PubMed Health⌕ Search

Biomedical subjects

E N Pattishall

Publications and source records attributed to E N Pattishall.

10 recordsLinked to original sources
PubMed1992

Passive smoking and middle ear effusion among children in day care.

One hundred thirty-two children who attended a research day-care center were studied to determine whether passive tobacco smoke exposure was associated with an increased rate of otitis media with effusion or with an increased number of days with otitis media with effusion during the first 3 years of life. Based on preliminary studies, a serum cotinine concentration of greater than or equal to 2.5 ng/mL was considered indicative of exposure to tobacco smoke. Otitis media with effusion was diagnosed using pneumatic otoscopy by nurse practitioners and pediatricians who reviewed the children's health status each weekday. The 87 children with serum cotinine concentrations greater than or equal to 2.5 ng/mL had a 38% higher rate of new episodes of otitis media with effusion during the first 3 years of life than the 45 children with lower or undetectable serum cotinine concentrations (incidence density ratio = 1.38, 95% confidence interval 1.21 to 1.56). The average duration of an episode of otitis media with effusion was 28 days in the children with elevated cotinine concentrations and 19 days in the children with lower cotinine concentrations (P less than .01). It is estimated that 8% of the cases of otitis media with effusion in this population and 17.6% of the days with otitis media with effusion may be attributable to exposure to tobacco smoke.

Age Factors↗
PubMed1990

Longitudinal response of pulmonary function to bronchodilators in cystic fibrosis.

Previous studies have found that between 0 and 95% of patients with cystic fibrosis (CF) have a significant response to bronchodilators. These studies have been limited by small numbers and the measurement of response at one point in time. We analyzed the response to bronchodilators of patients with CF in a longitudinal and cross-sectional manner using pulmonary function data from 1980 to 1988. Overall, the proportion of patients with a positive response to bronchodilators was relatively large but not consistent over time. Of 573 tests in 127 persons, a positive response occurred in 68 tests of 51 patients. A negative response occurred in 19 tests of 17 patients. Only nine patients had a positive response in more than one third of their tests. The cross-sectional analysis showed variability similar to previous cross-sectional studies. Although a large proportion of patients with CF had a response to bronchodilators, the response was not consistent and may have been related to the number of tests performed. Continued longitudinal testing is necessary for valid decisions for bronchodilator use and for documenting the length, variability, and clinical significance of these responses.

Aerosols↗
PubMed1990

Quality of well-being before and after antibiotic treatment of pulmonary exacerbation in patients with cystic fibrosis.

General quality of life has only recently been measured with an objective tool in patients with cystic fibrosis (CF), and there have been no reported attempts to document changes in patients' overall well-being over time, as patients deteriorate or respond to intervention. We applied the Quality of Well-Being scale (QWB) in 28 patients with CF before and after a two-week course of oral ciprofloxacin used to treat pulmonary exacerbations. There were significant correlations between changes in QWB and various pulmonary function test results; QWB vs FEV1: r = 0.4, p less than 0.03; QWB vs FVC: r = 0.5, p less than 0.01; and QWB vs SaO2: r = 0.4, p less than 0.05. Thus, the QWB can track changes in general well-being in CF patients over a brief time and detect changes associated with pulmonary exacerbation and its treatment.

Attitude to Health↗
PubMed1990

Pulmonary function testing reference values and interpretations in pediatric training programs.

A questionnaire was sent to all pediatric training programs to evaluate the use of pulmonary function reference standards and the interpretation of pulmonary function test results. Responses were obtained from 107 of 130 institutions, and 94 of these had pulmonary function laboratories available. Of the 94, 60 used one of three reference standards. The primary reason the reference standards were chosen was either unknown or because they came with the spirometer (24), were recommended by another person or were those used in that person's training (34), or were thought to be the best standards available or most applicable to the population to be tested (31). To define abnormality, most used an 80% predicted cutoff for forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow at 25% to 75% vital capacity. For a change in an individual through time, most used a 10% change for forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow at 25% to 75% vital capacity. Thirteen used statistical methods to define abnormal individuals and none used statistical methods to define a significant change over time. Although there are a few guidelines for reference standards and interpretations of pulmonary function tests, it appears that most laboratories are not using those guidelines and that further guidelines and education are needed.

Adolescent↗
PubMed1990

Negative clinical trials in cystic fibrosis research.

The statistical power of 61 negative clinical trials of therapeutic regimens in patients with cystic fibrosis published from 1977 through 1988 was reviewed and the ability of the investigations to detect small, medium, and large standardized differences was calculated. Small, medium, and large standardized differences were defined as ratios of 0.2, 0.5, and 0.8, respectively, of the observed difference compared with the standard deviation. The average numbers (+/- SD) of patients in the treatment and control groups were 14.3 +/- 6.9 and 14.5 +/- 7.9, respectively. None of the studies had 80% power to detect a small or medium standardized difference and only 4 of the reports had 80% statistical power to detect a large standardized difference. The variability of cystic fibrosis causes a decrease in the standardized difference, making it more difficult to demonstrate statistical significance. Statistical power of negative clinical trials reported in the literature deserves more attention from investigators as well as physicians who treat patients with cystic fibrosis.

Clinical Trials as Topic↗
PubMed1989

Noncomparability of cross-sectional and longitudinal estimates of lung growth in children.

Results from longitudinal and cross-sectional studies of pulmonary function are often compared. However, previous studies in adults suggest that results from longitudinal and cross-sectional studies are different and may not be comparable. In order to evaluate these differences further, prospectively collected data in a group of children were analyzed by both longitudinal and cross-sectional methods. Spirometry was performed longitudinally over a period of 8 years on 58 healthy children. Straight-line regressions of expiratory flow-volume parameters on height were computed by averaging the individual regression lines for each child. A cross-sectional sample from these same children was analyzed and compared to the longitudinal analysis. For all expiratory flow-volume parameters, the cross-sectional analysis resulted in a significantly greater increase in growth with increasing height than the longitudinal analysis (P less than 0.005 for slope for all parameters except PEFR, P less than 0.05 and Vmax75, P less than 0.01). These differences cannot be explained by learning or horse-racing effects, loss to follow-up, or regression to the mean; however, they could be explained by cohort changes, time trends of pulmonary function, differences in the weighted averages used in the two analyses, or incorrect modeling. These observations indicate that comparisons between cross-sectional and longitudinal investigations must be made cautiously. These data do not support many of the reasons suggested for the differences in previous reports. It is recommended that studies of pulmonary function use a control group and investigate the groups at the same time and in the same manner.

Body Height↗
PubMed1988

Use of bronchoalveolar lavage in immunocompromised children with pneumonia.

Because pneumonia in the immunocompromised host presents a diagnostic dilemma to the pediatrician, we prospectively studied the use of bronchoalveolar lavage (BAL) with flexible fiberoptic bronchoscopy in 14 immunocompromised children with pneumonia over a 5-month period. The children received immunosuppressive agents because of organ transplants, cancer, or systemic lupus erythematosus. A diagnosis was made by BAL in 10 (71%) of the 14 children. Pathogenic organisms included Pneumocystis carinii in six, cytomegalovirus (CMV) in two, Aspergillus fumigatus in one, and a mixed infection of Candida albicans and CMV in one. There were no complications. Because BAL by flexible fiber-optic bronchoscopy is a rapid and safe procedure and a diagnosis can be made in a majority of cases, we recommend its use in immunocompromised children with pneumonia before resorting to lung biopsy.

Adolescent↗
PubMed1986

Pulmonary function in children with sarcoidosis.

To document pulmonary function abnormalities in children with sarcoidosis, we reviewed the records of all children with this disease at the North Carolina Memorial Hospital. Spirometry was performed by 34 of 60 children at initial presentation and was repeated by 16 at least 1 yr after presentation (mean, 3.9 yr). Those with and without pulmonary function data available were similar in age, sex, race, and clinical manifestations at presentation. Results indicate that at presentation, 50% of children had the characteristic functional changes of restrictive lung disease (mean % predicted FVC, 79.8 +/- 16.0). Fifteen percent had a FVC of 70 to 80% predicted, 32% had a FVC of 50 to 70% predicted, and 3% had a FVC less than 50% predicted. The TLC and FRC supported the diagnosis of restrictive lung disease. There were 15% who had obstructive changes. Children with auscultatory abnormalities and parenchymal changes on chest radiograph had more severe decrements in pulmonary function; however, specific symptoms did not predict decrements in pulmonary function. There was significant improvement in lung function at the last pulmonary function test performed (mean % predicted FVC, 97.1 +/- 18.8).

Adolescent↗
PubMed1985

Serum cotinine as a measure of tobacco smoke exposure in children.

To document passive smoke exposure, we measured concentrations of serum cotinine, a major metabolite of nicotine, in 38 young children and compared the results with the smoking histories of home residents. Cotinine was detected in 26 children (68%), of which ten had no household exposure according to a questionnaire. The serum cotinine concentration was significantly elevated in blacks compared with whites after controlling for the number of smokers in the home. After stratifying by race, there was a significant direct correlation between the serum cotinine concentration and the number of smokers in the home, the amount smoked by the mother, and the amount smoked by others in the home. We conclude that the serum cotinine concentration is a useful indicator of the actual exposure of young children to tobacco smoke and that unexplained racial differences in cotinine levels exist.

Black or African American↗