calculations (61%). Few pediatricians are currently using PDAs for prescription writing (8%) or billing (4%). Users of PDAs were more likely to be male (adjusted odds ratio [AOR]: 2.29; 95% confidence interval [CI]: 1.64–3.19), in an urban community (AOR: 1.81; 95% CI: 1.30–2.55), in training (AOR: 2.64; 95% CI: 1.58–4.42), not in private practice (AOR: 1.47; 95% CI: 1.03–2.11), and a more recent graduate of medical school (AOR: 1.04 per year; 95% CI: 1.02–1.06). When controlling for covariates, those using PDAs were more likely to believe that PDAs can decrease medical errors (AOR: 2.22; 95% CI: 1.46–3.38) and increase efficiency (AOR: 2.40; 95% CI: 1.56–3.71). When compared with nonusers, users were less likely to view the small screen size (AOR: 0.53; 95% CI: 0.37–0.77) or system speed (AOR: 0.47; 95% CI: 0.26–0.84) as a problem but were significantly more likely to view memory as an issue (AOR: 3.48; 95% CI: 2.30–5.25).
Conclusions. More than one third of pediatricians are using PDAs in clinical practice. There seems to be a general consensus among users that they have the potential to improve patient safety and streamline care. Future studies should explore means to utilize their potential.
A Bitter Pill: Attempting Change in a Pediatric Morning Report
Authors: Elliott Sean P. , Ellis Susan C. 
Published: August 2004

Objective. To assess and address participants’ dissatisfaction with departmental morning report (MR).
Methods. Three consecutive MR sessions were observed, and those data, in combination with findings from the literature, were used to guide creation of a quantitative survey. The survey was administered to all faculty and housestaff. Survey items addressed the educational focus, leadership, and format of MR and the value of specific educational conferences. Subsequently, 2 interventions were developed to increase participants’ level of satisfaction with MR. The interventions’ effect was measured 1 year later using a second survey.
Results. Eighty-two percent of housestaff and 43% of faculty responded to the first survey. Our findings are contrary to those in the literature. For example, respondents rated the presence of all faculty at MR as desirable, and both subspecialty and general pediatric contributions were considered important. Housestaff assigned greater educational value to all teaching conferences than did faculty. Similarly, housestaff believed more strongly than faculty that MR leadership should be changed. A follow-up survey demonstrated a decrease in mean perceived value of MR after our interventions.
Conclusions. Despite aggressive research, we failed to identify the source of participants’ dissatisfaction. Although our interventions were based on research data and reflected participants’ perceptions and concerns related to MR, they were not supported by the faculty. This demonstrates the inherent difficulties in changing an “institution” such as MR. Thus, examination of MR goals and satisfaction by individual training programs should be conducted within the confines of the conference’s preexisting structure, without attempt to apply literature-driven expectations.