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Biomedical subjects

M A Baron

Publications and source records attributed to M A Baron.

At least 19 recordsLinked to original sources
PubMed1995

Fever without apparent source on clinical examination, lower respiratory infections in children, bacterial infections, and acute gastroenteritis and diarrhea of infancy and early childhood.

This section focuses on issues in infectious disease that are commonly encountered in pediatric office practice. Paul McCarthy discusses recent literature regarding the evaluation and management of acute fevers without apparent source on clinical examination in infants and children and the evaluation of children with prolonged fevers of unknown origin. David Bachman reviews recent literature about lower respiratory tract infection in children and focuses on community-acquired lower respiratory infections and respiratory syncytial virus. Eugene Shapiro discusses literature concerning several infectious diseases commonly seen in office settings and concerning which recent developments are of interest: the hemolytic-uremic syndrome and enterohemorrhagic Escherichia coli. Streptococcus pneumoniae resistant to penicillin, infections in day care centers, and new antimicrobial drugs. Michael Baron reviews recent literature about gastroenteritis and diarrhea of infancy and early childhood and discusses diagnosis, complications, pathogenesis and physiology, epidemiology, and treatment.

Bacterial Infections↗
PubMed1994

Empty sella.

Explore the source record for details and available documents.

Adult↗
PubMed1991

Demographic, clinical, and psychosocial predictors of the reliability of mothers' clinical judgments.

The purpose of this study was to investigate to what extent selected adverse demographic, clinical, and psychosocial data measured at the 2-week well child visit could predict poorer reliability of mothers' judgments during acute illness episodes over the next 32 months. The study was a randomized trial of the Acute Illness Observation Scales (AIOS); 369 mothers participated, 183 in the intervention group using the Acute Illness Observation Scales and 186 in the control group using a three-point global assessment scale. There were 704 acute illnesses judged simultaneously and independently by mothers and pediatricians. Standard Pearson r correlations were performed between the independent variables, taken singly and in all possible combinations, and the dependent variable, reliability of mothers' judgments as measured by weighted kappa (kappa W). Group assignment was entered as an independent variable. Analyses were performed separately for all first, second, and third acute illness visits to control for any "practice effect" (analysis 1). To control for consistency of observers, the first, second, and third visits of mothers with three visits were also analyzed (analysis 2). Depending on the visit number, adverse demographic, clinical, and psychosocial characteristics did correlate with poorer reliability independent of group assignment. The correlations ranged from small (analysis 1, first visit, multiple variable r2 = 4%) to large (analysis 2, second visit, multiple variable r2 = 29%). Controlling for both visit number and consistency of observers vs visit number alone (analysis 2 vs analysis 1) increased multivariate correlations to kappa W. The results support the untoward impact that adverse demographic, clinical, and psychosocial factors have on mothers' clinical judgment. These data may assist pediatricians in identifying parents who might benefit from more intensive teaching and support about acute illness episodes in their children.

Acute Disease↗
PubMed1990

Mothers' clinical judgment: a randomized trial of the Acute Illness Observation Scales.

The purpose of this study was to investigate whether the reliability, sensitivity, and specificity of mothers' judgments about acute illnesses in their children could be improved by using the Acute Illness Observation Scales (AIOS). At the 2-week well child care visit in a primary care center and a private practice, 369 mothers were divided at random into an intervention group (n = 183) and a control group (n = 186). A teaching film and booklet were used to educate mothers in the intervention group about the AIOS; control group mothers were taught a 3-point global scoring system for evaluating the chance of serious illness. In the 32 months of follow-up, 704 acute illnesses were evaluated in tandem and independently by mothers and pediatricians before the history and physical examination; 20 of these illnesses were serious. The judgments of the intervention group were more reliable than those of the control group (weighted kappa = 0.50 vs 0.26, respectively), as was the specificity of their judgments (85% vs 52%, respectively; p less than 0.0001). No difference was noted in the sensitivity of intervention group and control group mothers' judgments (80% vs 90%, respectively). Teaching parents to assess specific clinical information, as represented in the AIOS, has its greatest effect on the reliability and specificity, not the sensitivity, of their judgments. Such teaching could lead to fewer unnecessary office visits during acute illnesses.

Acute Disease↗
PubMed1989

Blood cultures in private pediatric practice: an eleven-year experience.

We describe an 11-year experience with bacteremia in a two-physician suburban private pediatric practice. Patients studied were ages 3 to 24 months with a body temperature of greater than or equal to 39.4 degrees C and nonfocal illness. During these 11 years, 23 such babies had bacteremia, 21 with Streptococcus pneumoniae. Three risk factors for bacteremia were identified: absolute neutrophil counts greater than or equal to 10,500/microliters; cool season (November to April), and Yale observation score greater than 10. The positive predictive values for bacteremia were 33, 41 and 57%, respectively, when (1) absolute neutrophil count was greater than or equal to 10,500, (2) absolute neutrophil count was greater than or equal to 10,500 and it was the cool season, and (3) all 3 risk factors existed. Of 158 babies at low risk for bacteremia by these criteria, none was treated and none developed serious complications of bacteremia. Eight of the 23 bacteremic infants received no expectant antibiotic therapy and 15 received presumptive amoxicillin treatment in dosages ranging from 20 to 174 mg/kg/day. Twelve bacteremic infants either were not treated or received dosages of 100 mg/kg/day or less; complications developed in 5 of the 12 (persistent bacteremia, 2; facial cellulitis, 3). The remaining 11 bacteremic babies received approximately 150 mg/kg/day (range, 136 to 174) and none had complications (P = 0.03 by Fisher's exact test). The costs of identifying and treating infants suspected of having possible occult bacteremia were examined.

Anti-Bacterial Agents↗
PubMed1987

Observation, history, and physical examination in diagnosis of serious illnesses in febrile children less than or equal to 24 months.

To determine if observational assessment performed in a systematic manner adds to the efficacy of the traditional history and physical examination in detecting serious illnesses in febrile children, and to determine the sensitivity of the combined evaluation, we studied consecutive patients less than or equal to 24 months of age seen for evaluation of fever at the Primary Care Center-Emergency Room (PCC-ER) of the Yale-New Haven Hospital (n = 143) and a suburban private practice (n = 207). An attending pediatrician performed the observation using the previously reported Acute Illness Observation Scales (AIOS). Subsequently, the history and physical examination were done by an attending pediatrician, and findings were scored as to whether they suggested the presence of a serious illness. Thirty-six patients, 28 in the PCC-ER and eight in the private practice, had a serious illness. The combined AIOS, history, and physical examination had a higher sensitivity and r correlation for serious illness than did the traditional history and physical examination. Three children with serious illnesses, all of whom had no abnormalities on history and physical examination, were identified only by use of AIOS. We conclude that assessment of appearance in a child with fever, when performed in a careful, integrated, stepwise fashion, improves the sensitivity of the history and physical examination in detecting serious illnesses in febrile children.

Evaluation Studies as Topic↗
PubMed1987

Do mothers overestimate the seriousness of their infants' acute illnesses?

The purpose of this study was to determine if mothers generally perceive their infants as more ill than do pediatricians, and if the presence of fever has an impact on the perceptions of either the mother or pediatrician. One hundred eighty-seven mothers and their infants, from a primary care clinic (n = 109) and private practice (n = 78), were enrolled at the 2-week well-child visit and were asked to contact a physician participating in the study whenever their infants became acutely ill. The mothers were asked to rate the severity of their infants' illness according to a 3-point scale, first at home and then simultaneously, but independently, with a physician in the office. In general, mothers rated their infants equally as ill at home as in the office (kappa = 0.59). However, both their home ratings (kappa = 0.15) and office ratings (kappa = 0.29) were in poor agreement with the ratings of the physicians. The mothers consistently rated their infants as more ill than did the pediatricians (p less than 0.0001). Both the mothers and physicians perceived infants with higher temperatures (greater than or equal to 38.9 degrees C) as significantly (p = 0.0004) more ill than infants with lower temperatures (less than 38.9 degrees C). We conclude that mothers generally perceive their infants as more ill than do pediatricians, and that it is important for pediatricians to address the perceptions of mothers in order to establish effective communication with them.

Acute Disease↗
PubMed1985

Predictive value of abnormal physical examination findings in ill-appearing and well-appearing febrile children.

In order to study the occurrence and positive predictive value of history and physical examination findings suggestive of serious illness in ill-appearing and well-appearing febrile children, 103 consecutive children aged less than or equal to 24 months with fever greater than or equal to 38.3 degrees C were evaluated from July 1, 1982 to Nov 24, 1982. Patients were initially classified by an attending physician (A) as to whether they appeared ill (Yale Observation Scale score greater than 10) or well (scale score less than or equal to 10). The history was then taken by two attending physicians (A and B) and a resident; the physical examination was performed by attending physician B and the same resident. As history and physical examination findings were elicited, they were scored as to whether they did or did not suggest a serious illness. Serious illness was defined as the presence of a positive laboratory test. Ill-appearing patients had a significantly greater (P less than .001, Fisher's exact test) occurrence of physical examination findings suggesting serious illness (14 of 22, 64%) than well-appearing children (12 of 81, 15%). The positive predictive values of abnormal physical examination findings for serious illness in ill-appearing (11 of 14, 79%) and well-appearing children (3 of 12, 25%) were significantly different (P = .02 by Fisher's exact test). The trends for abnormal history findings in ill-appearing and well-appearing children were similar to those for abnormal physical examination findings but did not achieve statistical significance. The results, indicating an important interaction between a febrile child's appearance and physical examination findings, are discussed in terms of probability reasoning in clinical decision making.

Bayes Theorem↗
PubMed1982

Plasma immunoreactive TSH: spurious elevation due to antibodies to bovine TSH which cross-react with human TSH.

A patient with thyroid carcinoma treated by thyroidectomy who received multiple injections of bovine (bTSH) exhibited elevated and nonsuppressible levels of plasma "immunoreactive TSH." Antibodies to TSH of the IgG class which bound bTSH and human TSH (hTSH) were demonstrated using specific radioimmunoassay and radioimmunoelectrophoretic techniques. Antibodies were present for more than one year and binding of bTSH was greater than that of hTSH throughout this period. Characterization of the antibodies with respect to the binding of human and bovine glycoprotein hormones and subunits revealed two populations of antibodies, one of which bound both bTSH and hTSH and the other which bound only bTSH. Both antibodies appeared to be directed toward antigenic sites on the beta subunit of TSH as both hTSH-beta and bTSH-beta displaced the binding of intact TSH from antibodies whereas the alpha subunits were virtually unreactive. The binding studies suggest that the cross-reactivity of the antibody to hTSH occurred on the basis of common antigenic determinants on the beta subunits of the two species. Documentation of a true elevation of plasma hTSH was achieved by gel filtration of plasma in which a peak of immunoreactivity co-eluting with [125I]-hTSH could be shown. Evidence for suppression of TSH secretion by thyroxine administration in the presence of interfering antibody was obtained by demonstrating that the level of plasma "immunoreactive TSH" did not change in response to TRH administration.

Adenocarcinoma↗
PubMed1981

Further definition of history and observation variables in assessing febrile children.

The experienced clinician makes a judgment (hereafter called overall assessment [OA]) about the degree of illness of a febrile child prior to physical examination. In order to define the history and observation variables on which OA is based, 262 febrile children less than or equal to 24 months of age were evaluated simultaneously by multiple observers including attending pediatricians, practicing pediatricians, pediatric house officers, and nurses. The observer listed history and observation variables he/she thought most important in making an OA on a blank, lined form and then scored those variables and OA as normal, or mildly, moderately, or severely impaired. Scoring for observation rather than history variables was better correlated with scoring for OA and serious illness. The observation variables most frequently mentioned by all observers were the child's "looking at the observer" and "looking around the room." There were 20 observation variables frequently mentioned, the scoring of which significantly correlated with scoring for OA; four of these 20 variables related to eye function. The child's response to a stimulus was noted in 105/186 different observation variables listed; both the attending pediatrician and the house officer scored these stimulus-response variables significantly different in children with, vs those without, serious illnesses. For attending pediatricians, house officers, and nurses, serious illness was five to seven times as likely if an OA of moderate or severe impairment was made than if it were not made. OA is a key skill in evaluating febrile children; these data identify variables on which OA is based, document the importance of assessing eye function in young, febrile children, and demonstrate that eye function is one key type of stimulus-response behavior on which the pediatrician as clinician and developmentalist relies to make judgments about febrile children.

Child Development↗
PubMed1980

Bacteremia in private pediatric practice.

The capillary white blood cell count and differential, a test easily done in office practice, was used in unexplained febrile illness of infants and toddlers to help distinguish those babies most likely to have bacteremia who would benefit from blood culture and early bacteriologic diagnosis. Four criteria were used as indicators suggestive of bacterial infection: white blood cell count greater than or equal to 15,000/cu mm, total segmented neutrophils greater than or equal to 10,000/cu mm, total band cells greater than or equal to 500/cu mm, and total polymorphonuclear leukocytes (segmented neutrophils plus band cells) greater than or equal to 10,500/cu mm. These measurements were found helpful in separating a small group of bacteremic babies at high risk of complications from a large group of babies who recovered without antibiotic treatment and without complications. There were 146 febrile illnesses recorded in babies 3 to 24 months of age; bacteremia was proven in eight of these. Three or four blood cell count criteria were fulfilled in seven of the eight bacteremic babies and in only ten (7.2%) of the remaining 138 febrile illnesses (P < .001 by chi 2 test).

Capillaries↗
PubMed1977

[Role of serum fibrinogen penetrating the subarachnoid space in the pathogenesis of brief cerebral arteriospasm].

A mixture of fibrinogen (4 ml in a 1 per cent solutions) and thrombin (10 I.U.) were instilled into the cisterma magna of 18 dogs which led to the formation of a fibrin clot in the subarachnoid space. This fibrin clot produced a spasm of the large cerebral arteries, which resulted in a narrowing to 84.8 +/- 1.8 per cent of the initial value. The subsequent administration of 400 units of fibrinolysin into the cisterna magna led to the dissolution of the fibrin clot and the dilatation of the arterie to 116.3 +/- 2.5 per cent of the initial value. Experiments carried out in 15 cats showed that, after being brought in the subarachnoid space, the spasmogenic factor of the clot, which consisted of all blood components, passes through the arachnoid into the subdural space. The penetration of the spasmogenic factor from the blood clot located on the surface of the arachnoid from the subdural to the subrarachnoid space was not observed. The arachnoid proves to be a membrane which can only be passed in one direction by the spasmogenic blood factor.

Animals↗
PubMed1976

[Cerebrospinal fluid bearing channels of the pia meter].

The pia mater of the human brain hemispheres has liquor canals which form a continuous network communicating with the cisterns of the brain base. The wall of the liquor canals is formed by a fibro-collagenous framework covered from two sides with the arachnoidendothelium. In the canal walls there are openings, through which the lumens of the canals communicate with the lumens of alveoli. The liquor canals are divided into the circulatory and excretory ones. The circulatory canals are disposed in the depth of the cerebral sulci, the secretory canals--on the surface of the convolutions. The liquor moves along the circulatory canals from the cisterns of the brain base onto the surface of cerebral hemispheres. Excretory canals adjoin the arachnoid membrane which is part of its wall (the "roof"). In the "roof" of the liquor canals the fibrocollagenous basis and the number of layers of the arachnoid--endothelium are reduced, the intercellular spaces between the cells of the arachnoidendothelium are dilated. Through the roofs of the liquor canals the liquor is excreted from the subarachnoid space into the subdural space. Inside the liquor canals there are arteries of the pia mater hung up to the canal walls by trabeculae (cords) of a dense connective tissue.

Humans↗