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Biomedical subjects

Stephen D Simon

Publications and source records attributed to Stephen D Simon.

At least 19 recordsLinked to original sources
PubMed2007

Resource utilization and expenditures for overweight and obese children.

OBJECTIVES: To compare health care utilization and expenditures for healthy-weight patients, overweight patients, and patients with diagnosed and undiagnosed obesity and to examine factors associated with a diagnosis of obesity. DESIGN: Retrospective study using claims data from a large pediatric integrated delivery system. SETTING: An urban academic children's hospital. PARTICIPANTS: Children aged 5 to 18 years who presented to a primary care clinic for well-child care visits during the calendar years 2002 and 2003 and who were followed up for 12 months. MAIN OUTCOME MEASURES: Diagnosis of obesity, primary care visits, emergency department visits, laboratory use, and health care charges. RESULTS: Of 8404 patients, 57.9% were 10 years or older, 61.2% were African American, and 72.9% were insured by Medicaid. According to the criteria of body mass index (calculated as weight in kilograms divided by the square of height in meters), 17.8% were overweight and 21.9% were obese. Of the obese children, 42.9% had a diagnosis of obesity. Increased laboratory use was found in both children with diagnosed obesity (odds ratio [OR], 5.49; 95% confidence interval [CI], 4.65-6.48) and children with undiagnosed obesity (OR, 2.32; 95% CI, 1.97-2.74), relative to the healthy-weight group. Health care expenditures were significantly higher for children with diagnosed obesity (adjusted mean difference, $172; 95% CI, $138-$206) vs the healthy-weight group. Factors associated with the diagnosis of obesity were age 10 years and older (OR, 2.7; 95% CI, 2.0-3.4), female sex (OR, 1.5; 95% CI, 1.2-1.8), and having Medicaid (OR, 1.6; 95% CI, 1.1-2.3). CONCLUSIONS: Increased health care utilization and charges reported in obese adults are also present in obese children. Most children with obesity had not been diagnosed as having obesity in this administrative data set.

Adolescent↗
PubMed2006

X chromosome gene expression in human tissues: male and female comparisons.

About 25% of X-linked genes may escape inactivation at least to some degree. However, in vitro results from somatic cell hybrids may not reflect what happens in vivo. Therefore, we analyzed the female/male (F/M) gene fold expression ratio for 299 X-linked and 7795 autosomal genes from 11 different tissues from an existing in vivo microarray database. On average 5.1 and 4.9% of genes showed higher expression in females compared with 7.4 and 7.9% in males, respectively, for X-linked and autosomal genes. A trend was found for F/M gene fold ratios greater than 1.5 for several X-linked genes indicating overexpression in females among multiple tissues. Nine X-linked genes showed overexpression in females in at least 3 of the 11 studied tissues. Of the 9 genes, 6 were located on the short arm and 3 on the long arm of the X chromosome. Six of the 9 genes have previously been reported to escape X inactivation. However, in general, no consistent pattern was seen for the expression of X-linked genes between in vitro and in vivo systems. This study indicates that factors other than the X-inactivation process may impact on the expression of X-linked genes resulting in an overall similar gender expression for both X-linked and autosomal genes.

Adolescent↗
PubMed2006

Impact of rapid influenza testing at triage on management of febrile infants and young children.

OBJECTIVE: To determine the impact of an emergency department (ED) triage protocol for rapid influenza testing of febrile infants and children on additional diagnostic testing, ED charges and patient time in the ED. METHODS: A trial of triage-based rapid influenza A and B testing of febrile infants and children 3 to 36 months of age presenting to an urban ED during December 2002 to March 2003 was performed. Children with a temperature of 39 degrees C or higher or history of fever 102 degrees F or higher at home were included. Those with obvious focal infection, potential immunodeficiency, and indwelling medical devices were excluded. The intervention group, tested for influenza at triage (TT) was compared with a nonintervention group consisting of those receiving usual care (SP). A subanalysis comparing influenza-positive children was performed. RESULTS: Of 1007 eligible subjects a total of 719 (71%) patients were in the SP group and 288 in the TT group. There were significant differences in respiratory syncytial virus rapid test (RSV; 18%-7%) and chest radiographs (CXRs; 26%-20%) tests in the TT group. In addition, significant increases in obtaining a complete blood count (relative risk [RR] 12.0; 95% confidence interval [CI] 2.9-49), blood culture (RR, 12.0; 95% CI, 3.0-51.0), RSV testing (RR, 0.9.2; 95% CI, 3.4-25.0), urinalysis (RR, 5.7; 95% CI, 2.0-16.0), CXR (RR, 2.2; 95% CI, 1.04-4.5), time in the ED (195 vs 156 minutes; 95% CI, of the difference 19-60), and medical charges ($666 vs $393; 95% CI, of the difference 153-392) were seen among those testing positive for influenza in the SP group. CONCLUSIONS: A triage protocol for rapid influenza testing for febrile infants and children appears to significantly decrease additional testing, time in the ED, and charges in children testing positive for influenza.

Child, Preschool↗
PubMed2006

Overcoming barriers to oxygen saturation targeting.

OBJECTIVE: To reduce hyperoxia in very low birth weight infants who receive supplemental oxygen, the Children's Mercy Hospital neonatal respiratory quality improvement committee introduced the potentially better practice of oxygen saturation targeting and identified strategies to overcome barriers to implementation of this practice. METHODS: Using rapid-cycle quality improvement projects, this center adapted an oxygen saturation targeting protocol and tracked hourly oxygen saturation as measured by pulse oximetry in very low birth weight infants who received supplemental oxygen. RESULTS: The percentage of time in the range of 90% to 94% of oxygen saturation as measured by pulse oximetry increased from 20% to an average of 35% after implementation of the protocol. The percentage of time with oxygen saturation as measured by pulse oximetry >98% dropped from 30% to an average of 5% to 10%. CONCLUSIONS: A well-planned strategy for implementing oxygen saturation targeting can result in a sustained change in clinical practice as well as change in the culture of the NICU regarding the use of oxygen.

Clinical Protocols↗
PubMed2006

Standardizing nasal cannula oxygen administration in the neonatal intensive care unit.

OBJECTIVE: A multicycle, quality improvement method was used to standardize nasal cannula O2 administration and weaning in the NICU. METHODS: A 2-armed nasal cannula standardized order form (nasal cannula for stable O2 arm and nasal cannula for stable flow arm) was developed after review of the literature, surveying of the practice of NICU physicians and nurse practitioners, and development of consensus among these providers. Outcomes were measured by tracking the distribution of protocol arm chosen, days on O2, weeks on nasal cannula, and disposition of infants who were supported by nasal cannula. Data were collected in an SPSS statistical data set. RESULTS: Of the 90 infants evaluated, 12 were supported on the stable O2 arm and 53 on the stable flow arm for their entire nasal cannula course. Twenty-five infants switched between arms of support. Patients who were on the stable flow arm of the standard order set for their entire nasal cannula course experienced fewer O2 days but more days on nasal cannula. A subpopulation of infants were supported on nasal cannula flow 0.5 to 1.0 L, with fraction of inspired O2 of 21%. When data from the first 10 weeks of observation were compared with that of the second 10 weeks, the rate of discharge on O2 had decreased from 13 (30%) of 44 to 3 (7%) of 39. CONCLUSIONS: The multiple steps of literature review, practice surveys, and consensus-building resulted in enthusiastic reception of the nasal cannula standardized order form. The 2-armed nasal cannula protocol forced caregivers to consider which method of support was most beneficial for each infant who was on nasal cannula and allowed a subpopulation of NICU patients to be supported with a lower fraction of inspired O2 than previously used in the NICU.

Catheterization↗
PubMed2005

A time to be promoted. The Prospective Study of Promotion in Academia (Prospective Study of Promotion in Academia).

OBJECTIVE: The study's objectives were to determine (1) the rate at which department of medicine faculty in the United States are promoted, (2) if clinician-educators (CEs) are promoted to Associate Professor at the same rate as clinician-investigators (CIs), and (3) the variables that predict promotion. METHODS: The Prospective Study of Promotion in Academia was a part-retrospective, part-prospective (from 2000 to 2003) cohort study. Six-hundred and four Internal Medicine junior faculty across the United States who had been registered as new appointees with the Association of American Medical Colleges in 1995 were invited to participate. Twenty-one percent of these had already left their institution when the study began. One hundred and eighty-three Internal Medicine faculty from 87 institutions in 35 states enrolled. The main outcome measure was the time from appointment as Assistant Professor to promotion to Associate Professor. RESULTS: Follow-up was complete for all 183 faculty. Among the faculty that achieved promotion, the estimated median time to promotion was 6.0 years (95% Conf. Int.=5.8 to 6.2). The unadjusted sixth-year promotion rate for CEs was 16%, while for CIs it was 26% (P=.002). Independent negative predictors of promotion included low amount of research time (Hazard Ratio [HR] =0.3, 95% Conf. Int.=0.2 to 0.5), having a manuscript review service (HR=0.4, 95% Conf. Int.=0.2 to 0.7), never meeting with Chairman/Chief about promotion (HR=0.4, 95% Conf. Int.=0.2 to 0.7), low job satisfaction (HR=0.5, 95% Conf. Int.=0.3 to 0.9), and working in the Northeast (HR=0.6, 95% Conf. Int.=0.4 to 1.1). Positive predictors included making between 130 dollars and 149,000 dollars per year (HR=1.9, 95% Conf. Int.=1.1 to 3.4), working more than 60 h/wk (HR=1.9, 95% Conf. Int.=1.1 to 3.0), having a career mentor available (HR=1.8, 95% Conf. Int.=1.1 to 2.9), and having access to a grant office (HR=1.6, 95% Conf. Int.=1.0 to 2.6). CONCLUSION: CEs and CIs appear to be promoted at different rates. The characteristics that are independently associated with earlier promotion may be helpful for institutions and individual faculty that are committed to achieving promotion efficiently.

Adult↗
PubMed2005

Timing of follow-up voiding cystourethrogram in children with primary vesicoureteral reflux: development and application of a clinical algorithm.

BACKGROUND AND OBJECTIVES: Of children diagnosed with urinary tract infection, 30% to 40% have primary vesicoureteral reflux (VUR). For the majority of these children, treatment involves long-term prophylactic antibiotics (ABX) and a periodic voiding cystourethrogram (VCUG) until resolution of VUR as detected by VCUG. Radiation exposure and considerable discomfort have been associated with VCUG. To date, no clear guidelines exist regarding the timing of follow-up VCUGs. The objective of this study was to develop a clinically applicable algorithm for the optimal timing of repeat VCUGs and validate this algorithm in a retrospective cohort of children with VUR. METHODS: Based on previously published data regarding the probability of resolution of VUR over time, a decision-tree model (DTM) was developed. The DTM compared the differential impact of 3 timing schedules of VCUGs (yearly, every 2 years, and every 3 years) on the average numbers of VCUGs performed, years of ABX exposure, and overall costs. Based on the DTM, an algorithm optimizing the timing of VCUG was developed. The algorithm then was validated in a retrospective cohort of patients at an urban pediatric referral center. Data were extracted from the medical records regarding number of VCUGs, time of ABX prophylaxis, and complications associated with either. VUR in patients in the cohort was grouped into mild VUR (grades I and II and unilateral grade III for those < or =2 years old), and moderate/severe VUR (other grade III and grade IV). Kaplan-Meier survival curves were created from the cohort data. From the survival curves, the median times to resolution of VUR were determined for the cohort, and these times were compared with the median times to VUR resolution of the data used for the DTM. The numbers of VCUGs performed, time of ABX exposure, and costs in the cohort were compared with those that would have occurred if the algorithm had been applied to both mild and moderate/severe VUR groups. RESULTS: Using an algorithm that results in a recommendation of VCUGs every 2 years in mild VUR would reduce the average number of VCUGs by 42% and costs by 33%, with an increase in ABX exposure of 16%, compared with a schedule of yearly VCUGs. For moderate/severe VUR, a VCUG performed every 3 years would reduce the average number of VCUGs by 63% and costs by 51%, with an increase in ABX exposure of 10%. Applying this algorithm to the retrospective cohort consisting of 76 patients (between 1 month and 10 years old) with primary VUR would have reduced overall VCUGs by 19% and costs by 6%, with an increase in ABX exposure of 26%. The patterns of VUR resolution, age distribution, and prevalence of severity of VUR were comparable between previously published results and the retrospective cohort. CONCLUSIONS: Delaying the schedule of VCUG from yearly to every 2 years in children with mild VUR and every 3 years in children with moderate/severe VUR yields substantial reductions in the average numbers of VCUGs and costs, with a modest subsequent increase in ABX exposure.

Algorithms↗
PubMed2004

Comparison of two formulae for estimation of glomerular filtration rate in children.

Glomerular filtration rate (GFR) was measured in 216 studies in 151 children using the cimetidine protocol. This was compared with the GFR calculated using Léger's pharmacokinetic equation and with that calculated using k*L/[Cr](s )(constant x length in centimeters divided by serum creatinine concentration). The GFR calculated using the equation GFR=k*L/[Cr](s) yielded a closer approximation to the measured GFR than that using Léger's pharmacokinetic equation. Currently there is focus on screening children for decreased GFR to identify those with asymptomatic chronic kidney disease at a time when intervention may delay progression to chronic renal failure. This study showed close approximation of the calculated GFR with the measured GFR using the equation GFR=k*L/[Cr](s), when the values for k were determined in the laboratory in which creatinine was measured.

Adolescent↗
PubMed2004

Development of a new standard laboratory protocol for estimation of the field attenuation of hearing protection devices: sample size necessary to provide acceptable reproducibility.

The mandate of ASA Working Group S12/WG11 has been to develop "laboratory and/or field procedure(s) that yield useful estimates of field performance" of hearing protection devices (HPDs). A real-ear attenuation at threshold procedure was selected, devised, tested for one earmuff and three earplugs via an interlaboratory study involving five laboratories and 147 subjects, and incorporated into a new standard that was approved in 1997 [Royster et al., "Development of a new standard laboratory protocol for estimating the field attenuation of hearing protection devices. Part I. Research of Working Group 11, Accredited Standards Committee S 12, Noise," J. Acoust. Soc. Am. 99, 1506-1526; ANSI, S12.6-1997, "American National Standard method for measuring real-ear attenuation of hearing protectors" (American National Standards Institute, New York, 1997)]. The subject-fit methodology of ANSI S12.6-1997 relies upon listeners who are audiometrically proficient, but inexperienced in the use of HPDs. Whenever a new method is adopted, it is important to know the effects of variability on the power of the measurements. In evaluation of protector noise reduction determined by experimenter-fit, informed-user-fit, and subject-fit methods, interlaboratory reproducibility was found to be best for the subject-fit method. Formulas were derived for determining the minimum detectable difference between attenuation measurements and for determining the number of subjects necessary to achieve a selected level of precision. For a precision of 6 dB, the study found that the minimum number of subjects was 4 for the Bilsom UF-1 earmuff, 10 for the E.A.R Classic earplug, 31 for the Willson EP100 earplug, and 22 for the PlasMed V-51R earplug.

Auditory Threshold↗
PubMed2004

When should cranial magnetic resonance imaging be used in girls with early sexual development?

OBJECTIVE: To determine whether concise parameters can be established in girls who present with signs of early puberty before the age of 8 years, which would help to identify those in whom cranial magnetic resonance imaging (MRI) is indicated. METHODS: A retrospective chart review was undertaken over a 10-year period from 1992-2002. The two requirements for inclusion in this study were girls who manifested pubertal changes before the age of 8.0 years and who underwent MRI of the brain. The records of 130 female patients with the presumptive diagnosis of precocious puberty (PP) were evaluated. Patients' medical records were reviewed for histories of any reported focal neurological complaint suspicious for intracranial lesions, such as headaches, seizures, or visual disturbances, as well as menses and advanced bone age (>2 SD) compared to chronological age. Seventy-five patients met these criteria and were divided into two groups. Group I consisted of nine patients with abnormal cranial MRI; Group II consisted of 66 patients with normal MRI. RESULTS: The patients in each group who had one or more of the central nervous system (CNS) signs and symptoms of early sexual development that were evaluated were markedly different. In Group I, 89% (CI 52-99.7%) had positive signs and symptoms that were suspicious for an intracranial lesion. In Group II, 94% (CI 85-98%), 63 of 66 girls, had no CNS signs or symptoms. CONCLUSION: The use of cranial MRI in the evaluation of girls with early sexual development is excessive. Girls with signs of pubertal development before age 8 years should be evaluated and followed. Those with specific CNS signs and symptoms, menses, and girls with a rapid advance in sexual development should undergo cranial MRI. Using this approach, far fewer patients in our study would have had cranial MRI.

Brain Neoplasms↗
PubMed2004

Low levels of tissue inhibitors of metalloproteinases with a high matrix metalloproteinase-9/tissue inhibitor of metalloproteinase-1 ratio are present in tracheal aspirate fluids of infants who develop chronic lung disease.

OBJECTIVE: The pathogenesis of chronic lung disease (CLD) involves inflammation with proteolytic damage to lung extracellular matrix. Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases that, acting in concert with their tissue inhibitors, tightly orchestrate extracellular matrix morphogenesis and repair after injury. Imbalances in their levels relative to that of their inhibitors have been implicated in diseases characterized by matrix disruption and remodeling. We investigated the possibility that imbalances in MMP-9 and MMP-2 relative to their tissue inhibitor of metalloproteinase-1 (TIMP-1) and TIMP-2, respectively, in tracheal aspirates of preterm infants may be involved in the development of CLD. METHODS: Serial tracheal aspirates collected from birth until extubation in 49 ventilated preterm infants (24-32 weeks' gestations) were analyzed for MMP-2, MMP-9, TIMP-1, and TIMP-2. Data normalized by TA values of free secretory component of immunoglobulin A were compared for CLD (n = 22) versus no CLD (n = 27). Also, known clinical predictors of CLD (gestational age, birth weight, and sex) were assessed for both groups. Association of predictors with the outcome CLD was assessed by logistic regression. RESULTS: Mean gestational age was lower in CLD infants, but birth weight and gender were comparable for both groups. CLD infants had significantly lower TIMP-1 level with higher MMP-9/TIMP-1 ratio during the first 2 weeks of life and low TIMP-2 and MMP-2 levels during the first 3 days of life compared with no-CLD infants. Logistic regression analysis indicated that the findings are predictive of CLD. CONCLUSIONS: We conclude that low tracheal aspirate levels of TIMPs, with a high MMP-9/TIMP-1 ratio early in life, are associated with subsequent development of CLD.

Bronchopulmonary Dysplasia↗
PubMed2004

Can an alternative umbilical arterial catheter solution and flush regimen decrease iatrogenic hemolysis while enhancing nutrition? A double-blind, randomized, clinical trial comparing an isotonic amino acid with a hypotonic salt infusion.

OBJECTIVE: In the process of sampling blood through an umbilical arterial catheter (UAC), infant blood comes into stagnant contact with infusion solution in the "waste syringe" before being reinfused. We have previously demonstrated in vitro that this process is associated with less hemolysis of red blood cells (RBCs) with use of an isotonic solution compared with a hypotonic 0.25 normal saline (NS) solution. The objective of this study was to compare the in vivo effect on hemolysis of 2 UAC infusion/flush regimens (an isotonic regimen vs a hypotonic regimen) and to assess the early nutritional benefit of an amino acid solution as the isotonic UAC infusion solution. METHODS: Infants who had a birth weight of < or =1.5 kg and were expected to have a UAC for > or =3 days were enrolled within 24 hours of life into this prospective, double-blind, randomized, clinical trial of 2 UAC infusion solution/flush regimens. Power analysis demonstrated that 40 infants were needed to determine differences in hemolysis quantified by plasma-free hemoglobin (PFH) level. Nutrition from glucose was evaluated by measurement of daily dextrose calories. C-peptide was measured to evaluate endogenous insulin production. Adverse events and protein tolerance were tracked. RESULTS: Twenty-two infants (mean gestational age: 27 weeks; 945 g birth weight) were enrolled in each group, for an average of 4.2 days (range: 2.5-8 days). There were no group differences in demographics. PFH levels were lower for infants who received isotonic amino acid (IAA) in comparison with 0.25 NS (33 +/- 14 mg/dL vs 62 +/- 27 mg/dL, respectively). C-peptide was higher in those who received IAA, as were nonprotein calories received on days 4 to 6 of the study (51 +/- 11 kcal/kg/day vs 44 +/- 12 kcal/kg/day, IAA vs 0.25 NS, respectively). CONCLUSIONS: Lower PFH levels in IAA versus 0.25 NS group were consistent with our hypothesis of decreased hemolysis with an isotonic infusion/flush regimen. IAA use may also allow greater early glucose nutrition, as indicated by the higher level of endogenous insulin production and improved glucose tolerance. IAA seems to be a superior UAC solution to 0.25 NS in that it is associated with less hemolysis and improved nutrition.

Amino Acids↗
PubMed2003

Influence of the news media on diagnostic testing in the emergency department.

OBJECTIVE: To examine the association between mass media attention regarding invasive group A streptococcal (GAS) disease and testing for GAS in a pediatric emergency department (ED). DESIGN, SETTING, AND PARTICIPANTS: An observational analysis was performed of patients who had GAS tests done in a pediatric ED between December 1, 1999, and November 30, 2001. Data were analyzed by dividing each of the 2 years into 4 consecutive 90-day intervals. Data including age, date of the visit, presenting complaint, primary discharge diagnosis, whether a GAS test was obtained, and the results were collected from an electronic data repository. The date of the news stories, the station, and the duration of the broadcast were collected from electronic archives of the local newspaper and a broadcast monitoring service. MAIN OUTCOME MEASURE: The rate of GAS tests done per 1000 ED visits and the rate of positive tests per 1000 ED visits. RESULTS: An average of 103 GAS tests were performed per 1000 ED visits in the December through February period in year 2 compared with 55 GAS tests per 1000 ED visits in a similar period in year 1. This difference was statistically significant (difference, 48 tests; 95% confidence interval, 24-72 tests; P<.001). There were no significant differences in the proportion of positive tests (32% in year 1 vs 20% in year 2; mean difference, -11%; 95% confidence interval, -23% to 1%; P =.07). There were a total of 16 newspaper articles and 34 television stories on GAS during the 2-year study period. The peak in GAS tests and the peak in media events were concomitant. CONCLUSION: A surge in news stories regarding GAS disease was associated with an increase in testing for GAS in a pediatric ED.

Child↗
PubMed2003

Evaluating the benefit of speech recoding hearing aids in children.

Children with significant high-frequency hearing loss may be difficult to fit with hearing aids using conventional amplification. Frequency-lowering hearing aids using dynamic speech recoding (DSR) technology have been proposed as a possible means to achieve full speech audibility. The current study investigated 78 children from ages 1.3 to 21.6 years (M = 10.6 years) who wore DSR hearing aids. These hearing aids provided significant improvements in pure-tone average (PTA; mean improvement for the aided versus unaided condition of 49 dB) and high-frequency PTA (mean improvement for the aided versus unaided condition of 56 dB). A subgroup of 19 children were previous users of conventional hearing aids. These participants demonstrated a mean improvement of 11 dB in PTA and 12.5% in word recognition scores for DSR versus conventional amplification. However, DSR hearing aids required repair 3 times as often as conventional hearing aids. The greatest benefit was observed in children whose word recognition scores were poorest using conventional hearing aids.

Adolescent↗
PubMed2003

Baby boomer nurses bearing the burden of care: A four-site study of stress, strain, and coping for inpatient registered nurses.

OBJECTIVE: Because today's nursing workforce faces a multitude of stressors, the objective of this study was to describe stress, strain, and coping across institution types for inpatient registered nurses (n = 694), and to identify the influence of age on these findings. METHODS: This study, using a multi-site, mixed methods approach, provides data to support more focused interventions that address the challenges of specific types of stressors and age cohort needs. RESULTS: The worst scores for sub-scales addressing stress and strain for this sample of inpatient nurses were problems associated with physical environment and responsibility. Consistency was found across the four institutions for the sub scale of responsibility. Baby Boomer nurses (born between 1946 and 1964) had significantly worse scores than other age cohorts, specifically with the stress and strain sub-scales of role overload, role insufficiency, role ambiguity, role boundary, and interpersonal strain. CONCLUSION: The authors outline specific ways to support registered nurses by using staffing metrics that factor in unit activity as well as supporting the Baby Boomer nurse, both physically and psychosocially.

Adaptation, Psychological↗
PubMed2002

Effect of rapid diagnosis of influenza virus type a on the emergency department management of febrile infants and toddlers.

BACKGROUND: Evidence shows that the rapid detection of influenza using an enzyme-linked immunosorbent assay decreases antibiotic use in the treatment of pediatric patients. To our knowledge, the effect on other diagnostic testing in an emergency department (ED) has not been examined. OBJECTIVE: To determine the effect of rapid diagnosis of influenza virus type A on the clinical management of febrile infants and toddlers in a pediatric ED at an urban children's hospital. MATERIALS AND METHODS: A retrospective review of ED records from an electronic database was performed. All children 2 to 24 months of age, with a temperature higher than 39 degrees C who had a positive influenza virus type A test result using an enzyme-linked immunosorbent assay from November 1, 1998, through April 30, 2000 (n = 72), were included in this study. Two groups were compared-those who had positive test results reported before discharge from the ED (early diagnosis) and those who had positive test results after discharge (late diagnosis). RESULTS: Forty-seven patients (65%) were in the early diagnosis group and 25 (35%) in the late diagnosis group. The groups were similar for age, temperature, and triage category. Fewer patients in the early diagnosis group received ceftriaxone sodium compared with those in the late diagnosis group (2% vs 24%, P =.006); there were fewer urinalyses (2% vs 24%, P =.006) and complete blood cell counts performed (17% vs 44%, P =.02). CONCLUSIONS: Rapid confirmation of influenza virus type A infection seems to decrease ancillary tests and antibiotic use in febrile infants and toddlers in the ED. A prospective study with a larger group is needed to confirm these findings.

Ceftriaxone↗
PubMed2002

A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age.

OBJECTIVES: To develop a succinct and comprehensive breast-feeding assessment score (BAS) to accurately identify infants at risk for early cessation of breast-feeding before initial hospital discharge. STUDY DESIGN: Mothers who intended to breast-feed their infants were solicited from 9 suburban hospitals. Two detailed data forms covering 107 items were completed before hospital discharge. A third form was completed at 7 to 10 days of age after telephone contact with the mother. RESULTS: Cessation of breast-feeding occurred in 113 of 1075 infants (10.5%). A multiple logistic regression analysis revealed 8 variables that were significant (P <.05) in predicting breast feeding cessation. A BAS was developed based on the odds ratios and relative risks of breast-feeding cessation for these 8 variables. CONCLUSIONS: The BAS was easily and quickly performed before hospital discharge for near term and term infants, which accurately predicted the risk of breast-feeding cessation within 7 to 10 days of age in the population studied.

Adult↗