bluuebunny/crossref_metadata_2025_split huggingface dataset:
Informed Proxy Consent: Communication Between Pediatric Surgeons and Surrogates About Surgery
Authors: Lashley Myrna , Talley William , Lands Larry C. , Keyserlingk Edward W. 
Published: August 2004

Objective.Informed consent for surgical procedures requires that the procedures are explained and that the patient understands the procedures and risks and agrees to undergo them. Proxy consent occurs when an individual is provided with the legal right to make decisions on behalf of another. This study was conducted to determine how surgeons communicate information to obtain an informed proxy consent, and to investigate how that information is received and processed by surrogates responsible for providing such consent.Study Design.Twenty English-speaking parents or legal guardians and 5 surgeons in an urban pediatric hospital were interviewed before, and 2 to 4 weeks after, the surgical procedure. In addition, the interview between the surgeon and surrogate, when consent was obtained, was audiotaped and subsequently analyzed. Semistructured interviews were used to elicit the motivations and influences on the surrogates to consent to the procedure. The same methodology was used to elicit the corresponding impressions of the surgeons. The data were analyzed using descriptive statistics and crosstabulations.Results.Demographic data did not influence the results. Although there was concordance between the surrogate's understanding of the procedure and the surgeon's impression of this understanding, only 3 of 17 surrogates could recall any specifics of the explained procedure. Contrary to the stated belief of surgeons, surrogates consulted with a variety of others, including medical and paramedical professionals, family members, and spiritual leaders.Conclusions.Communication plays an important role within the surrogate-surgeon dyad. Psychologic variables such as expectations, and the perception of both the surrogates and the surgeons, influence the amount of information that is proffered and the manner in which it is received. Improved communication may be achieved by use of visual aids, discussion of anesthesia and the postoperative course, recognition of the circumstances around the discussion, such as timing and location of the discussion, and personalization of the discussion.
Childhood Encephalopathies and Myopathies: A Prospective Study in a Defined Population to Assess the Frequency of Mitochondrial Disorders
Authors: Uusimaa Johanna , Remes Anne M. , Rantala Heikki , Vainionpää Leena , Herva Riitta , Vuopala Katri , Nuutinen Matti , Majamaa Kari , Hassinen Ilmo E. 
Published: August 2004

Objectives.
To assess the frequency of mitochondrial abnormalities in muscle histology, defects in respiratory chain enzyme activities, and mutations in mitochondrial DNA (mtDNA) in children with unexplained psychomotor retardation in the population of Northern Finland.

Background.
The frequency of mitochondrial diseases among patients with childhood encephalopathies and myopathies is not known. Frequencies are difficult to estimate because the clinical presentation of these disorders is variable.

Methods.
A total of 116 consecutive patients with undefined encephalopathies and myopathies were enrolled during a 7-year period in a hospital serving as the only neurologic unit for a pediatric population of 97 609 and as the only tertiary level neurologic unit for a pediatric population of 48 873. Biochemical and morphologic investigations were performed on muscle biopsy material, including oximetric and spectrophotometric analyses of oxidative phosphorylation, histochemistry, electron microscopy, and molecular analysis of mtDNA.

Results.
Ultrastructural changes in the mitochondria were the most common finding in the muscle biopsies (71%). Ragged-red fibers were found in 4 cases. An oxidative phosphorylation defect was found in 26 children (28%), complex I (n = 15) and complex IV (n = 13) defects being the most common. Fifteen percent of patients (n = 17/116) with unexplained encephalomyopathy or myopathy had a probable mitochondrial disease. Common pathogenic mutations were found in the mtDNA of only 1 patient (.9%).

Conclusions.
The common known mutations in mtDNA are rarely causes of childhood encephalomyopathies, which is in contrast to the considerable frequency of the common MELAS mutation observed among adults in the same geographical area. Biochemically and morphologically verified mitochondrial disorders were nevertheless common among the children, making the analysis of a muscle biopsy very important for clinical diagnostic purposes.
Use of the National Institutes of Health Criteria for Diagnosis of Neurofibromatosis 1 in Children
Authors: DeBella Kimberly , Szudek Jacek , Friedman Jan Marshall 
Published: August 2004

Objective.The National Institutes of Health (NIH) Diagnostic Criteria for neurofibromatosis 1 (NF1) are very useful clinically, but some individuals who are later shown to have NF1 cannot be diagnosed in early childhood using these criteria. The aim of this study is to determine the value of the NIH Diagnostic Criteria for NF1 in early childhood, to determine the age at which diagnosis can confidently be made, and to clarify the age at onset of the cardinal clinical features used in the NIH Diagnostic Criteria.Methods.We studied 1893 NF1 patients under 21 years old from the National Neurofibromatosis Foundation International Database to determine the age at which the features included in the NIH Diagnostic Criteria appear.Results.Approximately 46% of sporadic NF1 cases fail to meet the NIH Diagnostic Criteria by 1 year of age. Nearly all (97%; 95% confidence interval: 94–98) NF1 patients meet the criteria for diagnosis by 8 years old, and all do so by 20 years old. The usual order of appearance of the clinical features listed as NIH criteria is café-au-lait macules, axillary freckling, Lisch nodules, and neurofibromas. Symptomatic optic glioma is usually diagnosed by 3 years old, and characteristic osseous lesions are usually apparent within the first year of life.Conclusion.The diagnosis of NF1 cannot always be made in young children using the NIH Diagnostic Criteria. Modification of these criteria may be necessary for children under 8 years old.
Snowmobile Injuries and Deaths in Children: A Review of National Injury Data and State Legislation
Authors: Rice Manda R. , Alvanos Lynn , Kenney Brian 
Published: August 2004

Background.Snowmobiling is a popular family sport, with annual expenditures over $9 billion. The size and speed of snowmobiles make them potentially dangerous to children. Pediatric snowmobile-related trauma has not been studied in the United States.Methods.We analyzed 291 pediatric snowmobile- related injuries and 75 deaths reported to the Consumer Product Safety Commission from 1990 to 1998. We reviewed snowmobile legislation in the states that reported at least 1 death to the Consumer Product Safety Commission during this time period.Results.The most common sites of injury were the extremities (48.8%) and the head, neck, and face (28.2%). Head and neck injuries were the predominant cause of death (66.7%). The most common diagnosis was contusion/abrasion (30.9%), followed by laceration (22%), fracture (20.3%), and strain/sprain (14.4%). Nonfatal injuries most often involved ejection from the snowmobile (26.1%), but striking a stationary object was the most common mechanism in fatal crashes. The review of state legislation revealed that few age restrictions or helmet laws exist. Children as young as 8 years old may legally operate a snowmobile in some states. Often, restrictions do not apply to snowmobile use on private property, where 43% of pediatric snowmobile-related injuries occurred.Conclusions.Head, neck, and face injuries are common nonfatal injuries and are the most common cause of death. State legislation often lacks age restrictions on private property, and laws requiring helmet use are rare. Legislators have not addressed the dangers of pediatric snowmobile-related injuries. Helmet laws and age restrictions similar to those enacted for motorcycle riders are necessary and appropriate.
Health Appraisal Guidelines for Day Camps and Resident Camps
Authors:   Committee on School Health
Published: August 2004

The American Academy of Pediatrics recommends that specific guidelines be established for pre-camp health appraisals of young people in day and resident camps. Camp guidelines also should include reference to health maintenance, storage and administration of medication, and emergency medical services.
Although camps have diverse environments, there are general guidelines that apply to all situations, and specific recommendations are appropriate under special conditions.
The Highly Protective Effect of Newborn Circumcision Against Invasive Penile Cancer
Authors: Schoen Edgar J. , Oehrli Michael , Colby CTR‡; Christopher J. , Machin Geoffrey 
Published: August 2004

Objective.We determined the relation between newborn circumcision and both invasive penile cancer (IPC) and carcinoma in situ (CIS) among adult male members of a large health maintenance organization.Subjects and Methods.Circumcision status was ascertained by a combination of pathology reports, medical record review, and questionnaires for 213 adult male members of a large prepaid health plan who were diagnosed with IPC or CIS.Results.Of 89 men with IPC whose circumcision status was known, 2 (2.3%) had been circumcised as newborns, and 87 were not circumcised. Of 118 men with CIS whose circumcision status was known, 16 (15.7%) had been circumcised as newborns.Conclusions.Our results confirm the highly protective effect of newborn circumcision against IPC and the less protective effect against CIS.
Mortality and Time to Death in Very Low Birth Weight Infants: California, 1987 and 1993
Authors: Gould Jeffrey B. , Benitz William E. , Liu Hao 
Published: August 2004

Background.Recent advances in perinatal technology have dramatically increased the survival of very low birth weight (VLBW) infants (&lt;1500 g). The possibility that these advances may also prolong the time to death and increase pain and suffering has been of concern, but there have been no population-based evaluations of this issue.Methods.Infant, neonatal, and postneonatal mortality rates and time to death for infants 500 to 749 g, 750 to 999 g, 1000 to 1499 g, and all VLBW infants born during 1987 were compared with those outcomes for infants born in 1993 using statewide California linked birth/death cohort files. To assess the effects of improved survival and changes in time until death, we calculated the total days of life preceding an infant death per 1000 live born infants (TDD).Results.VLBW infants comprised .96% of California's live births in 1987 and .92% of those in 1993. Between 1987 and 1993, VLBW infant mortality rate decreased 28.4% (from 290.7 to 208.3 per 1000 live born VLBW infants), VLBW neonatal mortality rate decreased 30.3% (from 244.5 to 170.4), and VLBW postneonatal mortality rate decreased 25.3% (from 61.2 to 45.7 per 1000 VLBW alive at 28 days;P &lt; .05 for each rate). Infant mortality rates decreased by 18.8% (718.1 to 583.0 per 1000) for infants 500 to 749 g, 43.3% (375.1 to 202.6) for infants 750 to 999 g, and 40.1% (127.9 to 76.7) for infants 1000 to 1449 g (P &lt; .05 for each group). Neonatal mortality and postneonatal mortality rates also decreased in all 3 VLBW subgroups. These reductions in mortality rates were not accompanied by a significant difference in the distribution of times to death or a significant increase in the average time to death for all VLBW infants (22.0 vs 23.6 days) or for those with birth weights of 500 to 749 g (12.7 vs 71.5 days). Reduced mortality in larger infants was accompanied by an increase in the average time to death, from 24.3 to 32.5 days in infants 750 to 999 g and from 32.3 to 47.0 days in infants 1000 to 1449 g. TDD decreased from 6410 to 4908 days for all VLBW infants. TDD was also reduced 26.4% (2401 days), 24.3% (2115 days), and 22.5% (1043 days) for the 3 VLBW birth weight groups.Conclusions.Both mortality rate and timing of death are important when assessing the impact of advances in perinatal technology. Although the average time to death was significantly increased in VLBW infants weighing &gt;750 g, between 1987 and 1993, advances in perinatal technology dramatically decreased VLBW mortality. In the State of California in 1993, this resulted in 452 fewer VLBW deaths and 8233 fewer days preceding a VLBW death than expected.
Clinical Safety of Iron-Fortified Formulas
Authors: Singhal Atul , Morley Ruth , Abbott Rebecca , Fairweather-Tait Susan , Stephenson Terence , Lucas Alan 
Published: August 2004

Background.Iron-fortified formulas are recommended throughout infancy and are frequently used beyond, yet safety aspects have been inadequately studied. Iron could theoretically increase pro-oxidant stress, with potential adverse effects, including infection risk, and some clinicians suspect that iron-fortified formulas induce gastrointestinal disturbance.Objective.A planned component of a large intervention trial has been to test the hypothesis that infants receiving iron-fortified formula do not have a higher incidence of infections (primary outcome) or gastrointestinal problems (secondary outcome) than infants on low iron-formulas or cow's milk.Methods.Children (n = 493) 9 months old receiving cow's milk were recruited in 3 UK centers and randomized to: 1) cow's milk as before, 2) formula containing .9 mg/L of iron, or 3) an otherwise identical formula but containing 12 mg/L of iron. Children were followed at 3 monthly intervals and the episodes of infections, diarrhea and constipation, and general morbidity to 18 months old were recorded. Hematologic indices of iron status were determined at 18 months old.Results.Serum ferritin concentrations were increased in infants receiving iron-fortified formula but there were no intergroup differences in incidence of infection, gastrointestinal problems, or in general morbidity or weight gain.Conclusions.We were unable to identify adverse health effects in older infants and toddlers consuming a high iron-containing formula (12 mg/L) even when used in populations with a low incidence of iron deficiency.
Pediatric Milliman and Robertson Length-of-Stay Criteria: Are They Realistic?
Authors: Sills Marion R. , Huang Zhihuan J. , Shao Cheng , Guagliardo Mark F. , Chamberlain James M. , Joseph Jill G. 
Published: August 2004

Objective.
Guidelines for inpatient length of stay (LOS) have been developed by several groups; among the most widely applied are those published by Milliman and Robertson (M&R). Few published reports have examined the relationship of actual practice to such guidelines, none in pediatric populations. This study was designed to compare pediatric practice in a large and defined population to M&R LOS criteria.

Methods.
Administrative data from New York State in 1995 were used to examine LOS for discharges corresponding to 16 selected pediatric diagnoses for which M&R publishes guidelines. Outliers, defined as the 2% of discharges with the longest LOS, were eliminated. The distribution of LOS for each diagnosis was compared with M&R LOS guidelines.

Results.
In New York State during 1995, pediatric LOS was markedly divergent from M&R guidelines. In general, the percentage of discharges in excess of the criterion LOS was less for nonmandatory admissions (croup: 23%, gastroenteritis: 44%, and pneumonia: 48%) than for those requiring surgery (uncomplicated appendectomy: 67%, pyloromyotomy: 62%, and major but noncritical burns: 64%) or prolonged treatment with antibiotics (bacterial meningitis: 91% and osteomyelitis: 86%).

Conclusions.
In New York State during 1995, LOS for selected pediatric conditions was generally in excess of published M&R guidelines. This raises concern about the potential effects of such guidelines on both patients and the hospitals caring for them. While endorsing the need for cost-effective practice, we call attention to the methods used to develop and validate guidelines. length of stay, pediatrics, managed health care, administrative data, practice guidelines.
Effect of Infection Control Measures on the Frequency of Diarrheal Episodes in Child Care: A Randomized, Controlled Trial
Authors: Roberts Leslee , Jorm Louisa , PhD BVSc, MSc(Epid), , Patel Mahomed , Smith Wayne , Douglas Robert M. , McGilchrist Charles 
Published: August 2004

Background.Diarrheal infections are common in children who attend child care, and preventing transmission of disease in this setting depends on actions by child care staff. We set out to discover whether transmission of gastrointestinal infections in child care could be reduced by improved infection control procedures.Methods.We performed a cluster randomized, controlled trial of an infection control intervention conducted in child care centers for 1 city in Australia. The intervention was training of child care staff about transmission of infection and handwashing and focused on both staff and child behavior. Implementation of the intervention was recorded by an observer. Illness was measured by parent report in telephone interviews every 2 weeks.Results.There were 311 child-years of surveillance for diarrheal episodes. The rate of episodes of diarrhea was 1.9 per child-year in intervention centers and 2.7 per child-year in control centers. Multivariable analysis showed that diarrheal episodes were significantly reduced in intervention center children by 50%. However, the impact of the intervention was confined to children over 24 months of age. For those centers in which children's compliance with handwashing was high, diarrheal episodes were reduced by 66%.Conclusions.This trial supports education about infection control, for staff and children in child care, as a means of reducing transmission of diarrhea. Reduction in episodes of diarrhea in children in child care was limited to children over 24 months of age.
Symptoms Associated With Infant Teething: A Prospective Study
Authors: Macknin Michael L. , Piedmonte Marion , Jacobs Jonathan , Skibinski Christine 
Published: August 2004

Context.
Studies of infant teething have been retrospective, small, or conducted on institutionalized infants.

Objectives.
To conduct a large, prospective study of healthy infants to determine which symptoms may be attributed to teething and to attempt to predict tooth emergence from an infant's symptoms.

Design.
Prospective cohort.

Setting.
Clinic-based pediatric group practice.

Patients.
One hundred twenty-five consecutive well children of consenting Cleveland Clinic employees.

Outcome Measures.
Parents daily recorded 2 tympanic temperatures, presence or absence of 18 symptoms, and all tooth eruptions in their infants, from the 4-month well-child visit until the child turned 1 year old.

Results.
Daily symptom data were available for 19 422 child-days and 475 tooth eruptions. Symptoms were only significantly more frequent in the 4 days before a tooth emergence, the day of the emergence, and 3 days after it, so this 8-day window was defined as the teething period. Increased biting, drooling, gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, facial rash, decreased appetite for solid foods, and mild temperature elevation were all statistically associated with teething. Congestion, sleep disturbance, stool looseness, increased stool number, decreased appetite for liquids, cough, rashes other than facial rashes, fever over 102°F, and vomiting were not significantly associated with tooth emergence. Although many symptoms were associated with teething, no symptom occurred in &gt;35% of teething infants, and no symptom occurred &gt;20% more often in teething than in nonteething infants. No teething child had a fever of 104°F and none had a life-threatening illness.

Conclusions.
Many mild symptoms previously thought to be associated with teething were found in this study to be temporally associated with teething. However, no symptom cluster could reliably predict the imminent emergence of a tooth. Before caregivers attribute any infants' signs or symptoms of a potentially serious illness to teething, other possible causes must be ruled out. teething, tooth eruption, teeth, deciduous dentition.
Outcomes After Judicious Antibiotic Use for Respiratory Tract Infections Seen in a Private Pediatric Practice
Authors: Pichichero Michael E. , Green John L. , Francis Anne B. , Marsocci Steven M. , Murphy Marie L. 
Published: August 2004

Background.Most respiratory tract infections (RTIs) in children have a viral cause, they resolve on their own, and antibiotics need not be prescribed.Objective.We sought to provide evidence that judicious antibiotic use can be accomplished in private pediatric practice without observing an increase in return office visits or in the rate of bacterial infections that may follow.Study Design.This was a prospective 12-month study from July 1, 1996 through June 30, 1997. On the same 1 day each week, a representative convenience sample of acute respiratory tract illness patients was enrolled, and laboratory studies performed as appropriate, including viral cultures on all. Children were then followed for 30 days to ascertain the outcomes of not prescribing antibiotics except when specific bacterial infections were present at the initial visit.Results.Three hundred eighty-three children were enrolled; 293 (77%) did not receive antibiotics at the enrollment visit. Ninety children (23%) received antibiotics based on a diagnosis of acute otitis media (n = 53), acute streptococcal tonsillopharyngitis (n = 18), or other presumed or documented bacterial infections (n = 19). An unscheduled return visit related to the initial visit occurred for 86 (29%) of the 293 children not receiving antibiotics initially and in 40 (44%) of 90 children receiving antibiotics initially. Eighty-seven children (23%) had positive viral culture results. The most frequently isolated viruses were adenovirus, enterovirus, parainfluenzae virus, and influenza virus.Conclusion.Children with RTIs without a concomitant presumed or proven bacterial infection do not require antibiotics. In this busy office practice, &gt;75% of the children presenting with an RTI did not have a presumed or proven bacterial infection. These children did not have a higher rate of return office visits or an increase in bacterial infections. This reinforces the judicious use of antibiotics in managing children with RTIs. outcomes, antibiotic, respiratory infections.