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Biomedical subjects

C W Callahan

Publications and source records attributed to C W Callahan.

34 records · Page 2Linked to original sources

Pneumonia.

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Adolescent↗

Source of health care for military dependents with cystic fibrosis.

Health care to military dependents with cystic fibrosis (CF) may be compromised by lack of consistency. Civilian centers provide an alternative for care. A reliable count of dependents with CF is unknown. We surveyed 196 military treatment facilities (MTFs) to obtain data on dependents with CF and compared it with data from the National CF Registry. Seventy-seven percent of the MTFs responded and 143 patients were identified. Registry data identified 373 CHAMPUS patients at 82 civilian centers. There were 284 patients in the Registry only and 54 patients in the MTF survey only. Eighty-nine patients were identified through both data sources. A total of 427 patients were identified. Under current CHAMPUS reorganization plans, MTFs will serve as "gateways" for funding of specialized civilian care. Thus, the influx of these and other chronically ill children into the MTF may tax the resources and capabilities of these facilities.

Adolescent↗

Bronchiolitis in children.

Bronchiolitis is an acute inflammation of the airways. In infancy, it usually results from viral infection, with RSV the most common agent. The clinical syndrome is characterized by symptoms of lower respiratory tract infection and obstruction. In most patients, the duration of illness is 1 week, but bronchiolitis can cause serious morbidity in patients with pre-existing cardiopulmonary disease. In addition, patients may be left with serious sequelae, including PBAR and OB. RSV causes direct damage to airways, but an exaggerated host immune response may contribute to the pathogenesis of airway obstruction in bronchiolitis. The mainstays of therapy include oxygen supplementation and fluid resuscitation, and other modalities remain controversial. There are no studies to support the use of corticosteroids alone in the treatment of bronchiolitis, but several recent reports demonstrate the value of bronchodilator therapy in some patients. Antiviral agents such as ribavirin show great promise in a therapy for bronchiolitis. In addition, ribavirin may modify some aspects of the immune response during acute infection with RSV, and therefore may play a role in the prevention of long-term sequelae.

Adrenal Cortex Hormones↗

Tiny Tim remembered.

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Diagnosis, Differential↗

Health care for the children of Army service members: cost of alternatives.

The United States Army is committed to providing quality health care for active-duty service members, their dependents, and retired service members. Historically, the Army has never had enough active-duty physicians to provide care for all its beneficiaries. Alternatives utilizing civilian health care providers have been established to provide the balance of the medical services. In this review, the cost of each of the civilian health care providers in the Ft. Hood, Texas area is compared to that of the Army pediatrician. The Army pediatrician proves to be the least expensive of the health care providers.

Adult↗

Cost effectiveness of antibiotic therapy for otitis media in a military pediatric clinic.

Amoxicillin continues to be the drug of first choice in the treatment of acute otitis media in children, because it is generally considered to be the safest and least expensive of the available choices. However, amoxicillin may not be the most cost-effective therapy in some settings because of its decreasing efficacy and moderately high rate of minor adverse effects. In this review, the cost effectiveness of antibiotics used to treat otitis media in a large military pediatric clinic are compared, using the decision analysis method. With this model, trimethoprim-sulfamethoxyazole is more cost-effective than amoxicillin, and cefaclor, given twice a day for 5 days, is the next most cost-effective regimen. In addition, the major and minor adverse effects of each of the agents are compared and the additional impact on cost effectiveness is considered.

Acute Disease↗

Otitis media and language development.

Otitis media can be a vexing, recurrent problem. An episode is often treated with antibiotics, followed by reevaluation at two weeks. The complete resolution of effusion, however, may never be documented. Impairments in children's speech, language and cognition have been related to chronic and continuous middle ear disease. Responses to antibiotic regimens must be carefully monitored. Follow-up is essential.

Anti-Bacterial Agents↗

Etiology of chronic cough in a population of children referred to a pediatric pulmonologist.

BACKGROUND: Chronic cough is a common complaint encountered by physicians who care for children. It is also a common reason for referral to a pulmonologist. Determining the cause of chronic cough, however, rarely requires specialized diagnostic procedures that are unavailable to the primary care physician. METHODS: A computerized listing of new patients referred to a pediatric pulmonologist between July 1993 and June 1995 was reviewed. Of 299 patients examined as outpatients during this period, 95 were referred for chronic cough. The diagnosis and diagnostic procedures were examined to determine how frequently procedures available exclusively to subspecialists were necessary to determine the cause of chronic cough. RESULTS: Of the 95 patients who were examined for cough during the period studied, the diagnosis was made by history in 5, pulmonary function testing in 11, radiographic tests in 15, and a therapeutic trial in 58. In only 6 cases was the diagnosis made using tests unavailable to the primary care physician (5 bronchoscopy, 1 allergy skin testing). CONCLUSIONS: In 89 cases the cause of chronic cough was determined by procedures available to the referring physician. In most cases chronic cough in children can be diagnosed and managed by physicians who are aware of the spectrum of common disorders that lead to cough.

Asthma↗