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R O'Donnell

Publications and source records attributed to R O'Donnell.

At least 55 records · Page 3Linked to original sources
PubMed1995

Determination of normal ear temperature with an infrared emission detection thermometer.

STUDY OBJECTIVE: To determine normal body temperature with an infrared emission detection ear thermometer. DESIGN: Cross-sectional convenience sample. SETTING: Four acute and long-term health care facilities. PARTICIPANTS: Subjects who denied recent potentially febrile illness and ingestion of medications affecting normal body temperature. RESULTS: Two thousand four hundred forty-seven subjects aged 12 hours to 103 years were enrolled. Ear temperatures were normally distributed for each of eight age groups. There were differences in mean temperature among different age groups (P < .001, by ANOVA) and a striking cutoff at adolescence; the mean temperature for children aged 3 days to 10 years was 36.78 +/- 0.47 degrees C, as compared to 36.51 +/- 0.46 degrees C for subjects 11 years and older (P < .001, by t test). Temperatures were higher in female subjects and showed the characteristic diurnal variation of normal body temperature in five subjects studied longitudinally. The reproducibility of the ear thermometer was better than that of a commonly used electronic thermometer at the oral and axillary sites. CONCLUSION: The infrared emission detection ear thermometer is an accurate means of assessing normal body temperature without using corrective offsets to estimate temperature at other body sites. On the basis of these data, the 95th percentile for infrared emission detection temperature in children younger than 11 years old was 37.6 degrees C. The 99th percentile was 37.9 degrees C for children younger than 11 years old and 37.6 degrees C for people 11 years or older. Because only 1% of normal people have an infrared emission detection temperature higher than these values, these may represent appropriate cutoffs for fever screening using this device.

Adolescent↗
PubMed1994

Association of Lewis blood group phenotypes with urinary tract infection in children.

Many blood group antigens, genetically controlled carbohydrate molecules, are found on the surface of uroepithelial cells and may affect bacterial adherence and increase the frequency of urinary tract infection (UTI) in adults. Sixty-two children aged 2 weeks to 17 years (mean, 2.3 years) who were hospitalized with fever in association with UTIs caused by Escherichia coli had complete (n = 50) or partial (n = 12) erythrocyte antigen typing to determine the role of erythrocyte antigens and phenotypes in UTI in children; 62 healthy children undergoing nonurologic elective surgery, matched 1 to 1 for age, sex, and race to the patient group, formed the control group. In univariate tests, patients and control subjects did not differ in ABO, Rh, P, Kell, Duffy, MNSs, and Kidd systems by the McNemar test of symmetry (p > 0.05). The frequency of the Lewis (Le) (a-b-) phenotype was higher (16/50 vs 5/50; p = 0.0076) and the frequency of the Le(a + b +) phenotype was lower (8/50 vs 16/50; p = 0.0455) in the patient population than in the control subjects. A stepwise logistic regression model to predict UTI with the explanatory variables A, B, O, M, N, S, s, Pl, Lea, and Leb showed that only the Lea and Leb antigens entered the model with p < 0.1. The Le(a-b-) phenotype was associated with UTI in this pediatric population. The relative risk of UTI in children with the Le(a-b-) phenotype was 3.2 (95% confidence interval, 1.3 to 7.9). Specific blood group phenotypes in pediatric populations may provide a means to identify children at risk of having UTI.

Adolescent↗
PubMed1994

Abdominal injury score: a clinical score for the assignment of risk in children after blunt trauma.

PURPOSE: To develop a clinical scoring scheme that can be used to predict the risk of abdominal injury in children after blunt trauma. MATERIALS AND METHODS: Presenting clinical features and outcomes, including the need for surgery, were reviewed for 793 children who underwent computed tomography (CT) after blunt abdominal trauma. These data were submitted to a logistic regression model to identify predictors for major abdominal injury. An abdominal injury score was developed on the basis of results of these analyses; higher scores denoted a progressively higher risk. RESULTS: The proportion of children with abdominal injury increased significantly with progressively higher scores (P = .0001). There was no significant difference between the predicted and actual frequency distributions of abdominal injury (P = .782). Patients were assigned to low-, intermediate-, and high-risk groups according to abdominal injury score, with a predicted probability of abdominal injury for each group of < or = 5%, 6%-15%, and > or = 16%, respectively. Frequency of major abdominal injury increased with higher scores, as did the need for laparotomy. CONCLUSION: The abdominal injury score shows promise as a useful tool for triage of children considered for emergency CT after blunt abdominal trauma.

Abdominal Injuries↗
PubMed1993

The use of recombinant human erythropoietin in end stage renal disease.

We treated 57 patients who suffered from end stage renal disease (ESRD) with recombinant human erythropoietin (EPO) for a mean period of 56 weeks. Patients were aged between 18 and 81 years. Forty three patients were on haemodialysis and 14 on continuous ambulatory peritoneal dialysis (CAPD). Despite regular transfusions, the mean haemoglobin prior to EPO therapy was 7.4 g/dl +/- 1.7. The target haemoglobin of 10 g/dl was reached at a mean of 12 weeks for the CAPD patients and at 14 weeks for the haemodialysis population. Patients were noted during the study to have a progressive rise in mean red cell volume, and this appeared to be related to their level of iron stores. The mean dose EPO used to reach the target haemoglobin was 8,700 u/week (125 u/kg/week) for the haemodialysis patients and 7,200 u/week (102 u/kg/week) for the CAPD patients. Three patients (7%) developed thrombosis of their A/V fistula. Hypertension was exacerbated in 28% of the patients. We conclude that EPO is a very effective but not inexpensive therapy for the anaemia of ESRD.

Adolescent↗
PubMed1993

Counseling parents of a child dead on arrival: a survey of emergency departments.

The purposes of this study were to (1) document whether or not responding emergency departments (EDs) have a process and/or team to interact with parents of children dead on arrival (DOA); (2) conduct a needs assessment to determine what information is essential to convey to a family of a child DOA; and (3) determine what EDs are doing to their residents/fellows in crisis counseling. A survey instrument was developed using input from key health care professionals at Children's Hospital who are involved in the acute care of children and their families. This survey was sent to directors of EDs in all children's hospitals and those general hospitals with more than 400 beds. Respondents identified themselves as ED directors at children's hospitals or general hospitals throughout the United States. The survey documented the lack of a process or team approach to counseling the family of a child who presents DOA. Often, the most inexperienced physicians are expected to provide this information and to counsel parents. Few EDs reported offering communication skills training in this area. Many respondents expressed dissatisfaction about the lack of a process or team regarding patients who present DOA and recognize the need for improvement.

Child↗
PubMed1993

How much heparin? A simple in vitro test.

A simple in vitro test to calculate the dose of heparin required to achieve optimal in vivo anticoagulation during surgery has been assessed in 15 patients who subsequently underwent vascular surgery. Heparin was added to four aliquots of patients blood in vitro to give five solutions with heparin concentrations ranging from 0-0.8 units/ml of plasma. The activated partial thromboblastic times (APTT) of each of these samples was then measured and the natural log (ln) of the APTT calculated. The natural log of the APTT in vitro was then plotted against the in vitro heparin concentration. From this linear correlation the concentration of heparin required to achieve an APTT 2.5 times the normal in vitro (Hc) for the 15 different patients was calculated and ranged from 0.4-0.75 units/ml (median 0.47). Based on an estimate of the plasma volume (PV), the bolus dose of heparin given intravenously to each patient to produce an equivalent anticoagulant response in vivo was calculated (Hc x PB). Heparin boli administered ranged from 1000-2000 units (median 1500). The mean in vivo APTT achieved was 77% of the predicted value (range 62%-123%). Such an estimation of an in vivo response, by means of an in vitro test, should help to more accurately predict the effects of heparin in vivo and individualise anticoagulation dosage.

Aged↗
PubMed1993

Medical students' experiences with and perceptions of chronic illness prior to medical school.

Concerns have been expressed about the failure of the medical curriculum to address the health-care needs of the chronically ill. It has been shown in the literature that medical students develop cynicism and negative feelings towards chronic illness as they progress through their training, perhaps as a result of the attitudes and frustrations of their teachers. What has been inadequately addressed are the experiences with and perceptions about chronic illness that medical students have before entering medical school. Some recommendations are made for curriculum changes based on the findings reported.

Attitude to Health↗
PubMed1993

Cluster of Enterobacter cloacae pseudobacteremias associated with use of an agar slant blood culturing system.

From 1 February through 12 October 1990, 27 blood cultures processed at Shiprock Hospital were positive for Enterobacter cloacae; only 3 had been reported in the preceding 12 months. Twenty (74%) of the cultures were obtained from patients without clinical evidence of gram-negative septicemia. The increase in E. cloacae-positive blood cultures was temporally associated with the introduction of a new blood culturing system. To evaluate potential risk factors for an E. cloacae-positive blood culture (case-culture), we conducted a case-control study. Case-cultures were compared with 81 randomly selected cultures that were processed during the epidemic period and that were not positive for E. cloacae (controls). Because several factors suggested the possibility of pseudoinfection, we limited our analysis to the 20 blood cultures that appeared to be contaminants. Blood samples received in the laboratory during the midnight shift (5 of 20 [25%] versus 5 of 81 [6%]; odds ratio, 5.1; 95% confidence intervals, 1.01 to 24.6; P = 0.02) or present in the incubator with other E. cloacae-positive samples (17 of 20 [85%] versus 29 of 81 [36%]; odds ratio, 10.2, 95% confidence interval, 2.6 to 57.3; P < 0.001) were at increased risk for contamination. During mock experiments of the procedures for processing blood samples for culture, several breaks in aseptic technique and leakage from the blood culturing system were observed. Cultures of samples obtained from several environmental sites in the laboratory and the hand washings of two laboratory technicians grew E. cloacae. Plasmid and restriction enzyme analyses of E. cloacae isolates recovered from the patients' blood cultures, the two technicians' hand washings, and environmental sites in the laboratory indicated that all had identical plasmid profiles. Our findings suggest that the breaks in aseptic technique and the environmental contamination that occurred in association with the use of the new blood culturing system resulted in contamination of the blood cultures. This outbreak highlights the importance of routine environmental cleaning, periodic quality control assessments, and adherence to aseptic practices in clinical laboratories, particularly when new methods or equipment are introduced and/or new personnel are hired.

Agar↗
PubMed1992

Comparison of the erythropoietin response in children with aplastic anemia, transient erythroblastopenia, and iron deficiency.

To assess the effects of decreased erythrocyte production on the levels of serum erythropoietin in children, we measured simultaneous hemoglobin concentrations and erythropoietin in 18 children with iron deficiency anemia, 17 children with transient erythroblastopenia of childhood (TEC), and 7 children with aplastic anemia. In all but two patients (one with TEC; one with aplastic anemia), erythropoietin was measured at diagnosis, before institution of specific therapy for the anemia. There was a statistically significant inverse linear correlation between log10 erythropoietin and hemoglobin values for all patient groups (r = 0.904 to 0.912; p less than 0.005). A comparison of the slopes of the regressions for each patient group by analysis of covariance revealed a significantly steeper slope for the iron deficiency group (-0.553) versus the TEC (-0.287) and aplastic anemia (-0.256) groups (p = 0.0001). The difference in erythropoietin levels appeared greatest in patients whose presenting hemoglobin level was greater than 5 gm/dl. Decline in serum erythropoietin levels was more precipitous in the less severely anemic patients with iron deficiency anemia than in the patients with TEC or aplastic anemia. These data reveal quantitative and qualitative differences in the relationship between serum erythropoietin and hemoglobin levels when children with severe iron deficiency anemia versus those with TEC or aplastic anemia are considered, even though all three conditions are characterized by hypoproliferation of erythrocytes.

Analysis of Variance↗
PubMed1992

Association of asthma mortality with medical specialist density.

In 1980, rates of death from asthma at 5 to 34 years of age varied from .105 per 100,000 in the East North Central States to .271 in the Mountain States for whites and from .637 in the South Atlantic States to 1.343 in the Middle Atlantic States for blacks. In order to investigate possible relationships between availability of physicians and care for patients with asthma, we determined regional densities of medical specialists in allergy and immunology, emergency medicine, family practice, internal medicine, and pediatrics as listed by the Directory of Medical Specialists. Multiple linear regression analyses indicated that asthma mortality was increased in areas that had more medical specialists, even after adjustment for size of the regional area. Inadequate numbers of medical specialists do not account for higher asthma mortality rates in some regions.

Adolescent↗
PubMed1992

Prospective randomized double-blind study comparing L-epinephrine and racemic epinephrine aerosols in the treatment of laryngotracheitis (croup).

Aerosolized racemic epinephrine, but not L-epinephrine, is commonly used in treating croup. The efficacy and adverse effects of nebulized racemic and L-epinephrine in the treatment of laryngotracheitis were compared. Children 6 months to 6 years of age with a croup score of 6 or above were assigned in a randomized double-blind fashion to receive either racemic (n = 16) or L-epinephrine (n = 15) aerosols. Croup score, heart rate, blood pressure, respiratory rate, fraction of inspired oxygen, and oxygen saturation were recorded before treatment and at 5, 15, 30, 60, 90, and 120 minutes after the aerosol. Patients in both groups showed significant transient reduction of the croup score and respiratory rate following the aerosol (P less than .001), but there were no differences between treatment groups when croup score, heart rate, blood pressure, and respiratory rate were assessed over time. It is concluded that L-epinephrine is at least as effective as racemic epinephrine in the treatment of laryngotracheitis and does not carry the risk of additional adverse effects. L-Epinephrine is also more readily available worldwide, is less expensive, and can be recommended for this purpose.

Aerosols↗
PubMed1991

Indications for computed tomography in children with blunt abdominal trauma.

This investigation was undertaken to identify clinical variables, alone or in combination, that could be used to assign children to high- and low-risk categories for intra-abdominal injury following blunt trauma. Six hundred consecutive children who were examined with computed tomography (CT) following blunt trauma were enrolled. Complete data sets were available on 375 children. Stepwise logistic regression was used to identify predictor variables for the presence of abdominal injury. There were 174 children with abdominal injury detected by CT. Of these, 95 were classified as having significant injury. Indicators associated with significantly higher risk of abdominal injury included the following: more than three clinical indications given (odds likelihood ratio [OLR] = 4.60, 95% confidence interval [95% Cl] = 2.29, 9.21, p less than 0.001); gross hematuria (OLR = 5.80, 95% Cl = 2.51, 13.4, p less than 0.001); lap belt injury (OLR = 12.2, 95% Cl = 2.22, 66.8, p less than 0.01); assault or abuse as the mechanism of injury (OLR = 5.08, 95% Cl = 1.07, 24.2, p less than 0.05); abdominal tenderness (OLR = 2.73, 95% Cl = 1.296, 5.82, p less than 0.01); and Trauma Score less than or equal to 12 (OLR = 2.27, 95% Cl = 1.006, 5.13, p less than 0.01). No child with asymptomatic hematuria (n = 56), regardless of grade or neurologic impairment in the absence of abdominal findings (n = 15), had an abnormal CT examination. These data are useful as an adjunct to clinical judgment in triage when the availability of CT equipment is limited or there are competing extra-abdominal injuries.

Abdominal Injuries↗
PubMed1991

Lack of binding between cryoimmunoglobulins, immunoglobulins and fibronectin: implications for immune complex vasculitis.

Immune-complex-mediated vasculitis is a frequent complication of rheumatoid arthritis and systemic lupus erythematosus. The mechanism of deposition of immune complexes within the vessel wall in these diseases remains unknown, but probably involves other proteins. Fibronectin is a likely candidate since it possesses the ability to bind to collagen, endothelial cells, and possibly immunoglobulins and immune complexes. In this study, the binding of fibronectin to IgG and IgM cryoglobulins, cold soluble IgM, IgG, IgG subclasses and IgG fragments was investigated in the solution phase. Static light scattering, fluorescence anisotropy, fluorescence intensity, and PEG precipitation studies were used to investigate binding under different conditions of temperature and ionic strength. These studies failed to demonstrate significant binding between fibronectin and IgM, IgG, IgG subclasses and IgG fragments under the conditions studied. These findings argue against solution phase binding of fibronectin and immunoglobulins contributing to immune complex vasculitis. The possibility of important surface interactions between these proteins has not been ruled out.

Cryoglobulins↗
PubMed1990

Comparison of topical tetracaine, adrenaline, and cocaine anesthesia with lidocaine infiltration for repair of lacerations in children.

Local anesthetic infiltration is painful and frightening for children. We prospectively compared a topical alternative, TAC solution (tetracaine 0.5%, adrenaline 1:2,000, cocaine 11.8%), with 1% lidocaine infiltration for use in laceration repair in 467 children. Adequate anesthesia of facial and scalp wounds was achieved for 81% of TAC-treated wounds versus 87% of lidocaine-treated wounds (P = .005). TAC was less effective on extremity wounds; 43% had effective anesthesia compared with 89% of lidocaine-treated extremity wounds (P less than .0001). No systemic toxicity was observed. The incidence of wound infection was 2.2% for both TAC and lidocaine. Wound dehiscence occurred in seven TAC- and two lidocaine-treated facial or scalp wounds (4.5% vs 1.8%, NS) and in five TAC- and four lidocaine-treated extremity wounds (20% vs 17.4%, NS). The unusually high rate of dehiscence was due partially to recurrent trauma or coincident infection. TAC was well accepted by patients and parents. We encourage the careful use of TAC as a less painful alternative to lidocaine infiltration for selected scalp and facial lacerations in children.

Administration, Topical↗
PubMed1990

Pediatric acquired immunodeficiency syndrome: an unusually high incidence of twinning.

Surveillance data on incidence of twins among reported cases of pediatric AIDS in New York City are presented. Most pairs are concordant for HIV infection. Three discordant pairs have been described elsewhere. Possible reasons for the association are discussed, including the most likely explanation that twins show symptoms early and are overrepresented in the early years of surveillance of pediatric AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Lack of effect of geographic elevation on mortality from asthma.

One might expect prevalence of asthma to affect rates of mortality due to asthma. In France, asthma prevalence at 1350 m is less than at sea level. Calculation of asthma mortality rates for blacks and whites 5 to 34 years of age in 1980 for counties in the USA with populated places at elevations of at least 4000 feet disclosed no significant differences from rates at lower elevations. Nevertheless, asthma mortality rates were significantly higher for blacks than whites at both high and low elevations. The asthma death rates per 100,000 general population for elevations less than 4000 feet were .160 for whites and .896 for blacks. Asthma death rates for elevations of at least 4000 feet were .209 for whites and 1.150 for blacks.

Adolescent↗