bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Prevalence of Pain in Pediatric Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome as Reported by Participants in the Pediatric Late Outcomes Study (PACTG 219)
Authors: Gaughan Denise M. , Hughes Michael D. , Seage George R. , Selwyn Peter A. , Carey Vincent J. , Gortmaker Steven L. , Oleske James M. ,   PACTG 219 Team
Published: August 2004

Objectives. As the life expectancy of children with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) increases, quality-of-life outcomes are of increasing concern. The prevalence of pain in adults with AIDS ranges from 40% to 60%, depending on stage of illness. There is limited research concerning pain in HIV-infected children and youth.Design. The General Health Assessment for Children was administered to caregivers of HIV-infected children and youth enrolled in the Pediatric Late Outcomes Study (PACTG 219), a prospective cohort study. Pain is assessed over the previous month with 7 questions. For the purpose of this analysis, we defined pain as the presence of pain of at least moderate intensity. Participants were observed from January 1, 1996, to December 31, 1999.Results. A total of 985 HIV-positive participants had a baseline pain evaluation in 1995. The prevalence of pain remained relatively constant during each year of observation, averaging 20%. Lower CD4+ T-lymphocyte percentage, female gender, and an HIV/AIDS-related diagnosis were highly associated with an increased risk of reported pain. Pain was also independently associated with increased risk of death. After adjusting for CD4 percentage, use of combination therapy including protease inhibitors, comorbid diagnoses, and other sociodemographic characteristics, individuals reporting pain were over 5 times more likely to die than those not reporting pain (hazard ratio = 5.07; 95% confidence interval = 3.23–7.95).Conclusions. Pain is a frequently encountered symptom in children and youth with HIV disease and is also associated with increased mortality. These findings emphasize the importance of pain management in this population.
Pediatric Residents’ Clinical Diagnostic Accuracy of Otitis Media
Authors: Steinbach William J. , Sectish Theodore C. , Benjamin Daniel K. , Chang Kay W. , Messner Anna H. 
Published: August 2004

Objective. Pediatric resident physicians’ clinical diagnostic accuracy of otitis media is unknown. We attempted to correlate the clinical examination of pediatric house staff with pediatric otolaryngologists and tympanometry.
Methods. Pediatric residents evaluated patients who were scheduled in the pediatric acute care clinic and completed a provider examination form detailing their otoscopic findings, interpretation, and treatment plan. Patients were then immediately reevaluated by a pediatric otolaryngologist using an identical form. Tympanometry was also performed by a pediatric audiologist. We used κ statistics to calculate correlation of clinical findings and interpretation.
Results. A total of 103 patients consented for the study; 70 patients were examined by 27 different pediatric residents with 43 patients (86 ears) examined by all 3 providers. Correlation of clinical findings between all pediatric residents and the pediatric otolaryngologists was a κ statistic of 0.30 (fair agreement). The individual diagnostic finding with the greatest correlation was tympanic membrane erythema (κ statistic: 0.40 [fair agreement]), and the worst correlate was tympanic membrane position (κ statistic: 0.16 [slight agreement]). Resident interpretation and tympanometry yielded a κ statistic of 0.20 (slight agreement), and the otolaryngologist interpretation and tympanometry yielded a κ statistic of 0.32 (fair agreement).
Conclusions. Otitis media is the most common disease seen by practicing general pediatricians, but there is a paucity of formalized resident education. We demonstrated only a slight to moderate correlation between the clinical diagnostic examinations of pediatric residents and pediatric otolaryngologists and tympanometry.
Changes in Upper Extremity Position Cause Migration of Peripherally Inserted Central Catheters in Neonates
Authors: Nadroo Ali M. , Glass Ronald B. , Lin Jing , Green Robert S. , Holzman Ian R. 
Published: August 2004

Objective. The migration of peripherally inserted central catheters (PICCs) from the superior or inferior vena cava into the right atrium can pose a significant risk of lethal pericardial effusion and tamponade secondary to myocardial perforation. Arm movement has been reported to cause displacement of the catheter tip toward the heart and lead to ventricular tachycardia in adults. The objective of this study was to investigate whether adduction or abduction at the shoulder and flexion or extension at the elbow affect the position of PICCs placed via upper limb veins. We also hypothesized that arm movements can be used to reposition malpositioned catheters.
Methods. A total of 280 radiographs of 60 neonates with PICCs inserted via upper limb veins from July 2000 through June 2001 were reviewed. Differences in catheter tip position as a result of abduction versus adduction at the shoulder, flexion versus extension at the elbow, and combination changes in arm posture were determined by measurements in paired radiographs. Correction of malpositioned catheters was attempted in 10 patients by using arm movements without any alterations at the site of insertion.
Results. Arm movements were associated with significant displacement of catheters. Catheters that were placed via the basilic or axillary vein migrated toward the heart with adduction of the arm, whereas those that were placed via the cephalic vein moved away from the heart with adduction. Flexion of the elbow displaced catheters that were placed in the basilic or cephalic vein below the elbow toward the heart but did not have any effect on catheters that were placed via the axillary vein. For catheters that were placed in the basilic vein, simultaneous shoulder adduction and elbow flexion caused the greatest movement toward the heart (15.11 ± 1.22 mm). We were able to reposition correctly inappropriately placed catheters in 9 of 10 patients by using arm movements.
Conclusions. Arm movements significantly affect the position of the tip of the PICCs. Prevention of catheter migration into the right atrium requires radiographic determination of vein of insertion and monitoring of catheter tip position with upper extremity in position of maximum inward movement of catheter for that vein. Arm movements can be used to correct the malpositioned catheters.
Assessment of a Transcutaneous Device in the Evaluation of Neonatal Hyperbilirubinemia in a Primarily Hispanic Population
Authors: Engle William D. , Jackson Gregory L. , Sendelbach Dorothy , Manning Denise , Frawley William H. 
Published: August 2004

Objective. To compare estimates of serum bilirubin as determined by a transcutaneous device (BiliChek [BC]) with laboratory-measured total serum bilirubin (TSB) in a predominately Hispanic population in which a significant number of TSB values ≥15 mg/dL was anticipated.Methods. A total of 248 Hispanic and 56 non-Hispanic neonates were studied. Transcutaneous measurements were performed by 1 investigator within 30 minutes of blood sampling for TSB; TSB was determined in a large clinical laboratory using the diazo Jendrassik-Grof with blank method. Agreement between BC and TSB determinations was assessed using Bland-Altman plots and the Bradley-Blackwood test. Interdevice comparisons were made among the BC devices. Predictive indices for TSB &gt;10 mg/dL and &gt;15 mg/dL were determined using various BC cutoff values.Results. TSB was ≥15 mg/dL in 31% of the Hispanic neonates. BC generally tended to underestimate TSB determinations, and this trend was more pronounced when TSB was &gt;10 mg/dL. Very high sensitivities were observed only when relatively low BC cutoff values were used to predict TSB &gt;10 mg/dL or &gt;15 mg/L. Relatively small numbers of infants had BC values in these low ranges.Conclusions. The tendency of BC to underestimate TSB limits its usefulness in neonates with relatively high TSB. In this population, most infants would have required additional evaluation to ensure that TSB was not &gt;10 mg/dL or &gt;15 mg/dL. It seems that the discrepancy between this study and previous studies of BC is related to our relatively large number of TSB values ≥15 mg/dL.
Health Care Services Utilization in Children With Obstructive Sleep Apnea Syndrome
Authors: Reuveni Haim , Simon Tzahit , Tal Asher , Elhayany Asher , Tarasiuk Ariel 
Published: August 2004

Objective. Little is known about the effects of obstructive sleep apnea syndrome (OSAS) on utilization of health care services in children. The present study compares medical service utilization by children with OSAS with that of healthy children.
Methods. A cross-sectional study of 287 consecutively recruited children (1–18 years) with OSAS and no concomitant diseases and a control group matched by age, gender, and geographic location was conducted at the Clalit Health Care Services clinic in the southern region of Israel. Children in the study group underwent nocturnal polysomnography (PSG) studies. The control group (N = 1149) was randomly selected from the Clalit Health Care Services database. PSG was performed for the OSAS patients. Indices of health care utilization 1 year before the PSG study were analyzed.
Results. A 226% increase in health care utilization was noted among children with OSAS. Children up to 5 years of age consumed more health care resources than children over 5 years. Children with OSAS consumed more health care services than the control group at all ages. The leading components of this high cost are utilization of more hospital days, drugs, and visits to the emergency department. The severity of the OSAS correlates directly to total annual costs and independently to age (β = 0.19).
Conclusions. Children with OSAS are heavy consumers of health care services 1 year before any specific evaluation and treatment for apnea. Early diagnosis and intervention may be cost-effective.
Bedside Diagnosis of Influenzavirus Infections in Hospitalized Children
Authors: Poehling Katherine A. , Griffin Marie R. , Dittus Robert S. , Tang Yi-Wei , Holland Kathy , Li Haijing , Edwards Kathryn M. 
Published: August 2004

Objective. For preventing nosocomial influenza infections and to facilitate prompt antiviral therapy, an accessible, rapid diagnostic method for influenzavirus is needed. We evaluated the performance of a lateral-flow immunoassay (QuickVue Influenza Test) completed at the bedside of hospitalized children during the influenza season.
Methods. All children who were evaluated at a large teaching hospital during the 1999 to 2000 influenza season were eligible if they were 1) younger than 19 years and hospitalized with respiratory symptoms or 2) younger than 3 years and hospitalized with fever. Each study child had 2 nasal swabs obtained—1 for influenzavirus culture and polymerase chain reaction (PCR) and the other for the QuickVue Influenza Test. The performance of the rapid diagnostic test was compared with the results of culture or PCR for influenza A or B.
Results. Of 303 eligible children, 233 (77%) were enrolled. In this population, 19 children had culture- and/or PCR-confirmed influenza A infection, prevalence of 8%. The QuickVue Influenza Test had a sensitivity of 74%, specificity of 98%, positive predictive value of 74%, and negative predictive value of 98%.
Conclusions. Among children hospitalized with fever/respiratory symptoms during the influenza season, negative bedside QuickVue Influenza Tests indicated very low likelihood of influenza infection, whereas positive tests greatly increased the probability of influenza-associated illness.
Forced Use Treatment of Childhood Hemiparesis
Authors: Willis John K. , Morello Ann , Davie Anita , Rice Janet C. , Bennett James T. 
Published: August 2004

Objective. Forced use, or constraint-induced, movement therapy has shown some efficacy in the rehabilitation of adults with chronic hemiparesis as a result of stroke. We used restraint of the unimpaired arm to ascertain whether this would improve function of the paretic arm in children with chronic (&gt;1 year) hemiparesis.
Methods. Twelve hemiparetic treatment children (age 1–8 years) received a plaster cast on the unimpaired arm for 1 month; 13 hemiparetic control children did not. Peabody Developmental Motor Scales (PDMS) were performed on all treatment and control children immediately before and after casting and again 6 months later when controls crossed over to receive casts. Thus, PDMS were performed at entry, then 1 month, 6 months, and 7 months after entry. Any noted change in functional ability was also elicited by parental report. The frequency of visits to physical and occupational therapy was recorded.
Results. The 12 treatment (casted) children improved 12.6 PDMS points after 1 month of casting; the 13 control children improved 2.5 points. Improved PDMS scores persisted 6 months later when 7 treatment children returned. Similar results were obtained in the crossover when 10 control children received casts. Parental report corroborated improvement in casted children (22 of 22 parents) and its persistence at follow-up (21 of 22 parents). Receiving ongoing physical/occupational therapy did not seem to account for these results: control children received more (2.1 visits/wk) than treatment children (1.4 visits/wk).
Conclusions. Forced use can be an effective rehabilitation technique in children with chronic hemiparesis.
Pagers Combined With Telephones Improve Successful Follow-up From a Pediatric Emergency Department
Authors: Kim In K. , Lanni Karen A. , Collazo Edgar , Gracely Ed J. , Belfer Robert 
Published: August 2004

Objective. To determine whether there is a significant difference in initial successful contact when attempting follow-up of patients discharged from a pediatric emergency department (ED) using either pagers or the telephone. In addition, to evaluate whether the combination of both pager and telephone follow-up is more successful than telephone follow-up alone when confined to a 2-hour period.
Design and Setting. A prospective comparison of intervention and control groups taken from convenience samples of patients seen in an ED of an urban, tertiary care children’s hospital.
Participants. One hundred eighty-five patients whose families had access to both a pager and a telephone (intervention group) and 112 patients whose families had access to only a telephone (control group) were enrolled.
Intervention. Before discharging the patient from the ED, the investigators verified a pager number and/or a best contact telephone number for a follow-up telephone call. Participants were divided into 2 groups. The intervention group consisted of caretakers with both pagers and telephones. The control group consisted of caretakers with only telephones. On even calendar days after ED visits, intervention group caretakers were paged initially from 11:00 am to 11:59 am. On odd calendar days, intervention group caretakers were telephoned initially from 11:00 am to 11:59 am. Successful contact was defined as communication with a family member or guardian over the age of 18. If the caretaker spoke only Spanish, a translator was used. In a crossover design with the intervention group, if contact was unsuccessful after 1 hour, the alternative mode of communication was used at noon. Control group caretakers were telephoned from 11:00 am to 11:59 am. If telephone contact was unsuccessful, they were called again 1 hour later.
Results. Two hundred forty-six (36%) of 685 of the convenience sample of caretakers had access to both a pager and a telephone. Fifty-two (55%) of 94 intervention caretakers were contacted initially using pagers versus 47 (52%) of 91 intervention caretakers contacted initially by telephones. Overall successful contact of intervention caretakers (telephones and pagers) was 145 (78%) of 185 when confined to a 2-hour time period. In contrast, overall successful contact of control caretakers was 68 (61%) of 112 when confined to a 2-hour time period. Successful contact was greater with the intervention caretakers than with control caretakers (78% vs 61%).
Conclusions. No significant difference in successful contact was seen whether paged or telephoned initially. The combination of both pagers and telephone follow-up was more successful than telephone follow-up alone when confined between 11:00 am to 1:00 pm.
Relationship of Adherence to Pediatric Asthma Morbidity Among Inner-City Children
Authors: Bauman Laurie J. , Wright Elizabeth , Leickly Frederick E. , Crain Ellen , Kruszon-Moran Deanna , Wade Shari L. , Visness Cynthia M. 
Published: August 2004

Objectives. Morbidity from asthma among children is one of the most important US health concerns. This study examines the relationship of baseline nonadherence to subsequent asthma morbidity among inner-city children.Methods. A multisite, prospective, longitudinal panel study was conducted of 1199 children who were aged 4 to 9 years and had asthma and their caregivers, most of whom were parents, in emergency departments and clinics at 8 research centers in 7 US metropolitan inner-city areas. Nine morbidity indicators were collected at 3, 6, and 9 months after baseline, including hospitalizations, unscheduled visits, days of wheeze/cough, and days of reduced activities.Results. Children whose caregivers scored high on a new measure, Admitted Nonadherence, experienced significantly worse morbidity on 8 of the 9 measures. Children who scored high on a new Risk for Nonadherence measure experienced significantly worse morbidity on all 9 morbidity measures. Multiple and logistic regressions found that the adherence measures had independent significant effects on morbidity. Combining the measures improved estimates of morbidity: children whose caregivers were poor on either adherence measure had worse morbidity than those with good adherence on both, eg, rate of hospitalization was twice as high, they missed more than twice as much school, had poorer overall functioning, and experienced more days of wheezing and more restricted days of activity.Conclusions. Risk for Nonadherence and Admitted Nonadherence independently and jointly predicted subsequent asthma morbidity. Targeting risks for nonadherence may be an effective intervention strategy. Most risks can be controlled by physicians through reducing the complexity of asthma regimens, communicating effectively with caregivers about medication use, and correcting family misconceptions about asthma medication side effects.
Factors That Influence the Willingness of Private Primary Care Pediatricians to Accept More Medicaid Patients
Authors: Berman Steve , Dolins Judith , Tang Suk-fong , Yudkowsky Beth 
Published: August 2004

Objective. State Medicaid programs are obligated by federal law to ensure that enrolled children have access to care and services to the same extent as other children in the same geographic area. Because most children in the United States receive health care from private primary care physicians, participation by private, office-based primary care pediatricians is critical to meeting this equal access obligation. The objective of this study was to document variations in Medicaid participation of private office-based primary care pediatricians across states and to examine the effects of payment levels, prevalence of capitated Medicaid payment, and paperwork concerns on participation.Methods. Survey data collected from 3773 primary care pediatricians who practice in private office-based settings were analyzed with Medicaid physician payment data from other sources. Univariate analyses and a multiple regression were used to examine the effects of payment level, prevalence of capitated Medicaid payment, and paperwork concerns on private primary care pediatricians’ participation in state Medicaid programs.Results. Results revealed substantial state-to-state variation in respondents’ participation in Medicaid. Univariate analyses found that participation increased with state Medicaid payment levels but decreased as the proportion of Medicaid enrollees with primary care capitated payments rose and as paperwork concerns increased. With physician workforce held constant, a regression analysis showed that pediatrician participation in Medicaid increased significantly with Medicaid payment but decreased as the proportion of capitated Medicaid patients increased and as paperwork concerns rose.Conclusions. This study found that low payment, capitation, and paperwork concerns all relate to low Medicaid participation by primary care office-based pediatricians. It behooves state policy makers to address these 3 factors to ensure sufficient primary care physician capacity to serve appropriately children who are enrolled in state Medicaid programs.
Survey of Adverse Drug Reactions on a Pediatric Ward: A Strategy for Early and Detailed Detection
Authors: Weiss Jutta , Krebs Sabine , Hoffmann Claudia , Werner Ulrike , Neubert Antje , Brune Kay , Rascher Wolfgang 
Published: August 2004

Objective. Adverse drug reactions (ADRs) occur frequently in children. However, the exact incidence of ADRs is unknown. Therefore, we studied ADRs in 1 ward and assessed whether a general approach, eg, by a computerized monitoring system, to detect ADRs in children is feasible and likely to yield a higher rate of early detected ADRs. The aim was to assess the usefulness of a computerized monitoring system before implementing costly adaptations.
Methods. An 8-month prospective study was conducted at a 10-bed pediatric isolation ward of the University Hospital. Charts were reviewed once weekly by a pharmacoepidemiological team. Clinical signs as well as laboratory changes were documented and assessed. Algorithms were used to assess the probability and severity of each detected event.
Results. All 214 patients admitted were enrolled in the study. A total of 68 ADRs were detected in 46 of 214 patients by the pharmacoepidemiological team. Thirty-four ADRs (50%) were detected by the staff physician, and 27 (40%) were detected primarily by analyzing laboratory parameters. Antibiotics-associated ADRs (50%) predominated, followed by glucocorticoids (16%), tuberculostatic (4%), and immunosuppressive agents (4%). In 5 cases, an ADR was responsible for the prolongation of hospital stay, and in 4 children, the ADR was responsible for hospitalization.
Conclusions. The detection rate of ADRs would almost be doubled by a computerized monitoring system analyzing laboratory data. Implementation of a computer monitor system that automatically generates laboratory signals may help to identify ADRs in children, and to reduce morbidity and hospital stay, as well as costs.