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  • 1
    Online Resource
    Online Resource
    Tumor Angiogenesis and p53 Mutations : Prognosis in Head and Neck Cancer
    American Medical Association (AMA) ; 1998
    In:  Archives of Otolaryngology–Head & Neck Surgery Vol. 124, No. 1 ( 1998-01-01), p. 80-
    Details
    In: Archives of Otolaryngology–Head & Neck Surgery, American Medical Association (AMA), Vol. 124, No. 1 ( 1998-01-01), p. 80-
    Type of Medium: Online Resource
    ISSN: 0886-4470
    URL: Article
    DOI: 10.1001/archotol.124.1.80
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 1998
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  • 2
    Online Resource
    Online Resource
    Paediatric trainees and end-of-life care: a needs assessment for a formal educational intervention
    Ubiquity Press, Ltd. ; 2015
    In:  Perspectives on Medical Education Vol. 4, No. 1 ( 2015-02-03), p. 25-32
    Details
    In: Perspectives on Medical Education, Ubiquity Press, Ltd., Vol. 4, No. 1 ( 2015-02-03), p. 25-32
    Abstract: Background Literature suggests a paucity of formal training in end-of-life care in contemporary American medical education. Similar to trainees in adult medicine, paediatric trainees are frequently involved in end-of-life cases. Objective To determine current experience and comfort levels among paediatric trainees when caring for dying patients with the hypothesis that more clinical experience alone would not improve comfort. Methods Paediatric residents, subspeciality fellows and programme directors at the University of Chicago completed a voluntary electronic needs assessment in June and July 2013. Ten question pairs determined frequency of experiencing various aspects of end-of-life care in clinical practice and comfort levels during these encounters. Results 118 respondents participated (63.8 % response rate): 66.4 % were female; 53 % had previous education in end-of-life care. The proportion of those with experience in end-of-life care increased through the third year of training, and remained at 1.0 thereafter. Conversely, positive comfort scores increased gradually throughout all six years of training to a maximum proportion of 0.45. Comfort in many specific aspects of care lagged behind experience. Previous education had a significant positive effect on comfort levels of most, but not all, aspects of care. 58 % or more of trainees desired further education on specific end-of-life topics. Conclusions Paediatric trainees are often involved in end-of-life care but may not be comfortable in this role. More experience alone does not improve comfort levels; however, there is a positive correlation with comfort and previous education.
    Type of Medium: Online Resource
    ISSN: 2212-277X
    URL: Article
    DOI: 10.1007/S40037-015-0161-4
    Language: Unknown
    Publisher: Ubiquity Press, Ltd.
    Publication Date: 2015
    detail.hit.zdb_id: 2670231-9
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  • 3
    Online Resource
    Online Resource
    Elevated protein concentrations in newborn blood and the risks of autism spectrum disorder, and of social impairment, at age 10 years among infants born before the 28th week of gestation
    Springer Science and Business Media LLC ; 2018
    In:  Translational Psychiatry Vol. 8, No. 1 ( 2018-06-08)
    Details
    In: Translational Psychiatry, Springer Science and Business Media LLC, Vol. 8, No. 1 ( 2018-06-08)
    Abstract: Among the 1 of 10 children who are born preterm annually in the United States, 6% are born before the third trimester. Among children who survive birth before the 28th week of gestation, the risks of autism spectrum disorder (ASD) and non-autistic social impairment are severalfold higher than in the general population. We examined the relationship between top quartile inflammation-related protein concentrations among children born extremely preterm and ASD or, separately, a high score on the Social Responsiveness Scale (SRS total score ≥65) among those who did not meet ASD criteria, using information only from the subset of children whose DAS-II verbal or non-verbal IQ was ≥70, who were assessed for ASD, and who had proteins measured in blood collected on ≥2 days ( N  = 763). ASD ( N  = 36) assessed at age 10 years is associated with recurrent top quartile concentrations of inflammation-related proteins during the first post-natal month (e.g., SAA odds ratio (OR); 95% confidence interval (CI): 2.5; 1.2–5.3) and IL-6 (OR; 95% CI: 2.6; 1.03–6.4)). Top quartile concentrations of neurotrophic proteins appear to moderate the increased risk of ASD associated with repeated top quartile concentrations of inflammation-related proteins. High (top quartile) concentrations of SAA are associated with elevated risk of ASD (2.8; 1.2–6.7) when Ang-1 concentrations are below the top quartile, but not when Ang-1 concentrations are high (1.3; 0.3–5.8). Similarly, high concentrations of TNF-α are associated with heightened risk of SRS-defined social impairment ( N  = 130) (2.0; 1.1–3.8) when ANG-1 concentrations are not high, but not when ANG-1 concentrations are elevated (0.5; 0.1–4.2).
    Type of Medium: Online Resource
    ISSN: 2158-3188
    URL: Article
    DOI: 10.1038/s41398-018-0156-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2018
    detail.hit.zdb_id: 2609311-X
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  • 4
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    Online Resource
    Resuscitation in the “Gray Zone” of Viability: Determining Physician Preferences and Predicting Infant Outcomes
    American Academy of Pediatrics (AAP) ; 2007
    In:  Pediatrics Vol. 120, No. 3 ( 2007-09-01), p. 519-526
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 120, No. 3 ( 2007-09-01), p. 519-526
    Abstract: OBJECTIVE. We assessed physician preferences and physician prognostic abilities regarding delivery room management of exceedingly low birth weight/short gestation infants. METHODS. We surveyed US neonatologists to assess their behavior in the delivery room when confronted with infants with gestational ages of 22 to 26 weeks. We identified 102 infants in our NICU with birth weights/gestational ages of 400 g/23 weeks to 750 g/26 weeks, whose follow-up care was ensured because of their participation in ongoing clinical trials. We determined 4 proxy measures for “how the infant looked” in the delivery room (Apgar scores at 1 and 5 minutes and heart rates at 1 and 5 minutes) and assessed the predictive value of each marker for subsequent death or neurologic morbidity. RESULTS. For infants with birth weights of & lt;500 g and gestational ages of 23 weeks, only 4% of 666 responding neonatologists would provide full resuscitation. In contrast, for infants with birth weights of & gt;600 g and gestational ages of 25 weeks, & gt;90% of neonatologists considered resuscitation obligatory. For infants with birth weights of 500 to 600 g and gestational ages of 23 to 24 weeks, only one third of neonatologists responded that parental preference would determine whether they resuscitated the infant in the delivery room. The majority wanted “to see what the infant looked like.” For 102 infants with birth weights of ≤750 g, Apgar scores at 1 and 5 minutes and heart rates at 1 and 5 minutes were neither sensitive nor predictive for death before discharge, survival with a neurologic abnormality, or intact neurologic survival. CONCLUSIONS. The “gray zone” for delivery room resuscitation seems to be between 500 and 600 g and 23 and 24 weeks. For infants born in that zone, neonatologists' reliance on accurate prediction of death or morbidity in the delivery room may be misplaced.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2006-2966
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2007
    detail.hit.zdb_id: 1477004-0
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  • 5
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    Online Resource
    Tachycardia in the Neonate
    SLACK, Inc. ; 2015
    In:  Pediatric Annals Vol. 44, No. 10 ( 2015-10)
    Details
    In: Pediatric Annals, SLACK, Inc., Vol. 44, No. 10 ( 2015-10)
    Abstract: Atrial flutter (AFL) is the second most common type of tachyarrhythmia in the fetus and neonate. An atrial rate of 240 to 360 beats per minute, 2:1 atrioventricular conduction, and a “saw tooth” appearance on electrocardiogram (ECG) are characteristic. On echocardiogram, bilateral atrial dilatation is the most common finding. Treatment is dependent on the severity of symptoms; delivery is usually indicated in the case of fetal heart failure or hydrops fetalis, whereas postnatal AFL is most commonly treated with direct current cardioversion (DCC). This article presents an illustrative case in which the patient presented antenatally via abnormal nonstress testing and subsequent fetal echocardiogram that was concerning for AFL. Postnatal ECG confirmed this diagnosis and the patient received DCC on the day of birth, followed by digoxin and propranolol as maintenance therapy. [ Pediatr Ann . 2015;44(10):e247–e250.]
    Type of Medium: Online Resource
    ISSN: 0090-4481 , 1938-2359
    URL: Article
    DOI: 10.3928/00904481-20151012-09
    Language: English
    Publisher: SLACK, Inc.
    Publication Date: 2015
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  • 6
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    Online Resource
    Implementation of an antenatal late-preterm corticosteroid protocol at a high-volume tertiary care center
    Elsevier BV ; 2020
    In:  American Journal of Obstetrics & Gynecology MFM Vol. 2, No. 1 ( 2020-02), p. 100076-
    Details
    In: American Journal of Obstetrics & Gynecology MFM, Elsevier BV, Vol. 2, No. 1 ( 2020-02), p. 100076-
    Type of Medium: Online Resource
    ISSN: 2589-9333
    URL: Article
    DOI: 10.1016/j.ajogmf.2019.100076
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2988319-2
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  • 7
    Online Resource
    Online Resource
    Just, in Time: Ethical Implications of Serial Predictions of Death and Morbidity for Ventilated Premature Infants
    American Academy of Pediatrics (AAP) ; 2008
    In:  Pediatrics Vol. 121, No. 4 ( 2008-04-01), p. 732-740
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 121, No. 4 ( 2008-04-01), p. 732-740
    Abstract: OBJECTIVES. For a cohort of extremely premature, ventilated, newborn infants, we determined the power of either serial caretaker intuitions of “die before discharge” or serial illness severity scores to predict the outcomes of death in the NICU or neurologic performance at corrected age of 2 years. METHODS. We identified 268 premature infants who were admitted to our NICU in 1999–2004 and required mechanical ventilation. For each infant on each day of mechanical ventilation, we asked nurses, residents, fellows, and attending physicians the following question: “Do you think this child is going to live to go home or die before hospital discharge?” In addition, we calculated illness severity scores until either death or extubation. RESULTS. A total of 17066 intuition profiles were obtained on 5609 days of mechanical ventilation in the NICU. One hundred (37%) of 268 profiled infants had ≥1 intuition of die before discharge. Only 33 infants (33%) with an intuition of die actually died in the NICU. Of 48 infants with even 1 day of corroborated intuition of die in the NICU, only 7 (14%) were alive with both Mental Developmental Index and Psychomotor Developmental Index scores of & gt;69, and only 2 (4%) were alive with both Mental Developmental Index and Psychomotor Developmental Index Scores of & gt;79 at corrected age of 2 years. On day of life 1, the Score for Neonatal Acute Physiology II value for nonsurvivors (38.2 ± 18.1) was significantly higher than that for survivors (26.3 ± 12.7). However, this difference decreased steadily over time as scores improved for both groups. CONCLUSIONS. Illness severity scores become progressively less helpful over time in distinguishing infants who will either die in the NICU or survive with low Mental Developmental Index/Psychomotor Developmental Index scores. Serial caretaker intuitions of die before discharge also fail to identify prospective nonsurviving infants. However, corroborated intuitions of die before discharge identify a subset of infants whose likelihood of surviving to 2 years with both MDI and PDI & gt;80 is approximately 4%.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2006-2797
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2008
    detail.hit.zdb_id: 1477004-0
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  • 8
    Online Resource
    Online Resource
    Common Symptoms, but Rare Diagnoses in Neonatology
    SLACK, Inc. ; 2015
    In:  Pediatric Annals Vol. 44, No. 10 ( 2015-10), p. 434-434
    Details
    In: Pediatric Annals, SLACK, Inc., Vol. 44, No. 10 ( 2015-10), p. 434-434
    Type of Medium: Online Resource
    ISSN: 0090-4481 , 1938-2359
    URL: Article
    DOI: 10.3928/00904481-20151012-06
    Language: English
    Publisher: SLACK, Inc.
    Publication Date: 2015
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  • 9
    Online Resource
    Online Resource
    Video and CD-ROM as a Training Tool for Performing Neurologic Examinations of 1-Year-Old Children in a Multicenter Epidemiologic Study
    SAGE Publications ; 2005
    In:  Journal of Child Neurology Vol. 20, No. 10 ( 2005-10), p. 829-831
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 20, No. 10 ( 2005-10), p. 829-831
    Abstract: In lieu of traditional training of examiners to identify cerebral palsy on a neurologic examination at age 1 year, we proposed an alternative approach using a multimedia training video and CD-ROM we developed after a two-step validation process. We hypothesized that use of CD-ROM interactive training will lead to reliable and valid performance of the neurologic examination by both pediatric neurologists and nonpediatric neurologists. All examiners were asked to take one of six interobserver variability tests found on the CD-ROM on two occasions. In the first interobserver variability evaluation, 89% (531 of 594) of the responses agreed with the gold standard responses. Following annotated feedback to the examiners about the two items that had a 60% correct rate, the correct response rate rose to 93% (114 of 123). In the second interobserver variability evaluation, 88% (493 of 560) of the responses agreed with the gold standard responses. Following annotated feedback to the examiners about the four items that had a 70% correct rate, the correct response rate rose to 96% (104 of 108). Interactive CD-ROM examination training is an efficient and cost-effective means of training both neurologists and non-neurologists to perform structured neurologic examinations in 1-year-old children. It provides an effective means to evaluate interobserver variability, offers a route for feedback, and creates an opportunity to reevaluate variability, both immediately and at periodic intervals. ( J Child Neurol 2005;20:829—831).
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.1177/08830738050200101001
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
    detail.hit.zdb_id: 2068710-2
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  • 10
    Online Resource
    Online Resource
    Pemphigus of the Air and Food Passages
    SAGE Publications ; 1977
    In:  Annals of Otology, Rhinology & Laryngology Vol. 86, No. 5 ( 1977-09), p. 584-587
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 86, No. 5 ( 1977-09), p. 584-587
    Abstract: Pemphigus vulgaris is one among many bullous diseases which involve the mucous membranes of the oropharynx and the larynx. The pernicious nature and previous high mortality of this disease have been greatly reduced with early diagnosis and the appropriate use of corticosteroids and immunosuppressive agents. Thirteen patients with pemphigus vulgaris were seen at Rush-Presbyterian-St. Luke's Medical Center from 1970 through 1976. All patients had moderate-to-severe generalized eruptions and were biopsy-positive for pemphigus vulgaris. A moderate prednisone dosage of 80 to 120 mg/day in moderate-to-severe cases was utilized in 11 out of 13 patients. All patients were treated initially with prednisone only, and after control of the acute generalized eruptions was achieved, Cytoxan® was added to the regimen to allow reduction of the prednisone dosage. One patient in our series died as a result of disseminated herpes simplex, probably secondary to high-dose corticosteroid treatment. Mortality in our series was 7.6% This investigation suggests that lower prednisone doses of 80 to 120 mg/day, except in recalcitrant cases, may be efficacious in the treatment of pemphigus vulgaris, especially in conjunction with adjuvant immunosuppressive therapy.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/000348947708600503
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1977
    detail.hit.zdb_id: 2033055-8
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