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Biomedical subjects

M K Farrell

Publications and source records attributed to M K Farrell.

At least 19 recordsLinked to original sources
PubMed2000

Sustaining the implementation of an evidence-based guideline for bronchiolitis.

OBJECTIVE: To describe the changes occurring over a 3-year period after implementation of an evidence-based clinical practice guideline for the care of infants with bronchiolitis. DESIGN: Before and after study. SETTING: Children's Hospital Medical Center, Cincinnati, Ohio. PATIENTS: Infants 1 year or younger admitted to the hospital with a first-time episode of typical bronchiolitis. INTERVENTION: The guideline was implemented January 15, 1997. Data on all patients discharged from the hospital with bronchiolitis, from January 15 through March 27, in 1997, 1998, and 1999, were stratified by year and compared with data on similar patients discharged from the hospital in the same periods in the years 1993 through 1996. MAIN OUTCOME MEASURES: Patient volumes, length of stay for admissions, and use of specific laboratory and therapeutic resources ancillary to bed occupancy. RESULTS: After implementation of the guideline, admissions decreased 30% and mean length of stay decreased 17% (P<.001). Nasopharyngeal washings for respiratory syncytial virus were obtained in 52% fewer patients (P<.001); 14% fewer chest x-ray films were ordered (P<.001). There were significant reductions in the use of all respiratory therapies, with a 17% decrease in the use of at least 1 beta(2)-agonist inhalation therapy (P<.001). In addition, 28% fewer repeated inhalations were administered (P<.001); mean costs for all resources ancillary to bed occupancy fell 41% (P<.001); and mean costs for respiratory care services fell 72% (P<.001). CONCLUSIONS: An evidence-based clinical practice guideline for the care of patients encountered in major pediatric care facility has been successfully sustained beyond the initial year of its introduction to practitioners in southwest Ohio.

Algorithms↗
PubMed1999

Evaluation of an evidence-based guideline for bronchiolitis.

OBJECTIVE: To describe the effect of implementing an evidence-based clinical practice guideline for the inpatient care of infants with bronchiolitis at the Children's Hospital Medical Center in Cincinnati, Ohio. METHODOLOGY: A multidisciplinary team generated the guideline for infants < or = 1 year old who were admitted to the hospital with a first-time episode of typical bronchiolitis. The guideline was implemented January 15, 1997, and data on all patients admitted with bronchiolitis from that date through March 27, 1997, were compared with data on similar patients admitted in the same periods in the years 1993 through 1996. Data were extracted from hospital charts and clinical and financial databases. They included LOS and use and costs of resources ancillary to bed occupancy. RESULTS: After implementation of the guideline, admissions decreased 29% and mean LOS decreased 17%. Nasopharyngeal washings for respiratory syncytial virus were obtained in 52% fewer patients. Twenty percent fewer chest radiographs were ordered. There were significant reductions in the use of all respiratory therapies, with a 30% decrease in the use of at least 1 beta-agonist inhalation therapy. In addition, 51% fewer repeated inhalations were administered. Mean costs for all resources ancillary to bed occupancy decreased 37%. Mean costs for respiratory care services decreased 77%. CONCLUSIONS: An evidence-based clinical practice guideline for managing bronchiolitis was highly successful in modifying care during its first year of implementation.guideline, bronchiolitis, evidence-based medicine, pediatrics, outcome research.

Administration, Inhalation↗
PubMed1998

Bone mineral content in children with short bowel syndrome after discontinuation of parental nutrition.

To determine whether children with short bowel syndrome had evidence of metabolic bone disease, total body bone mineral content was measured by dual-energy x-ray absorptiometry in 18 patients and 36 age-, sex-, and race-matched control subjects. Children with short bowel syndrome had decreased bone mineral content compared with control subjects; however, it was not significant when adjusted for differences in weight and height. Whether these children will have normal bone accretion throughout puberty is not known.

25-Hydroxyvitamin D 2↗
PubMed1997

The 13C-xylose breath test for the diagnosis of small bowel bacterial overgrowth in children.

BACKGROUND: We evaluated the clinical utility of the 13C-xylose breath test for the diagnosis of small bowel bacterial overgrowth in children. METHODS: To determine the optimal dose of 13C-xylose, 29 healthy children, 3 to 12 years old, were randomly assigned to receive one of three doses of 13C-xylose (10, 25, or 50 mg). After an overnight fast, the oral dose of 13C-xylose was administered, and breath samples were collected every 30 minutes for 4 hours. Samples were analyzed for 13CO2 by gas chromatography with mass spectrometry. Using the 50 mg dose, we then performed nine breath tests with concurrent duodenal bacterial cultures in 6 children, 3 to 12 years old, with short-bowel syndrome (n = 2), immunodeficiency states (n = 1), and motility disorders (n = 3). RESULTS: Excretion of 13CO2 in breath peaked at 2.5 hours in all three control groups. The 50-mg dose produced the highest median peak and the smallest range of 13CO2 excretion in breath within each time period. The time of peak 13CO2 excretion in breath varied among the diseased children; however, the six patients with small-bowel bacterial overgrowth (2 x 10(5)-3.5 x 10(5) gram negative rods) all had peak 13CO2 that exceeded the maximum breath 13CO2 level in breath of the control subjects at the corresponding time period (100% sensitivity). Of the three patients with negative cultures, two had negative breath test results and one had positive results (67% specificity). One subject had normalization of both duodenal culture and breath test results after antibiotic treatment of small-bowel bacterial overgrowth. CONCLUSIONS: Our preliminary results suggest that with a dose of 50 mg 13C-xylose, breath test results reliably predict small-bowel bacterial overgrowth in susceptible children.

Bacteria↗
PubMed1994

Intensive nutritional support and remedial surgical intervention for extreme short bowel syndrome.

Management of extreme short bowel syndrome (SBS) has changed dramatically over the last 20 years with notable improvements in survival and quality of life in patients with this syndrome. A review of our institution's medical records over a 12-year period (1980-1992) revealed 32 patients with < 100 cm (range, 14-94; median, 40) of functional small bowel after intestinal resection. The causes of intestinal loss included necrotizing enterocolitis (11 cases), atresias (8 cases), long-segment Hirschsprung's disease (5 cases), midgut volvulus (5 cases) and gastroschisis (3 cases). The mean follow-up period was 4.2 years, and four deaths were recorded (12.5%). Survival of eight of nine (88.9%) patients without an ileocecal valve (ICV) and with < 40 cm of small bowel was noted. The absence of an ICV, however, was associated with significantly prolonged total parenteral nutrition. Follow-up surgical procedures, including intestinal lengthening, tapering enteroplasty. Martin's procedure, longitudinal myectomy-myotomy, and ostomy take-down, were performed in 20 of the patients (64%). Prolonged survival and normal development can be expected for the patient with severe SBS who is given meticulous nutritional support and treated with carefully planned secondary surgical intervention. These results are also seen in patients with extreme SBS (< 40 cm residual small bowel length) and no ICV.

Follow-Up Studies↗
PubMed1993

Use of abdominal and pelvic ultrasound in the evaluation of chronic abdominal pain.

The value of sonography in assessing chronic abdominal pain (CAP) in children, the characteristics of CAP, and the local pediatrician's practice in evaluating CAP are reported. Fifty-seven patients with CAP had abdominal and/or pelvic sonography; 56 were normal. One sonogram showed an ovarian cyst on the side opposite the CAP; the cyst later resolved. Pain was usually localized in the periumbilical area (56%). Follow-up data were obtained from referring physicians and patients' medical records. No serious diagnosis related to CAP was missed. After six months, CAP had resolved in 43% of patients. Of the responding physicians, 61% indicated they would have used more and costlier contrast studies if ultrasonography had been unavailable.

Abdomen↗
PubMed1993

Evaluation of pediatric training by the alumni of a residency program.

An evaluation of a large pediatric residency program by its alumni was undertaken to determine whether the program is providing quality education and relevant training for pediatricians. A questionnaire was mailed to physicians who began their training at Children's Hospital Medical Center in July 1974 or later and finished prior to July 1990. Of the 372 questionnaires sent, 274 were returned (74% response rate). Current positions included primary care physicians (41%), academic pediatricians (33%), and other (26%). Fifty-seven percent pursued fellowship training. Overall, 94% of the responders believed that their pediatric training was adequate in preparing them for their current position. The variety of patients seen, the inpatient experience, resident camaraderie, and neonatology training were rated the highest quality, means 4.38 to 4.75 (1 = poor, 3 = average, 5 = excellent quality). Behavioral/developmental pediatrics, adolescent medicine, well-child care/continuity clinic, the outpatient experience, and pediatric surgery were rated the poorest quality, means 2.66 to 3.08, and judged to have too little quantity of training relative to the other aspects of training, means 1.93 to 2.42 (1 = too little, 3 = just enough, 5 = too much quantity). The quantity of neonatology training, the volume of patients, on-call experience, subspecialty inpatient services, such as bone marrow transplantation, and overall inpatient experience were considered too high relative to other components, means 3.51 to 4.08. There were no significant differences in responses by whether the alumni were in academic or primary care positions nor by year of training, and few differences by whether or not the training was considered adequate preparation for their current position.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Hypophosphatemia in the nutritional recovery syndrome.

We studied the incidence of hypophosphatemia in patients during the nutritional recovery syndrome. The charts of 150 patients receiving a complete nutritional assessment for 18 months were reviewed; 45 met established nutritional risk criteria. Only 9 of these 45 had serial phosphorus values measured during nutritional repletion, and 5 of these 9 patients had hypophosphatemia (phosphorus levels less than 0.97 mmol/L). Anthropometric measurements of arm circumference and arm muscle circumference were less than the fifth percentile in all patients developing hypophosphatemia. We concluded that hypophosphatemia is an underrecognized complication of nutritional repletion and that anthropometric measurements may be predictive of patients at risk. All patients with significant malnutrition should be evaluated for this complication of refeeding.

Adolescent↗
PubMed1986

Parenteral nutrition and hepatobiliary dysfunction.

Parenteral nutrition associated cholestasis is a condition that challenges even the most astute clinician. The risk:benefit ratio of parenteral nutrition must be individualized for each neonate. The dilemma is based on weighing the risk of progressive cholestasis and its complications against the risk of starvation, malnutrition, and their consequences. Avoiding excessive nutrient infusion and providing even minimal enteral calories may prevent or mitigate cholestasis. Routine monitoring of hepatic function in all neonates receiving parenteral nutrition allows early detection and intervention. Affected infants must be evaluated for treatable causes of neonatal cholestasis. Parenteral nutrition related cholestasis remains a diagnosis of exclusion. Further research is needed to unravel the cause and to define the long-term consequences of parenteral nutrition associated cholestasis.

Adult↗
PubMed1985

Concomitant psychological and cardiac improvement during successful treatment of anorexia nervosa.

A patient with anorexia nervosa in whom concurrent nutritional, psychological, and cardiovascular assessments were obtained sequentially during successful treatment is presented. At the time of diagnosis, severe multisystem dysfunction was present including depression, low self-esteem, hypotension, bradycardia, exercise intolerance, and abnormalities of systolic and diastolic cardiac function. Treatment resulted in weight gain and increased skinfold thickness and arm circumference. There were concomitant improvements in the psychometric indices of depression and self-esteem as well as decreased anorectic tendencies. During her recovery, working capacity increased and diastolic function improved. However, echocardiographic evidence of impaired systolic function persisted. Despite the apparent treatment success in this patient, this report suggests a potential need for further studies to determine the extent, if any, of long-term cardiac sequelae.

Adolescent↗
PubMed1984

Abdominal pain.

Chronic abdominal pain affects 10% to 12% of school-aged children. In 90% to 95% of such patients, no organic cause can be elicited. Certain behavioral and personality characteristics are frequently evident in these children. Significant stress is usually present in the families. The goal of the evaluation is education of the child and family about the abdominal pain. The reality of the pain is acknowledged, but the stress is dealt with as the primary issue.

Abdomen↗
PubMed1984

An unusual presentation of Wegener's granulomatosis mimicking inflammatory bowel disease.

An unusual presentation of Wegener's granulomatosis is described in a 16.67-yr-old black woman with diarrhea, fever, weight loss, abdominal pain, arthralgias, and mouth ulcers, suggesting the diagnosis of inflammatory bowel disease. However, biopsy specimens of rectal mucosa, oro- and nasopharynx, and skin conclusively demonstrated the vasculitic lesion of Wegener's granulomatosis. Furthermore, cyclophosphamide therapy induced remission of clinical and histologic abnormalities. This case emphasizes the diagnostic value of taking biopsy specimens of oral lesions in patients with suspected inflammatory bowel disease and demonstrates that the presentation of Wegener's granulomatosis may mimic that of inflammatory bowel disease.

Adolescent↗