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Biomedical subjects

C Conroy

Publications and source records attributed to C Conroy.

At least 19 recordsLinked to original sources
PubMed2001

Improving emergency medical services for children with special health care needs: does training make a difference?

This study evaluated the impact of a paramedic training program on emergency medical services (EMS) responses for children with special health care needs. EMS responses for children with a congenital or acquired condition or a chronic physical or mental illness, were reviewed. Responses, related to the child's special health care need, involving paramedics who had completed our training program were compared with responses with paramedics not participating in the training. There was significantly more advanced life support treatment for responses with paramedics completing the training program compared with other responses. However, there was no significant difference in transport to a hospital or in-hospital admission between these 2 groups. This finding suggests that existing EMS protocols may play a more important role in emergency treatment and transport of children with special health care needs than specialized training of already certified paramedics.

Adult↗
PubMed2001

Use of insulin pumps in pregnancies complicated by type 2 diabetes and gestational diabetes in a multiethnic community.

OBJECTIVE: To describe the use of insulin pump therapy in women with gestational diabetes mellitus (GDM) or type 2 diabetes in pregnancy and persistent hyperglycemia despite multiple injections of subcutaneous insulin. RESEARCH DESIGN AND METHODS: As part of a service audit, deliveries to women with diabetes at a single South Auckland hospital were reviewed from 1991 through 1994. Glycemic control was estimated by the mean of self-recorded and laboratory postprandial glucose concentrations. In a nested case-control study, pregnancies complicated by GDM/type 2 diabetes with use of an insulin pump were compared with those without insulin pump therapy and peak insulin requirements of 100-199 units/ day, matched for ethnicity and type of diabetes. RESULTS: A total of 30 of 251 Polynesian, European, and South Asian women with singleton pregnancies complicated by insulin-requiring GDM/type 2 diabetes used an insulin pump. An additional two women with high insulin requirements discontinued pump therapy. None of the women with GDM/type 2 diabetes experienced severe hypoglycemia, whereas 79% of the women had improved glycemic control within 1-4 weeks. Mothers using a pump had greater insulin requirements (median maximum 246 vs. 130 units per day) and greater weight gain (10.6 vs. 5.0 kg). Their babies were more likely to be admitted to the Special Care Baby Unit but were neither significantly heavier nor experienced greater hypoglycemia than control subjects. CONCLUSIONS: Insulin pump therapy seems to be safe and effective for maintaining glycemic control in pregnancies complicated by GDM/type 2 diabetes and requiring large doses of insulin.

Adult↗
PubMed2000

A novel telephone-based system for management of secondary prevention to a low-density lipoprotein cholesterol < or = 100 mg/dl.

Unfortunately, lipid-lowering drug therapy remains underutilized in clinical practice, and few secondary prevention patients achieve the low-density lipoprotein (LDL) cholesterol level (< or = 100 mg/dl) recommended by the National Cholesterol Education Program. To improve patient management, a telephone-based computerized system primarily managed by dietitians was implemented in one of our cardiology clinics. Lipid results from all lipid and cardiology referrals and patients admitted to the cardiology service at 1 hospital are managed through this system. Patients are contacted via computer-generated postcards and the dietitians every 3 to 6 months. At baseline (September 1, 1994, through August 31, 1995; n = 1,969), 34% and 66% had LDL cholesterol < or = 100 and < or = 130 mg/dl, respectively. By September 1, 1997, to August 31, 1998 (n = 2,827), the proportion of patients with LDL cholesterol < or = 100 mg/dl had increased to 61%, and 89% had LDL cholesterol < or = 130 mg/dl. Statin use increased from 47% to 85% of patients. By 1997 to 1998, 74% and 40% of patients received statin doses that would, on average, produce a 34% and 41% reduction in LDL cholesterol, respectively. Whether a patient had LDL cholesterol < or = 100 mg/dl was not predicted by patient characteristics, drugs given, or by medication insurance coverage.

Adult↗
PubMed2000

Early hominid brain evolution: a new look at old endocasts.

Early hominid brain morphology is reassessed from endocasts of Australopithecus africanus and three species of Paranthropus, and new endocast reconstructions and cranial capacities are reported for four key specimens from the Paranthropus clade. The brain morphology of Australopithecus africanus appears more human like than that of Paranthropus in terms of overall frontal and temporal lobe shape. These new data do not support the proposal that increased encephalization is a shared feature between Paranthropus and early Homo. Our findings are consistent with the hypothesis that Australopithecus africanus could have been ancestral to Homo, and have implications for assessing the tempo and mode of early hominid neurological and cognitive evolution.

Animals↗
PubMed2000

Incidence and risk factors for neonatal hypoglycaemia among women with gestational diabetes mellitus in South Auckland.

AIMS: To describe the incidence and risk factors for neonatal hypoglycaemia among the offspring of women with gestational diabetes mellitus (GDM) in South Auckland, New Zealand METHODS: A retrospective audit was undertaken of singleton pregnancies delivered between 1991 and 1994. Data were obtained for 373 women and their deliveries (57 European, 76 Maori, 198 Pacific Islands, 42 other). RESULTS: Pacific Islands women were most likely to have large babies with neonatal hypoglycaemia in spite of a high use of insulin. Postnatally Maori and Pacific Islands women had a high incidence of Type 2 diabetes mellitus (21.4, 21.7 vs. 4.3% Europeans, 12.0% others, P =0.035). Babies experiencing hypoglycaemia were more likely to have a mother with past GDM (51.2 vs. 27.2%, P = 0.01) and greater hyperglycaemia (at diagnosis fasting 6.8 +/- 1.7 vs. 5.7 +/- 1.1 mmol/l, P < 0.001; finger-prick glucose 5.7 +/- 1.0 vs. 5.2 +/- 0.8 mmol/l, P < 0.001). Macrosomia, Caesarian section and special care baby unit admission were more common in pregnancies complicated by neonatal hypoglycaemia. CONCLUSIONS: Maternal hyperglycaemia was a major contributing factor to neonatal hypoglycaemia in this population. Undiagnosed Type 2 diabetes was common among Maori and Pacific Islands women, confirming the need for earlier detection and treatment.

Adult↗
PubMed2000

Increasing paramedics' comfort and knowledge about children with special health care needs.

This study evaluated a continuing education program for paramedics about children with special health care needs (CSHCN). Pretraining, posttraining, and follow-up surveys containing two scales (comfort with CSHCN management skills and comfort with Pediatric Advanced Life Support [PALS] skills) were administered. Objective measures of knowledge were obtained from pre- and posttraining tests. Differences in average scores were assessed using t-tests. Response rates for paramedics completing the program ranged from 94% for the posttraining survey, 81% for the initial comfort survey, 56% for the knowledge pretest, and 56% for the follow-up survey. PALS comfort scores were significantly higher than CSHCN comfort scores both before and after training, both P < .01. Posttraining surveys showed an increase in CSHCN comfort, P < .01. The follow-up surveys showed a significant decline in CSHCN comfort, P = .05. Scores on the tests showed a similar pattern, with a significant increase in knowledge from pre- to posttraining (P = .02) and a significant decrease in knowledge from posttraining to follow-up (P < .01). Comfort was significantly higher for standard pediatric skills than for specialized management skills. Completion of the self-study program was associated with an increase in comfort and knowledge, but there was some decay over time.

Adult↗
PubMed2000

The Haddon matrix: applying an epidemiologic research tool as a framework for death investigation.

The Haddon matrix is a research tool used by injury epidemiologists. Although this matrix has typically been used only in epidemiologic studies, it may serve as a framework to investigate the circumstances of traumatic deaths. This matrix consists of three rows representing time phases (before the injury incident, during the incident, and after the incident) and four columns representing the energy agent, characteristics of the deceased person, the environment, and the vehicle or vector resulting in the abnormal energy exchange, which are considered in the context of the three time phases. The authors present four cases illustrating how this epidemiologic tool can be useful during death investigations. Although the objectives for epidemiologic studies and medicolegal death investigations differ, this approach can be used to describe the circumstances surrounding an injury-related death.

Accident Prevention↗
PubMed1999

Continuous intravenous midazolam infusion for Centruroides exilicauda scorpion envenomation.

STUDY OBJECTIVE: We sought to describe the effects of continuous intravenous midazolam infusion as therapy for severe bark scorpion (Centruroides exilicauda) envenomation. METHODS: A retrospective chart review from July 1, 1993, through January 1, 1998, identified all patients treated at a university hospital with International Classification of Diseases, Ninth Revision, codes 989.5 (toxic effect of venom) or E905.2 (scorpion sting causing poisoning). By using standardized collection forms, data were extracted from the medical record of every patient who had a grade III or IV envenomation and was treated with a continuous intravenous midazolam infusion. RESULTS: Our search identified 104 patients; 34 had grade III or IV envenomation. Of these, 33 were treated in the ICU with continuous intravenous midazolam infusion. Median patient age was 4 years (range, 1 to 68 years). Midazolam dosage was adjusted to induce a light sleep state to control agitation and involuntary motor activity. The median amount of midazolam resulting in the first recorded decrease in agitation and involuntary motor activity was 0.30 mg/kg (range, 0.03 to 1.76 mg/kg). This first evidence of clinical improvement was recorded as 1.00 hour (median), with a range of 0.00 to 3.75 hours. The initial midazolam infusion rate was 0.10 mg x kg(-1) x h(-1) (median), with a range of 0.01 to 0.31 mg x kg(-1) x h(-1). The maximal midazolam infusion rate was 0.30 mg x kg(-1) x h(-1) (median), with a range of 0.06 to 1.29 mg x kg(-1) x h(-1). The median time until the maximal midazolam infusion rate was 2.5 hours (range, 0.00 to 8.50 hours). The median duration of infusion was 9. 50 hours (range, 4.25 to 20.50 hours). The median length of stay in the ICU was 15.17 hours (range, 6.0 to 28.0 hours), and 85% of patients were discharged directly home. All patients had resolution of abnormal motor activity and agitation during their midazolam infusion. Transient hypoxemia without evidence of end-organ dysfunction was documented in 4 patients during midazolam therapy. CONCLUSION: A continuous intravenous midazolam infusion can be a safe, effective, and readily available treatment option for patients with grade III or IV C exilicauda envenomation.

Adolescent↗
PubMed1999

Emergency medical service agency definitions of response intervals.

STUDY OBJECTIVE: There is a time continuum from emergency medical services (EMS) dispatch, response, scene, transport, and arrival at the hospital. Previous research has documented favorable patient outcome with short response intervals; however, these studies revealed the documentation of EMS time intervals is not always consistent. This study evaluates how agencies estimate these times and factors that may affect the length of response intervals. METHODS: The study used a mail questionnaire to assess factors related to response intervals and to determine how agencies define and record response intervals. All ground-based EMS agencies in a southwestern state were invited to participate in the survey. Univariate and stratified data analyses compared definitions of response intervals. RESULTS: Agencies varied as to how they defined the start and end of the response. Fifty-six percent stated that their response started when the responding unit was notified of the call. However, almost 23% defined response interval as starting when dispatch received the call, and 11% defined it as starting with the initial 911 call. A factor that affected response intervals was routing of the 911 call. Less than 6% of agencies had only 1-call routing. CONCLUSION: Agencies use different time points as the start and end of their response interval, which makes comparison of results directly related to response intervals across agencies or regions difficult. To maintain an appropriate standard of prehospital emergency medical care throughout the state, the use of consistent standard terminology defining response intervals will help reach that goal.

Emergency Medical Services↗
PubMed1999

Fatal injury: characteristics and prevention of deaths at the scene.

BACKGROUND: Almost half of all trauma deaths occur at the scene. It is important to determine if these deaths can be prevented. METHODS: Penetrating or blunt force trauma deaths were identified through the Office of the Medical Examiner during a 2-year period. Data were also obtained through review of these records. RESULTS: There were 312 deaths at the scene that received no medical care. Almost 60% were firearm-related. About 80% of the victims were men, and 55% of these deaths occurred in people between 20 and 49 years old. Suicide accounted for nearly half of these deaths. Eighty percent of these injured people had Abbreviated Injury Scale scores of 5 or 6. CONCLUSION: Almost 60% of deaths at the scene occurred at the same time as injury and reflect severe injury to vital regions of the body. These findings suggest that primary prevention of the initial event causing injury may be more important than definitive prehospital emergency medical care to prevent these deaths.

Adult↗
PubMed1997

Fatal trauma: the modal distribution of time to death is a function of patient demographics and regional resources.

BACKGROUND: Unlike previous studies in an urban environment, this study examines traumatic death in a geographically diverse county in the southwestern United States. METHODS: All deaths from blunt and penetrating trauma between November 15, 1991, and November 14, 1993, were included. As many as 150 variables were collected on each patient, including time of injury and time of death. Initial identification of cases was through manual review of death records. Information was supplemented by review of hospital records, case reports, and prehospital encounter forms. RESULTS: A total of 710 traumatic deaths were analyzed. Approximately half of the victims, 52%, were pronounced dead at the scene. Of the 48% who were hospitalized, the most frequent mechanism of injury was a fall. Neurologic dysfunction was the most common cause of death. Two distinct peaks of time were found on analysis: 23% of patients died within the first 60 minutes, and 35% of patients died at 24 to 48 hours after injury. CONCLUSIONS: Although there appears to continue to be a trimodal distribution of trauma deaths in urban environments, we found the distribution to be bimodal in an environment with a higher ratio of blunt to penetrating trauma.

Adult↗
PubMed1995

Low level laser therapy: a prospective double blind trial of its use in an orthopaedic population.

We have conducted a prospective, double blind trial of low level laser therapy (LLLT) in musculoskeletal injuries to assess its efficacy. We assigned patients with a variety of painful skeletal soft tissue conditions to one of two treatment groups, treatment from a functional machine, placebo treatment from an inactive machine. Both machines were identical and both appeared functional. The operative status of each machine was unknown to both the therapist and the patient. The results suggest that LLLT has no significant therapeutic effect and acts primarily as a placebo.

Adult↗
PubMed1993

Criteria for gestational diabetes: a cautionary tale.

The diagnosis of gestational diabetes was developed to predict neonatal outcome (particularly perinatal mortality, macrosomia and hypoglycaemia) and future maternal diabetes. A variety of criteria for this diagnosis have evolved over time, assessed predominantly among European women. We describe a Pacific Islands woman with multiple risk factors for future diabetes yet a borderline 100 g glucose tolerance test result, who delivered a stillborn macrosomic baby weighing 6.7 kg at 38 weeks' gestation. Six weeks postpartum, diabetes was diagnosed by 75 g oral glucose tolerance test. This case highlights the need for caution when interpreting the glucose tolerance test in pregnancy and suggests that closer fetal monitoring and involvement of the diabetes team may be necessary among women with a borderline glucose tolerance test in the presence of additional risk factors for future diabetes (eg obesity, ethnic group).

Adult↗