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Biomedical subjects

L Quan

Publications and source records attributed to L Quan.

At least 73 records · Page 4Linked to original sources
PubMed1997

Paediatric life support. An advisory statement by the Paediatric Life Support Working Group of the International Liaison Committee on Resuscitation.

This document reflects the deliberations of ILCOR. The epidemiology and outcome of paediatric cardiopulmonary arrest and the priorities, techniques and sequence of paediatric resuscitation assessments and interventions differ from those of adults. The working group identified areas of conflict and controversy in current paediatric basic and advanced life support guidelines, outlined solutions considered and made recommendations by consensus. The working group was surprised by the degree of conformity already existing in current guidelines advocated by the American Heart Association (AHA), the Heart and Stroke Foundation of Canada (HSFC), the European Resuscitation Council (ERC), the Australian Resuscitation Council (ARC), and the Resuscitation Council of Southern Africa (RCSA). Differences are currently based upon local and regional preferences, training networks and customs, rather than scientific controversy. Unresolved issues with potential for future universal application are highlighted. This document does not include a complete list of guidelines for which there is no perceived controversy and the algorithm/decision tree figures presented attempt to follow a common flow of assessments and interventions, in coordination with their adult counterparts. Survival following paediatric prehospital cardiopulmonary arrest occurs in only approximately 3-17% and survivors are often neurologically devastated. Most paediatric resuscitation reports have been retrospective in design and plagued with inconsistent resuscitation definitions and patient inclusion criteria. Careful and thoughtful application of uniform guidelines for reporting outcomes of advanced life support interventions using large, randomized, multicenter and multinational clinical trials are clearly needed. Paediatric advisory statements from ILCOR will, by necessity, be vibrant and evolving guidelines fostered by national and international organizations intent on improving the outcome of resuscitation for infants and children worldwide.

Adolescent↗
PubMed1997

[Effects of HE particles on medicinal plant Agastache rugosus (Fisch. et Mey.) O. Ktze].

The biological effect of HE particles on the seeds of Agastache rugosus was probed in experiments on board a retrievable satellite. The result shows that the germination rate of the seeds pierced by HE particles radiation appears rather low. The seeds hit by HE particles (piercing radiation or not) start to germinate two days earlier than those in the control group, and the first leaf emerges four to five days earlier than that in the control group. The resultant seedlings grow markedly faster. Variations take place in the nuclear types of chromosome. The yield of essential oils becomes slightly higher. No marked changes have been observed in the major chemical components of these oils.

Chromosomes↗
PubMed1997

Comparative study of hyperacuity and retinometer tests for the evaluation of vision in patients with advanced cataract.

OBJECTIVE: To investigates the clinical application value of hyperacuity test for evaluating vision through dense cataracts. METHODS: Ten normal subjects (20 years) were tested both with Bailey-Lovie type chart and three points vernier acuity test (one of the hyperacuity test); and retinometer test were performed preoperatively and postoperatively in 30 patients (31 eyes) with senile cataract. These patients' lens opacity was classified with LOCS III system. RESULTS: The correlation of vernier acuity and visual acuity of normal subjects is significant. The result of difference compression of pre-surgical and post-surgical vernier acuity of 30 cataract patients is not significant. The correlation of retinometer findings with post-surgical visual acuity shows not statistically significant. Our result shows that there is good correlation between vernier acuity and post-surgical visual acuity. CONCLUSION: It appears that hyperacuity is a good test for foveal function behind dense cataract and other ocular opacities.

Adult↗
PubMed1996

Inflicted submersion in childhood.

OBJECTIVE: To improve characterization and recognition of inflicted pediatric submersions. DESIGN: Retrospective case series, records review. SETTING: A regional children's hospital and the King County (Washington) Medical Examiner's office. PATIENTS: Children younger than 19 years who sustained submersion injury between 1983 and 1991 and were hospitalized or autopsied. OUTCOME MEASURES: Two pediatricians, using preestablished criteria, categorized abstracted case scenarios as either inflicted or unintentional events. The two groups were compared. RESULTS: Of 205 submersions, 16 (8%) were judged to have been inflicted. Objective physical signs of abuse and incompatibilities between the history and the child's stage of development or physical findings were common (69% and 50%, respectively). Inflicted submersion victims were likely to be young (median age, 2.1 years). They tended to be the youngest sibling in a large (three or more children) household. Social and demographic attributes of inflicted and unintentional submersion victims did not differ significantly. Bathtubs were the most common site for inflicted submersions (9/16 [56%]), and submersions in bathtubs were frequently inflicted (9/34 [26%]). Compared with unintentional submersion victims, children who were inflicted submersion victims were less likely to be revived by bystanders (relative risk, 0.10; confidence interval, 0.01 to 0.72) and were more likely to die (relative risk, 4.32; confidence interval, 1.40 to 21.43). CONCLUSIONS: Enough childhood submersions are inflicted to warrant careful case evaluation. Bathtub submersion victims and children with physical and historical findings common to other forms of abuse are most likely to be the victims of inflicted submersion.

Child↗
PubMed1996

Physicians' children are treated differently in the emergency department.

The objective was to determine whether children with a physician parent receive treatment different from that of children of nonphysician parents when they present to the emergency department (ED). The design was a retrospective cohort study. The setting was a university-affiliated children's hospital ED. All children with a physician parent seen in the ED during a 16-month period were identified. Children with a nonphysician parent were matched to children with a physician parent by date and time of visit. Length of stay in ED, performance of laboratory or radiological testing, evaluation by a consultant, and training level of the least experienced physician to evaluate the patient in the ED were measured. The authors identified 92 children with a physician parent and 181 children with nonphysician parents. Children of physician parents were similar to controls with regard to age, sex, nursing acuity level, length of stay, and whether a laboratory or radiographic procedure was performed. Children with a physician parent saw significantly fewer nonconsultant physicians while in the ED (P = .005). Compared with controls, the most junior member of the medical team seen by children of a physician parent was less likely to be a medical student (relative risk [RR] = 0.22) or a resident (RR = 0.71) and more likely to be an ED staff physician (RR = 1.52) or consultant (RR = 1.84). This trend was statistically significant (P = .002). The children of physician parents are more likely to see only an ED staff physician and/or consultant and less likely to see trainees than other children presenting to the pediatric ED.

Adolescent↗
PubMed1996

Physician parents and utilization of a pediatric emergency department.

OBJECTIVE: Health care costs might be reduced if patients could be taught to avoid using an emergency department (ED) for nonurgent illness. This study sought to determine whether children with a physician parent, a group whose parents possess special expertise in judging the severity of acute illness, utilize a pediatric ED differently from children with non-physician parents. DESIGN: Retrospective cohort study. SETTING: A children's hospital ED. PARTICIPANTS: The study population consisted of all children who visited the ED over an 11-month period who had a physician parent. These children were compared to 1000 controls randomly selected from children who visited the ED over the same time period. Two other groups were selected for comparison to controls: children with a nurse parent and children with an attorney parent. MAIN OUTCOME MEASURES: Urgent versus nonurgent final diagnosis. RESULTS: There were no clinically important or statistically significant differences with regard to age, sex, time of presentation, disposition from the ED, or nursing acuity level when the 72 children with a physician parent, the 136 children with a nurse parent, or the 135 children with an attorney parent were compared to the control children. Compared to the control group, children of physician parents were less likely to have a nonurgent final diagnosis: 33 versus 53%; relative risk (RR) 0.62 (95% confidence interval [CI] 0.44-0.87). Children with a nurse parent and children with an attorney parent were no more likely to present with a nonurgent diagnosis compared to control children: 49 versus 53%, RR 0.92 (95% CI 0.76-1.10) for children with a nurse parent and 45 versus 53%, RR 0.85 (95% CI 0.70-1.03) for children with an attorney parent. CONCLUSIONS: Children with a physician parent were less likely to use a pediatric ED for nonurgent problems compared to other children. However, children with a nurse parent, a group whose parents have more medical education than we can expect the general public to ever attain, had a pattern of pediatric ED utilization that was similar to the control children. These data suggest that improved parental education alone may not decrease ED use for conditions that could be managed in a less costly setting.

Adolescent↗
PubMed1995

Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein Style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council. Writing Group.

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern Virginia Medical School, Children's Hospital of the King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.

Child↗
PubMed1995

Recommended guidelines for uniform reporting of pediatric advanced life support: the Pediatric Utstein Style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council.

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, recommendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern Virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.

Child↗
PubMed1995

Outbreak of Escherichia coli O157:H7 hemorrhagic colitis and hemolytic uremic syndrome: effect on use of a pediatric emergency department.

STUDY OBJECTIVE: To evaluate the effect of an outbreak of Escherichia coli O157:H7 colitis, and media coverage of the outbreak, on use of an emergency department. DESIGN: Review of pediatric ED use and charges for gastrointestinal illness during the epidemic and during a control period. SETTING: Pediatric ED in Seattle, Washington. PARTICIPANTS: All children seen in the ED with a gastrointestinal illness during the epidemic period (January and February 1993) and during a control period (January and February 1992). RESULTS: During the epidemic, 31 patients with E coli O157:H7 infection had 45 visits to the ED. The number of visits for gastrointestinal illness not caused by E coli O157:H7 was 103% higher in the epidemic period than in the control period (653 in 1992, 1,327 in 1993). The number of visits was closely associated with the number of newspaper stories about E coli O157:H7 illness (correlation coefficient, .88; P = .002). The increased number of evaluations for gastrointestinal illness not caused by E coli O157:H7 infection during the epidemic period was associated with an additional $101,193 in charges per month compared with the control period. There were no important differences in the evaluation of gastrointestinal illness between 1992 and 1993 except for an increase in the proportion of patients with stool cultures (13.1% versus 26.4%, P < .001). CONCLUSION: For every visit by a patient with E coli O157:H7 infection, there were 15 additional visits (above the baseline from the control period) by patients with other gastrointestinal illness. The true cost of this epidemic included not only the evaluation of patients with disease but also the evaluation of those who presented because they were worried they had the disease. The intensity of media coverage of a disaster may correlate with the number of visits to the ED, and understanding of this fact may help in disaster planning.

Adolescent↗
PubMed1995

Predicting outcome in pediatric submersion victims.

STUDY OBJECTIVE: To predict outcome in children after near-drowning. DESIGN: Retrospective cohort study. Vegetative state and death were classified as unfavorable outcomes, whereas all other outcomes were classified as favorable. Demographic, episode-related, clinical, laboratory, and treatment variables available at the time of admission were evaluated for their usefulness in predicting outcome. SETTING: Pediatric referral hospital. PARTICIPANTS: Children admitted after submersion injury in non-icy waters. RESULTS: The study cohort comprised 194 children (median age, 2.6 years; range, 5 months to 18 years); 131 were neurologically normal at the time of discharge, 10 had some degree of neurologic impairment, 15 were in a vegetative state at the time of discharge, and 38 died. We used a combination of partitioning and logistic regression to combine variables in a prediction rule that was always correct when unfavorable outcome was predicted. The final rule predicted favorable outcome for all children who were not comatose. Among comatose children, unfavorable outcome was predicted by a combination of absent pupillary light reflex, increased initial blood glucose concentration, and male sex. This rule had a specificity of 100%--children with favorable outcomes were always predicted to do well--and a sensitivity of 65%. Therefore the rule was overly optimistic for 35% of patients with unfavorable outcomes. CONCLUSION: Pediatric submersion victims can be assigned to high or low likelihoods of unfavorable outcome with the use of four variables: comatose state, lack of pupillary light reflex, sex, and initial blood glucose concentration. This prediction rule may be useful if it can be validated in another cohort.

Adolescent↗
PubMed1995

Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein style.

This statement is the product of a task force meeting held June 8, 1994, in Washington DC in conjunction with the First International Conference on Pediatric Resuscitation and a follow-up task force writing group meeting held September 18, 1994, in Chicago. Draft versions of the statement were circulated for comment to all members of the task force, the American Heart Association Subcommittee on Pediatric Resuscitation, and several outside reviewers. This statement and the International Conference on Pediatric Resuscitation were cosponsored by the American Academy of Pediatrics and the American Heart Association. The development of this statement was authorized by the American Academy of Pediatrics; the American Heart Association National Subcommittees on Pediatric Resuscitation, Basic Life Support, and Advanced Cardiac Life Support, the Committee on Emergency Cardiac Care, the Science Advisory Committee; and the European Resuscitation Council. In addition to the writing group, members of the Pediatric Utstein Task Force are Paul Anderson, M Douglas Baker, Jane Ball, Desmond Bohn, Dena Brownstein, J Michael Dean, Niranjan Kissoon, Bruce Klein, Patrick Malone, Karin McCloskey, James McCrory, P Pearl O'Rourke, Mary Patterson, Charles Schleien, James Seidel, Joseph J Tepas III, and Becky Yano.

Child↗
PubMed1995

Out-of-hospital ventricular fibrillation in children and adolescents: causes and outcomes.

STUDY OBJECTIVE: To compare causes and outcomes of patients younger than 20 years with an initial rhythm of ventricular fibrillation versus asystole and pulseless electrical activity. DESIGN: Retrospective cohort study. SETTING: Urban/suburban prehospital system. PARTICIPANTS: Pulseless, nonbreathing patients less than 20 years who underwent out-of-hospital resuscitation. Patients with lividity or rigor mortis or who were less than 6 months old and died of sudden infant death syndrome were excluded. RESULTS: Ventricular fibrillation was the initial rhythm in 19% (29 of 157) of the cardiac arrests. Rhythm assessment was performed by the first responder in only 44% (69 of 157) of patients. All three rhythm groups were similar in age distribution, frequency of intubation (96%), and vascular access (92%); 93% of ventricular fibrillation patients were defibrillated. The causes of ventricular fibrillation were distributed evenly among medical illnesses, overdoses, drownings, and trauma, only two patients had congenital heart defects. Seventeen percent were discharged with no or mild disability, compared with 2% of asystole/pulseless electrical activity patients (P = .003). CONCLUSION: Ventricular fibrillation is not rare in child and adolescent prehospital cardiac arrest, and these patients have a better outcome than those with asystole or pulseless electrical activity. Earlier recognition and treatment of ventricular fibrillation might improve pediatric cardiac arrest survival rates.

Adolescent↗
PubMed1995

Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council.

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern Virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.

Child↗
PubMed1994

Mechanism of the vasodilatory action of nicorandil on coronary circulation in dogs.

Nicorandil possesses hybrid properties as a nitrate and a potassium (K) channel opener. We have previously reported that large coronary arteries responded to nicorandil at low plasma concentrations, while dilatation of small coronary arteries only occurred at higher plasma concentrations (above 200 ng/ml) in chronically instrumented dogs. In this study we examined the effects of intravenous nicorandil on epicardial coronary artery diameter (CoD) and coronary blood flow (CBF) in the absence and presence of glibenclamide, a K+ channel blocker, as well as the effects of nitroglycerin and cromakalim as reference drugs. The increase in CBF induced by nicorandil and cromakalim was significantly suppressed by glibenclamide. However, the increase in CoD induced by nicorandil and nitroglycerin was not suppressed by glibenclamide. These findings suggest that nicorandil-induced dilatation of the large coronary arteries was related to its nitrate action, while nicorandil-induced dilatation of the small coronary arteries was closely related to its effect as a K+ channel opener. In addition, the former response to nicorandil occurred at low concentrations, while the latter occurred at higher concentrations.

Animals↗
PubMed1994

Glibenclamide-induced oscillation of canine coronary artery is independent of myocardial ischemia.

To investigate the in vivo role of the ATP-sensitive potassium channel (KATP) in the coronary arteries, we examined the effects of intravenous (i.v.) glibenclamide (GLB, 0.3, 1.0, and 3.0 mg/kg), a specific KATP blocker, in chronically instrumented dogs. Epicardial coronary artery diameter (CoD) and coronary blood flow (CBF) were measured continuously. CoD and CBF oscillated in all 6 dogs after injection of 3 mg/kg GLB. CoD oscillated only slightly, with a decrease of 2.3 +/- 0.4%; CBF showed marked oscillation, with a peak flow rate of 21.9 +/- 2.7 ml/min (+26.6%) and a trough flow rate of 10.3 +/- 2.9 ml/min (-46.3%) (baseline flow rate was 17.8 +/- 2.4 ml/min). GLB 1 mg/kg produced a slight decrease in CBF without oscillation, and at 0.3 mg/kg had almost no effect. These oscillations were not associated with a decrease in myocardial blood flow as measured by the hydrogen gas clerance method. Nicorandil (0.2 mg/kg), cromakalim (20 micrograms/kg), and diltiazem (0.2 mg/kg) almost completely suppressed the GLB-induced oscillations, but nitroglycerin (NTG 15 micrograms/kg) did not. Thus, oscillation of large and small coronary arteries was induced by GLB and was independent of myocardial ischemia. In addition, these findings suggest that KATP has an important in vivo role in modulating large and small coronary artery tone through activation of the voltage-dependent Ca2+ channel.

Adenosine Triphosphate↗