Biomedical subjects

Constance D Baldwin

Publications and source records attributed to Constance D Baldwin.

6 recordsLinked to original sources

PubMed2003

Middle ear fluid histamine and leukotriene B4 in acute otitis media: effect of antihistamine or corticosteroid treatment.

OBJECTIVE: Two potent mediators of acute inflammation, histamine and leukotriene B4 (LTB4), have been shown to play important roles in the pathogenesis and clinical course of acute otitis media (AOM) in children. The purpose of this study was to evaluate the ability of adjuvant drugs, antihistamine and corticosteroid, in reduction of the levels of histamine and LTB4 in the middle ear and their ability to improve outcomes of AOM. METHODS: Eighty children with AOM (aged 3 months to 6 years) were enrolled in a prospective, randomized, double-blind, placebo controlled study. All children received one dose of intramuscular ceftriaxone and were randomly assigned to receive either chlorpheniramine maleate (0.35 mg/kg per day) and/or prednisolone (2 mg/kg per day) or placebos three times a day for 5 days. Tympanocentesis was performed at enrollment and after 5 days of adjuvant drug treatment. MEFs were collected for bacterial and viral studies and histamine and LTB4 levels. The subjects were followed for the duration of middle ear effusion or up to 3 months. RESULTS: Histamine or LTB4 levels in the MEF after 5 days of treatment were not significantly reduced by adjuvant drug treatment. However, subjects receiving corticosteroid had a lower rate of treatment failure during the first 2 weeks and shorter duration of middle ear effusion. CONCLUSIONS: Five day of antihistamine or corticosteroid treatment does not reduce the levels of histamine or leukotriene B4 in the MEF of children with AOM. Positive clinical outcomes of AOM cases associated with corticosteroid treatment needs to be confirmed in a larger clinical trial of children with intact tympanic membranes, who do not receive tympanocentesis.

Acute Disease↗

PubMed2003

A randomized, placebo-controlled trial of the effect of antihistamine or corticosteroid treatment in acute otitis media.

OBJECTIVES: To determine whether the adjunctive drugs antihistamine and corticosteroid improve immediate and long-term outcomes of acute otitis media (AOM). STUDY DESIGN: Children with AOM (3 mos-6 y) were enrolled in a randomized, double-blind, placebo-controlled trial. All 179 children received one dose of intramuscular ceftriaxone and were assigned to receive either chlorpheniramine maleate (0.35 mg/kg/d) and/or prednisolone (2 mg/kg/day) or placebo for 5 days. Main outcome measures were rate of treatment failure during the first 2 weeks, duration of middle ear effusion, and rate of recurrences of AOM to 6 months. RESULTS: Clinical outcomes and recurrence rates did not differ significantly with treatment. Children who received antihistamine alone had significantly longer duration of middle ear effusion (median, 73 days) than subjects in other treatment groups (median, 23 to 36 days, P=.04). Temporary normalization of tympanometric findings on day 5 occurred more frequently in the corticosteroid-treated group (P=.04). CONCLUSIONS: Five-day treatment with antihistamine or corticosteroid, in addition to antibiotic, did not improve AOM outcomes. Antihistamine use during an acute episode of OM should be avoided, since the drug may prolong the duration of middle ear effusion. The efficacy of 7- to 10-day treatment of AOM with corticosteroid, in addition to antibiotic, deserves further investigation.

Acute Disease↗

PubMed2003

Integrating Web-based computer cases into a required clerkship: development and evaluation.

PURPOSE: To evaluate a five-year experience (1995-2000) developing and integrating computer cases into a required clerkship. METHOD: In Study 1, 54 volunteer students were randomly assigned to study articles, a paper case, or a computer case on low back pain/kidney stones. Students were given an exam immediately after the exercise and one week later. In Study 2, 325 clerkship students were asked to select and complete two computer cases or to prepare assignments on unrelated topics. Among the cases offered were two test cases on low back pain/kidney stones and pneumonia. Questions specific to the computer test cases (CC) and other noncomputer cases (NCC) were in the final exam. Exam scores related to CC questions and NCC questions were compared between the groups of students who did and did not complete the computer cases. Students also rated the computer cases on a questionnaire. RESULTS: In Study 1, reading articles required the most time and received the most negative comments. The students who completed the computer case scored the best on the exam one week later. In Study 2, the students who completed the two computer cases scored significantly higher on the CC questions than did students who studied only one or none of the computer cases (p <.001). There was no difference among groups for the NCC scores (p =.76). Students rated the computer cases with a mean of 6 on a seven-point scale (7 = strongly agree). CONCLUSION: Computer cases are effective learning tools, are well-received by students, and can be successfully integrated into existing clerkships.

Clinical Clerkship↗

PubMed2003

Bullous myringitis: a case-control study.

Prior studies have shown that bullous myringitis (BM) accounts for <10% of acute otitis media (AOM) cases, and that the distribution of viral and bacterial pathogens in BM is similar to that in AOM without BM, except for a relative increase in the proportion of Streptococcus pneumoniae in BM. We studied 518 cases of AOM in children aged 6 months to 12 years. Using tele-otoscopy to assist the diagnosis, we identified 41 cases (7.9%) with BM. Children who had AOM with BM were older than AOM patients without BM (median age: 4.3 years vs 18 months). We compared 41 cases of AOM with BM to 41 control cases of age-, race-, and gender-matched AOM patients without BM. When compared with this matched control group, children with BM had more severe symptoms at the time of diagnosis and were more likely to have bulging of the tympanic membrane in the quadrants that were not obscured by the bulla. Children with AOM and BM may require aggressive pain management. Although parents and clinicians may agree that a watchful waiting approach is appropriate for older children with mild AOM, children experiencing painful AOM with BM may not be successful candidates for a watchful-waiting approach, because parents may resist postponement of antibiotic therapy in children who are more symptomatic.

Acute Disease↗

PubMed2003

Significance of violence in stories of young children.

Stories told by 72 5-yr.-old children were scored for themes of violence and correlated with their mothers' reports of aggressive or fearful behaviors. Values for the entire sample were not significant. However, when data for Hispanic children were removed from the sample the correlation of violent stories to ratings of children's aggression was significant (r = .27) and for a count of violent words r = .30. The correlation of violent words to fearfulness was .28 and for girls only .35. The count of violent words was also correlated with African-American children's ratings of fearfulness (r = .64).

Books↗

PubMedDate not supplied

Meeting the computer technology needs of community faculty: building new models for faculty development.

OBJECTIVE: We aimed to identify the evolving computer technology needs and interests of community faculty in order to design an effective faculty development program focused on computer skills: the Teaching and Learning Through Educational Technology (TeLeTET) program. METHODOLOGY: Repeated surveys were conducted between 1994 and 2002 to assess computer resources and needs in a pool of over 800 primary care physician-educators in community practice in East Texas. Based on the results, we developed and evaluated several models to teach community preceptors about computer technologies that are useful for education. RESULTS: Before 1998, only half of our community faculty identified a strong interest in developing their technology skills. As the revolution in telecommunications advanced, however, preceptors' needs and interests changed, and the use of this technology to support community-based teaching became feasible. In 1998 and 1999, resource surveys showed that many of our community teaching sites had computers and Internet access. By 2001, the desire for teletechnology skills development was strong in a nucleus of community faculty, although lack of infrastructure, time, and skills were identified barriers. The TeLeTET project developed several innovative models for technology workshops and conferences, supplemented by online resources, that were well attended and positively evaluated by 181 community faculty over a 3-year period. CONCLUSIONS: We have identified the evolving needs of community faculty through iterative needs assessments, developed a flexible faculty development curriculum, and used open-ended, formative evaluation techniques to keep the TeLeTET program responsive to a rapidly changing environment for community-based education in computer technology.

Community Health Services↗