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Biomedical subjects

Charles W Callahan

Publications and source records attributed to Charles W Callahan.

10 recordsLinked to original sources
PubMed2006

Concurrent use of metered-dose and dry powder inhalers by children with persistent asthma does not adversely affect spacer/inhaler technique.

BACKGROUND: Studies conducted in adults have suggested that patients who use a metered-dose inhaler/holding chamber spacer (MDI/S) and dry powder inhaler (DPI) concurrently will have poorer MDI/S technique than that of patients who use MDI/S exclusively. To our knowledge, as of August 31, 2006, no studies have been performed in pediatric patients. OBJECTIVE: To compare MDI/S technique scores of children using only MDI/S with scores of those using both MDI/S and DPIs. METHODS: The MDI/S technique of children aged 6-17 years, with persistent asthma, recruited from a general pediatric practice population for an asthma intervention study project was scored using a standardized checklist. MDI/S scores of children who were being treated with maintenance and rescue medication delivered only by MDI/S were compared with those treated with both MDI/S (rescue) and DPI (maintenance). Scores lower than 70% were considered to be inadequate. RESULTS: A total of 117 patients (73 male, 44 female), aged 9.70 +/- 3.1 years (mean +/- SD), with persistent asthma, participated in the study. There were 83 children (54 male, 29 female, age 9.4 +/- 3.2 y) in the MDI/S only group and 34 (19 male, 15 female, age 10.3 +/- 2.9 y) in the MDI/S + DPI group. In the MDI/S + DPI group, Diskus was the DPI used for 32 patients, and Turbuhaler was used by 2 children. Sixteen patients had severe persistent asthma, 80 had moderate persistent asthma, and 21 had mild persistent asthma as classified by National Heart Lung and Blood Institute guidelines. No difference in sex and age demographics existed; however, there was a difference in the distribution of asthma severity between groups (ie, no patients with mild persistent asthma in the MDI/S + DPI group; p < or = 0.01). Mean score for the MDI/S only group was 86 +/- 17% and, for the MDI/S + DPI group, 90.1 +/- 12% (p = 0.15). More patients in the MDI/S group had inadequate scores (18%) compared with those in the MDI/S + DPI group (3%; p < 0.05). CONCLUSIONS: While DPI and MDI/S techniques are markedly different in several significant ways, concurrent use of these inhalers did not adversely affect MDI/S technique scores of pediatric patients with persistent asthma, compared with those using MDI/S alone. Patients in the MDI/S only group had an inadequate MDI/S score (<70%) more often than did patients in the MDI/S + DPI group.

Administration, Inhalation↗
PubMed2005

Effectiveness of an Internet-based store-and-forward telemedicine system for pediatric subspecialty consultation.

BACKGROUND: Pediatric subspecialists are often separated from the children who need them by distance, time, or socioeconomic factors. The Electronic Children's Hospital of the Pacific is an Internet-based store-and-forward pediatric consultation system established to overcome these barriers. OBJECTIVE: To characterize the use of the Electronic Children's Hospital of the Pacific and its impact on access to specialty care, the quality of the care provided, and cost savings. DESIGN: Prospective trial. SETTING: Twenty-two military treatment facilities in the Pacific. PARTICIPANTS: Primary care providers, pediatric consultants, and 5 reviewers. MAIN OUTCOME MEASURES: Consult response time, physician panel review, and evacuation cost avoidance. RESULTS: There were 267 cases from 16 sites. The mean +/- SD response time by a consultant was 32 +/- 8 hours. The panel review deemed that the initial diagnosis was changed or modified in 15% (39/267) of the cases, the diagnostic plan was changed or modified in 21% (57/267), and the treatment plan was changed or modified in 24% (64/267) (P < .01 for all). Routine air evacuations to a tertiary care medical center were avoided in 32 cases (12%), with an estimated cost savings of $185 408. CONCLUSIONS: The Electronic Children's Hospital of the Pacific improved the quality of patient care by providing expeditious specialty consultation. Significant cost avoidance in this military pediatric population was documented. Store-and-forward Internet-based teleconsultation is an effective means of providing pediatric subspecialty consultation to a population of underserved children.

Adolescent↗
PubMed2004

Caring for children with asthma through teleconsultation: "ECHO-Pac, The Electronic Children's Hospital of the Pacific".

A Web-based store-and-forward teleconsultation asthma management system was implemented to provide subspecialty asthma care to military children with asthma living in the Western Pacific. Seven children with moderate to severe asthma (mean age 11.9 +/- 3.7 years) were followed for 1 year by their primary care provider (PCM) using a Web-based asthma pathway, with regular pediatric pulmonary teleconsults to Tripler Army Medical Center. Therapeutic monitoring included MPEG video recording of patient using metered-dose inhaler (MDI) technique submitted to the pulmonologist at specified intervals. Utilization of services for unscheduled asthma-related visits was monitored. PCMs were surveyed regarding their asthma practice before and after the intervention. Data were analyzed using Student's t test for continuous variables and Wilcoxon signed-rank or chi-square for noncontinuous variables. Therapeutic adherence was evidenced by improved inhaler technique in all patients. There were fewer ED visits for asthma (3.85 +/- 5.14, range 0-15 vs. 0 visits, p < 0.05) and fewer unscheduled acute clinic visits (1.57 +/- 1.27, range 0-4 vs. 0.286 +/- 0.48, p < 0.05) in the study year versus the preceding year. There were two hospitalizations in the year prior to the study; however, no patients were hospitalized during the study PCM use of an asthma action plan increased from 24% to 73% (p < 0.01) and provision of asthma education increased from 18% to 73%, (p < 0.01). However, PCMs reported that they were not more likely to watch their patient's MDI technique themselves (29% vs. 45%) nor order or interpret spirometry on their patients (12 vs. 18%). In this project, children with asthma followed by teleconsultation had improved outcomes. Store-and-forward teleconsultation can be used to follow children with chronic disease such as asthma over time.

Academic Medical Centers↗
PubMed2003

An Internet-based store-and-forward video home telehealth system for improving asthma outcomes in children.

The adherence and disease-control outcomes associated with the use of an Internet-based store-and-forward video home telehealth system to manage asthma in children were studied. Pediatric patients with persistent asthma were provided with home computers and Internet access and monitored biweekly over the Internet. All patients were seen in the pediatric clinic at 0, 2, 6, 12, and 24 weeks. Half of the patients received asthma education in person and half via an interactive Web site. Adherence measures were assessed by therapeutic and diagnostic monitoring. Therapeutic monitoring included digital videos of patients using their controller medication inhaler. Diagnostic monitoring included an asthma symptom diary and a video of peak flow meter use. Videos were submitted electronically twice a week by using in-home telemonitoring with store-and-forward technology. Feedback was provided electronically to each patient. Disease control was assessed by examining quality of life, utilization of services, rescue-therapy use, symptom control, satisfaction with home telemonitoring, and retention of asthma knowledge. Patients were randomly assigned to an asthma education group (Internet versus office), and the data were analyzed by comparing results for study days 0-90 and 91-180. Ten children participated. A total of 321 videos of inhaler use and 309 videos of peak flow meter use were submitted. Inhaler technique scores improved significantly in the second study period. Submission of diagnostic monitoring videos and asthma diary entries decreased significantly. Peak flow values as a percentage of personal best values increased significantly. Overall, there was no change in quality of life reported by patients. However, the caregivers in the virtual-education group reported an increase in the patients' quality-of-life survey scores. Emergency department visits and hospital admissions for asthma were avoided. Rescue therapy was infrequent. A high rate of satisfaction with home telemonitoring was reported. Internet-based, store-and-forward video assessment of children's use of asthma medications and monitoring tools in their homes appeared effective and well accepted.

Adolescent↗
PubMed2002

Bronchiectasis in children: orphan disease or persistent problem?

More than a decade ago, bronchiectasis unrelated to cystic fibrosis was termed an "orphan disease", because it had become an uncommon clinical entity among children in the developed world. Bronchiectasis is more common among children in lower socioeconomic classes and in developing countries, presumably due to more frequent and recurrent respiratory infections, environmental airway irritants, poor immunization rates, and malnutrition. Reports from the Southern Pacific and from Alaska Native children reveal persistently high rates of childhood bronchiectasis. Better epidemiologic data throughout the world are needed to reassess the importance of this condition. The pathophysiology includes airway inflammation, mucus production, and regional airway obstruction, yet the reasons why some children develop bronchiectasis while other do not is unclear. The coexistence of asthma with bronchiectasis is associated with more severe disease, yet the impact of asthma therapy in children with both disorders has not been studied. Similarly, the pattern of antibiotic use for children with bronchiectasis varies by region with little data to justify one particular approach. It may be that public health measures aimed at improving living conditions for children and prevention of respiratory infections with antiviral vaccines will have more impact on childhood bronchiectasis than medical treatments in the future.

Bronchiectasis↗
PubMed2002

Report of the first annual Hawaii Asthma Research Consortium.

The first Hawaii Asthma Research Consortium was held on 7 May 2001 at Tripler Army Medical Center. Researchers investigating asthma-related problems and program directors of asthma projects were solicited statewide to present their projects. Ten lecturers focused on research and asthma projects in Hawaii in 20-minute presentations. An informal ten-minute discussion followed each presentation to encourage audience questions about the project and to discuss possible collaboration efforts between institutions. The institutions that were represented include: American Lung Association-Hawaii, Kaiser Permanente Center for Health Research Hawaii, Kapiolani Medical Center, Tripler Army Medical Center, University of Hawaii at Manoa, and Waianae Coast Comprehensive Health Center.

Asthma↗
PubMedDate not supplied

Increased diagnosis of asthma in hospitalized infants: the next target population for care management?

Hospitalization of children with asthma declined at our institution between 1996 and 2000, before stabilizing for the past 5 years. The ages of children hospitalized since 2000 were examined to see if the demographics of the hospitalized population have changed to better understand why the hospitalization rate has remained the same despite continued, aggressive screening and education efforts. Data were gathered for our hospital through the Department of Defense Medical Health System Management Analysis and Reporting System (M2). The mean age (+/- SD) of children hospitalized in 2003 (2.84 +/- 2.53) was less than the mean age for 2000 and 2002 (4.85 +/- 3.7 and 4.61 +/- 4.45), respectively (p < 0.05), and more infants less than 2 years of age were hospitalized in 2003 (33/60, 55% p < 0.01) and 2004 (32/68, 47% p < 0.05) than in 2000 (19/70, 27%). The diagnosis of asthma in hospitalized infants and young children has increased over the past 5 years, suggesting better recognition and providing a new target population for intervention with early asthma controller therapy.

Age Factors↗