bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preventing Provider Errors: Online Total Parenteral Nutrition Calculator
Authors: Lehmann Christoph U. , Conner Kim G. , Cox Jeanne M. 
Published: August 2004

Objective. To describe the development of a pragmatic low-cost medical information system that reduces errors in the ordering of total parenteral nutrition (TPN) in the newborn intensive care unit at the Johns Hopkins Hospital.
Methods. We designed an online total parenteral nutrition order entry system (TPNCalculator) using Internet technologies. Utilization, impact on medical errors, and user satisfaction were evaluated prior to and immediately after introduction of TPNCalculator (intervention 1) and after 2 years (intervention 2).
Results. Total software development time was 3 weeks. The number of orders was similar during the 3 periods: 0.39 orders per patient per day (N = 557) were received compared with 0.35 and 0.43 orders per patient per day (N = 471 and N = 656) in 2 intervention periods. During the control period, an average of 10.8 errors were detected per 100 TPN orders compared with 4.2 per 100 orders in the first intervention period (61% reduction of error rate) and 1.2 per 100 orders after 2 years and some redesign of TPNCalculator (89% reduction of error rate). We found a reduction in the following types of problems (intervention 1; intervention 2): calculation errors (100%; 100%), osmolality outside the allowed range (88%; 91%), and other knowledge problems (84%; 100%). There was a 35% increase in the number of incomplete forms in the first intervention period and a 100% reduction in the second. Rapid cycle development was used in the development of this application. Users of the system were enthusiastic and supportive and compared it favorably to the previous paper-based system.
Conclusion. Low-cost, pragmatic approaches using Internet technology in the design of medical information systems can reduce medical errors and might pose a viable option for the prevention of adverse drug events.
National Institute of Mental Health Multimodal Treatment Study of ADHD Follow-up: 24-Month Outcomes of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder
Authors:   MTA Cooperative Group
Published: August 2004

Objective. In the Multimodal Treatment Study of ADHD (MTA), the effects of medication management (MedMgt) and behavior modification therapy (Beh) and their combination (Comb) and usual community comparison (CC) in the treatment of attention-deficit/hyperactivity disorder (ADHD) differed at the 14-month assessment as a result of superiority of the MTA MedMgt strategy (Comb or MedMgt) over Beh and CC and modest additional benefits of Comb over MedMgt alone. Here we evaluate the persistence of these beneficial effects 10 months beyond the 14 months of intensive intervention.
Methods. Of 579 children who entered the study, 540 (93%) participated in the first follow-up 10 months after the end of treatment. Mixed-effects regression models explored possible persisting effects of the MTA medication strategy, the incremental benefits of Comb over MedMgt alone, and the possible superiority of Beh over CC on 5 effectiveness and 4 service use domains.
Results. The MTA medication strategy showed persisting significant superiority over Beh and CC for ADHD and oppositional-defiant symptoms at 24 months, although not as great as at 14 months. Significant additional benefits of Comb over MedMgt and of Beh over CC were not found. The groups differed significantly in mean dose (methylphenidate equivalents 30.4, 37.5, 25.7, and 24.0 mg/day, respectively). Continuing medication use partly mediated the persisting superiority of Comb and MedMgt.
Conclusion. The benefits of intensive MedMgt for ADHD extend 10 months beyond the intensive treatment phase only in symptom domains and diminish over time.
Short-Term Use of Umbilical Artery Catheters May Not Be Associated With Increased Risk for Thrombosis
Authors: Coleman Mae M. , Spear Michael L. , Finkelstein Mark , Leef Kathleen H. , Pearlman Stephen A. , Chien Christopher , Taylor Scott M. , McKenzie Steven E. 
Published: August 2004

Objective. Umbilical arterial catheters (UACs) have rare but serious complications related to thrombus formation. Two specific serum markers of thrombogenesis—prothrombin fragment (F1.2) and thrombin-antithrombin (TAT)—can be assayed and correlated with abdominal ultrasound visualization of UAC thrombosis. Levels of these markers of thrombogenesis have not been studied in infants with UACs. The objective of this study was to determine F1.2 and TAT levels longitudinally and compare the levels with platelet counts and ultrasound evidence of thrombi during the first week of life in infants with UACs.
Methods. This study was conducted as a prospective, nonblinded, observational study performed between June 2001 and January 2002 at Christiana Care Hospital, a level III neonatal intensive care unit. Infants with a UAC in place in the first 24 hours of life were studied. All received equal amounts of heparin in the UAC. F1.2, TAT, platelet counts, and abdominal aorta ultrasounds were examined every other day starting within 24 hours of life. Studies were not done when the UAC was removed within the 5-day study period. Enzyme-linked immunosorbent assay for TAT and F1.2 was performed using a commercially available kit from Enzyngost. Data were analyzed with repeated measures analysis of variance evaluating TAT, F1.2, and platelet count over time.
Results. Thirty-three patients were investigated (mean ± standard deviation; gestational age: 27.4 ± 3.5 weeks; birth weight: 1139 ± 729 g). A total of 66 measurements of TAT, F1.2, and platelet counts were obtained. Sixty-one abdominal ultrasounds were performed; only 1 study was positive for UAC thrombus. There was no significant difference between F1.2 and TAT over time during the study period. Platelet counts seemed to fall over the 5-day study period, although this decrease did not reach statistical significance.
Conclusion. Indwelling UACs in sick infants may not carry an increased risk of thrombosis during the first 5 days of use.
Educational and Social Competencies at 8 Years in Children With Threshold Retinopathy of Prematurity in the CRYO-ROP Multicenter Study
Authors: Msall Michael E. , Phelps Dale L. , Hardy Robert J. , Dobson Velma , Quinn Graham E. , Summers C. Gail , Tremont Michelle R. ,   for the Cryotherapy for Retinopathy of Prematurity Cooperative Group
Published: August 2004

Objective. To describe the educational status and special education services at 8 years among children who had threshold retinopathy of prematurity (ROP).
Methods. A prospective study was conducted of a cohort of children who had birth weight of &lt;1251 g and threshold ROP in the Cryotherapy for Retinopathy of Prematurity multicenter study. At age 5.5 years, visual status, functional skills, and social information were obtained. At 8 years, special education classes, developmental disabilities, rehabilitation therapies, and academic and social competencies were determined by questionnaire. Visual status was considered favorable/unfavorable on the basis of the better eye.
Results. Of 255 survivors, 216 (85%) were evaluated at both 5.5 and 8 years. Major impairments were significantly more prevalent in children with unfavorable versus favorable visual status: cerebral palsy (39% vs 16%), developmental disability (57% vs 22%), autism (9% vs 1%), and epilepsy (23% vs 3%). Special education services (63% vs 27%), below-grade-level academic performance (84% vs 48%), and school-based rehabilitation services were significantly less common in children with favorable visual status. Favorable visual status, favorable functional ratings at 5.5 years, markers of higher socioeconomic status, and nonblack race were associated with significantly lower rates of both special education placement and below-grade-level academic performance at age 8. On multivariate logistic regression, only favorable visual status and functional status remained significant predictors for decreasing special education placement.
Conclusion. Threshold ROP is associated with high rates of developmental, educational, and social challenges in middle childhood; preserved vision was associated with a clear advantage, with more than half of the children with favorable visual status performing at grade level.
Maternal, Neonatal, and Placental Features Associated With Diffuse Chorioamniotic Hemosiderosis, With Special Reference to Neonatal Morbidity and Mortality
Authors: Ohyama Makiko , Itani Yasufumi , Yamanaka Michiko , Goto Akiko , Kato Keisuke , Ijiri Rieko , Tanaka Yukichi 
Published: August 2004

Objective. Our purpose was to examine the significance of diffuse chorioamniotic hemosiderosis (DCH) on neonatal morbidity and mortality.
Methods. Using data from a retrospective case-control study, we analyzed 46 singleton placentas with DCH from infants who were delivered and/or admitted to the neonatal intensive care unit of Kanagawa Children’s Medical Center during 1987–2001 and 92 control placentas without DCH from infants of comparable gestational age, birth weight, and duration.
Results. Mean and standard deviation of gestational age and infants’ birth weight at delivery from the DCH group were 27 ± 3 weeks and 939 ± 342 g, respectively. Macroscopically, the placentas with DCH were more likely to show old peripheral blood clots (46% in the DCH group vs 8% in control group), subchorionic hematoma (20% vs 1%), and circumvallation (13% vs 1%). Histologically, amniotic necrosis was significantly more frequent in the DCH group (63% vs 24%). Of the obstetric factors, incidence of recurrent episodes of vaginal bleeding (70% vs 11%), oligohydramnios (59% vs 8%), and chronic abruption-oligohydramnios sequence (57% vs 5%) were significantly higher in the DCH group. Of the neonatal factors, persistent pulmonary hypertension of the newborn (29% vs 8%) and dry lung and/or pulmonary hypoplasia (20% vs 4%) were more common. However, respiratory distress syndrome was rare (15% vs 45%) in the DCH group. Neonatal death including stillbirth was increased in the DCH group but was not significant (24% vs 15%). Of infants who survived beyond day 28, chronic lung disease (CLD) was more frequent in the DCH group (51% vs 22%). The association of DCH, especially accompanied by amniotic necrosis, with CLD was still evident using likelihood ratio test.
Conclusion. DCH is closely associated with preterm delivery, pulmonary hypertension of the newborn, and dry lung syndrome and is a significant risk factor for CLD.
Risk Factors for Emesis After Therapeutic Use of Activated Charcoal in Acutely Poisoned Children
Authors: Osterhoudt Kevin C. , Durbin Dennis , Alpern Elizabeth R. , Henretig Fred M. 
Published: August 2004

Objectives. Vomiting frequently complicates the administration of activated charcoal. The incidence of such vomiting is not defined precisely in the pediatric population. Little is known about the patient-, poison-, or procedure-specific factors that contribute to emesis of charcoal. This study aimed to estimate the incidence of vomiting subsequent to therapeutic administration of charcoal to poisoned children ≤18 years of age and to examine the relative contributions of several risk factors to the occurrence of vomiting.
Methods. Data were collected on a prospective cohort of 275 consecutive children who were treated with activated charcoal for acute poisoning exposure. The study was set in the emergency department of an urban, tertiary-care children’s hospital. Sorbitol content of the charcoal was alternately assigned. Potential risk factors for vomiting were recorded prospectively, and the occurrence of vomiting within 2 hours of charcoal administration was measured.
Results. A total of 56 (20.4%) of 275 patients vomited. Median time to vomiting was 10 minutes. Previous vomiting (relative risk: 3.41; 95% CI: 1.48–7.85) and nasogastric tube administration (relative risk: 2.40; 95% CI: 1.13–5.09) were found to be the most significant independent risk factors for vomiting. The increased risk among children &gt;12 years of age, compared with younger children, approached significance. Sorbitol content, large charcoal volumes, or fast administration rates did not increase vomiting risk significantly.
Conclusions. One of every 5 children who are given activated charcoal within our pediatric emergency department vomited. Children with previous vomiting or nasogastric tube administration were at highest risk, and these factors should be accounted for in future investigation of antiemetic strategies. Sorbitol content of charcoal was not a significant risk factor for emesis.
Medication Adherence in Pediatric and Adolescent Liver Transplant Recipients
Authors: Shemesh Eyal , Shneider Benjamin L. , Savitzky Jill K. , Arnott Lindsay , Gondolesi Gabriel E. , Krieger Nancy R. , Kerkar Nanda , Magid Margret S. , Stuber Margaret L. , Schmeidler James , Yehuda Rachel , Emre Sukru 
Published: August 2004

Objective. Nonadherence to medications is a leading cause of morbidity in children and adolescents who have had a transplant, yet there are no published data about the use of different methods for detecting whether these children are taking their medications. There are also no published data about the age of transition at which a child assumes responsibility over taking the medications. This information is important if interventions to improve adherence are contemplated.
Methods. We present an analysis of data obtained in the first year of the implementation of an adherence assessment protocol at a pediatric liver transplant clinic in a tertiary medical care center. Data were obtained for children and adolescents who had a liver transplant at least 1 year before the assessments took place. We used 5 adherence detection methods. The 4 subjective methods were self-reported, scaled questionnaires answered by nurses, physicians, caregivers, and patients. For the objective method, a standard deviation (SD) was calculated for tacrolimus blood levels obtained from each patient over time. A higher SD suggests increased variation among patients’ blood levels and hence more erratic medication taking. We also asked the patients and caregivers who is responsible for taking the medications and what are the reasons for not taking them. The medical outcome measures were biopsy-proven rejection episodes, number of biopsies regardless of the results, number of hospital admissions, and number of in-patient days.
Results. An analysis of 81 cases (258 assessments) revealed that the only method that predicted the medical outcome variables (biopsy-proven rejection and number of biopsies) was the SD of medication blood levels. Patients’, clinicians’, and caregivers’ reports were not predictive. Clinicians’ ratings of adherence were not correlated with patients’ or caregivers’. The transition of responsibility for medication taking occurred approximately at the age of 12 years. Forgetfulness was cited as the most common reason for nonadherence by patients and caregivers; medication side effects were not frequently cited.
Conclusions. Our results indicate that clinical impression is not sufficient to determine whether children and adolescents are taking their medications after they have had a liver transplant. An objective assessment method should be used. Interventions targeting adherence should address the child’s increasing role beginning in early adolescence. A clinical protocol incorporating objective assessments of adherence could potentially be implemented in other settings. It could form the basis for the evaluation of efficacy of interventions seeking to improve adherence to medications.
Rest-Activity Patterns of Premature Infants Are Regulated by Cycled Lighting
Authors: Rivkees Scott A. , Mayes Linda , Jacobs Harris , Gross Ian 
Published: August 2004

Objectives. Many hospitalized premature infants are exposed to continuous dim lighting rather than to cycled lighting. However, we do not know whether dim lighting or low-intensity cycled lighting is more conducive to the development of rest-activity patterns that are in phase with the solar light-dark cycle. Thus, we examined the effects of nursery lighting conditions on the development of activity patterns in premature infants.Methods. Premature infants who were born at &lt;32 weeks’ postmenstrual age and were medically stable in neonatal intensive care unit rooms were randomly assigned between 32 and 34 weeks’ postmenstrual age to either continuous dim lighting (&lt;25 lux; duration 24 days; control group; n = 29) or cycled lighting (239 ± 29 lux, 7:00 am to 7:00 pm; &lt;25 lux, 7:00 pm to 7:00 am; duration: 25 days; experimental group; n = 33). Activity was continuously monitored from enrollment until approximately 1 month after discharge from the hospital. Weight and head circumference were also assessed up to 6 months after discharge from the hospital.Results. Over the first 10 days at home, distinct day-night differences in activity were not seen in control subjects (D day-night: N 1.07 ± 0.02), but experimental group infants were more active during the day than at night (day-night: 1.25 ± 0.03). It was not until 21 to 30 days after discharge that day-night activity ratios in control infants matched those seen in experimental group infants shortly after discharge, yet even at this age, experimental group infants (day-night: 2.13 ± 0.19) were considerably more active during the day than at night as compared with control subjects (day-night: 1.43 ± 0.09).Conclusion. Exposure of premature infants to low-intensity cycled lighting in the hospital nursery induces distinct patterns of rest-activity that are apparent within 1 week after discharge. In comparison, the appearance of distinct patterns of rest and activity are delayed in infants who are exposed to continuous dim lighting in the hospital. These observations show that day-night rhythms in activity patterns can be detected shortly after discharge to home in premature infants and that the circadian clock of developing infants is entrained by cycled lighting.
Flavor Programming During Infancy
Authors: Mennella Julie A. , Griffin Cara E. , Beauchamp Gary K. 
Published: August 2004

Objective. Although individuals differ substantially in their flavor and food preferences, the source of such differences remains a mystery. The present experimental study was motivated by clinical observations that early experience with formulas establishes subsequent preferences.
Design. Infants whose parents had chosen to formula-feed them were randomized into 1 of 4 groups by the second week of life. One group was assigned to be fed a milk-based formula (Enfamil), whereas another was assigned to be fed (Nutramigen), a particularly unpleasant-tasting protein hydrolysate formula. The remaining groups were assigned to be fed Nutramigen for 3 months and Enfamil for 4 months; the timing of exposure differed between the groups. After 7 months of exposure, infants were videotaped on 3 separate days while feeding, in counterbalanced order, Enfamil, Nutramigen, and Alimentum, a novel hydrolysate formula.
Results. For each of the 4 interrelated measures of behavior (intake, duration of formula feeding, facial expressions, and mothers’ judgments of infant acceptance), previous exposure to Nutramigen significantly enhanced subsequent acceptance of both Nutramigen and Alimentum. Seven months of exposure led to greater acceptance than did 3 months.
Conclusions. The bases for clinical difficulties in introducing hydrolysate formulas during older infancy are clarified in this study. More broadly, variation in formula flavor provided a useful model for demonstrating experimentally the effects of long-term exposure differences on later acceptance. Such early variation, under more species-typical circumstances (eg, via exposure to different flavors in amniotic fluid and mothers’ milk), may underlie individual differences in food acceptability throughout the life span.
Early Experience Alters Brain Function and Structure
Authors: Als Heidelise , Duffy Frank H. , McAnulty Gloria B. , Rivkin Michael J. , Vajapeyam Sridhar , Mulkern Robert V. , Warfield Simon K. , Huppi Petra S. , Butler Samantha C. , Conneman Nikk , Fischer Christine , Eichenwald Eric C. 
Published: August 2004

Objective. To investigate the effects of early experience on brain function and structure.Methods. A randomized clinical trial tested the neurodevelopmental effectiveness of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Thirty preterm infants, 28 to 33 weeks’ gestational age (GA) at birth and free of known developmental risk factors, participated in the trial. NIDCAP was initiated within 72 hours of intensive care unit admission and continued to the age of 2 weeks, corrected for prematurity. Control (14) and experimental (16) infants were assessed at 2 weeks’ and 9 months’ corrected age on health status, growth, and neurobehavior, and at 2 weeks’ corrected age additionally on electroencephalogram spectral coherence, magnetic resonance diffusion tensor imaging, and measurements of transverse relaxation time.Results. The groups were medically and demographically comparable before as well as after the treatment. However, the experimental group showed significantly better neurobehavioral functioning, increased coherence between frontal and a broad spectrum of mainly occipital brain regions, and higher relative anisotropy in left internal capsule, with a trend for right internal capsule and frontal white matter. Transverse relaxation time showed no difference. Behavioral function was improved also at 9 months’ corrected age. The relationship among the 3 neurodevelopmental domains was significant. The results indicated consistently better function and more mature fiber structure for experimental infants compared with their controls.Conclusions. This is the first in vivo evidence of enhanced brain function and structure due to the NIDCAP. The study demonstrates that quality of experience before term may influence brain development significantly.