PubMed Health⌕ Search

Biomedical subjects

M D Baker

Publications and source records attributed to M D Baker.

At least 19 recordsLinked to original sources
PubMed1992

Lacerations involving glass. The role of routine roentgenograms.

OBJECTIVE: To determine, when evaluating a laceration caused by glass, whether seeing that the bottom of the wound is free of glass eliminates the possibility that glass is present in the wound. RESEARCH DESIGN: Prospective patient series. SETTING: Two pediatric emergency departments. PARTICIPANTS: 226 children with lacerations due to glass occurring in a period of 21 months. SELECTION PROCEDURES: Consecutive sample. INTERVENTIONS: Before obtaining a roentgenogram, the triage nurse or the managing physician visually inspected each wound and recorded whether the bottom of the wound was seen, if glass was seen in the wound, and the length and depth of the wound. Further treatment of the wound was at the discretion of the managing physician. MEASUREMENTS/MAIN RESULTS: Glass was seen in the wounds of 10 children on initial inspection. Of the remaining 216 injuries, glass was contained in 12 (21.4%) of the 56 lacerations when the bottom of the wound was not visualized, and in 11 (6.9%) of the 160 lacerations when the bottom of the wound was visualized. There was a significant association between the depth of the wound and an inability to see the bottom of the wound, and deeper wounds were significantly more likely to contain glass. All but one of the lacerations containing glass had a depth of at least 0.5 cm. CONCLUSIONS: In the population studied, seeing that the bottom of the laceration was free of glass reduced, but did not eliminate, the possibility that glass was present in the wound. In addition, superficial lacerations (less than 0.5 cm) rarely contained undetected glass fragments. We recommended that further investigation concerning the mechanism of injury, the depth of the wound, and the type of glass involved is needed before physicians abandon routine roentgenography for lacerations due to glass.

Child↗
PubMed1992

Infections in severely traumatized children.

To study the incidence and types of infection among severely traumatized children, we reviewed the medical charts of 212 children, hospitalized following traumatic injury, who received antibiotics at sometime during their hospitalization. Infection occurred in 19%. Eleven children had trauma-related infections, whereas 29 (71% of those infected) had 36 nosocomial infections. Tracheitis, sepsis, and urinary tract infections were the most common nosocomial infections and were diagnosed in the second week (10 +/- 3 days) following injury. Nosocomial infections were more likely to develop in children who were more severely injured and who had a greater number of invasive procedures. Severe head injury (cerebral edema or subarachnoid hemorrhage) was more common in those with nosocomial infection (P < .0002, odds ratio 6.8, 95% confidence interval 2.2 to 21.3). Those without these injuries were much less likely to develop nosocomial infections (specificity 97% and negative predictive value 86%). Finally, the development of any nosocomial infection prolonged the hospitalization by a mean of 16 +/- 6 days when comparing children with the same degree of traumatic injury. Prevention of nosocomial infection in children with severe trauma will significantly reduce length of hospitalization.

Accidents, Traffic↗
PubMed1992

Ectopic recombination within homologous immunoglobulin mu gene constant regions in a mouse hybridoma cell line.

We have transferred a pSV2neo vector containing the wild-type constant region of the immunoglobulin mu gene (C mu) into the mutant hybridoma igm482, which bears a 2-bp deletion in the third constant-region exon of its haploid chromosomal mu gene (C mu 3). Independent igm482 transformants contain the wild-type immunoglobulin C mu region stably integrated in ectopic chromosomal positions. We report here that the wild-type immunoglobulin C mu region can function as the donor sequence in a gene conversion event which corrects the 2-bp deletion in the mutant igm482 chromosomal C mu 3 exon. The homologous recombination event restores normal immunoglobulin M production in the mutant cell.

Animals↗
PubMed1991

Documentation in the pediatric emergency department: a review of resuscitation cases.

STUDY OBJECTIVE: Documentation practices of staff physicians, residents, and nurses managing critically ill children were reviewed for completion of standard documentation requirements. DESIGN: Retrospective chart review. SETTING: Municipal children's hospital. PARTICIPANTS: 144 patients treated in the cardiopulmonary/trauma resuscitation room over a 17-month period. INTERVENTION: Emergency department records of these patients were reviewed for medical information required by Joint Commission on Accreditation of Healthcare Organizations guidelines: history of present illness, medical history, vital signs, physical examination, laboratory results, clinical observations, and diagnostic impression. In addition, the frequency of medical record review by legal representatives of the patient and by the state's social service agencies was evaluated. RESULTS: Attending physicians demonstrated more complete documentation than residents in clinical observations of patients (36.4% vs 18.0%, P less than .005) and diagnostic impression (97% vs. 78.4%, P less than .03). Nurses demonstrated more complete documentation than physicians, as a group, in laboratory results (83.9% vs 47.6%, P less than .001) and clinical observations (80.6% vs 22.2%, P less than .001). Sixty-six medical records (37.9%) were subjected to legal review: 37 (21.3%) by patients' legal representatives, and 29 (16.7%) by the state's social service agency. CONCLUSION: ED record documentation of pediatric patients treated in a cardiopulmonary/trauma resuscitation room often does not meet standard guidelines. Complete documentation is important due to the frequency of legal review of these records and the need to ensure post-ED continuity of care.

Documentation↗
PubMed1991

The role of footwear in childhood injuries.

To assess the influence of footwear on injury, we prospectively studied all injured children presenting to the Emergency Department of The Children's Hospital of Philadelphia during February, May, July, and October 1988. Information was collected concerning the type and characteristics of footwear worn and environmental factors. Comparisons were made between those involving and those not involving loss of footing (LOF) during injury. Of the 3015 children studied, LOF occurred in 1075 (35.8%). Overall, significantly more injuries involved LOF in children whose feet were covered (n = 946, 37.0%) than in those who were barefoot (n = 129, 29.1%) at the time of injury (P less than 0.001). However, children wearing low-top sneakers had the lowest rate of LOF (24.0%) of any group. Children wearing rough-sole footwear had LOF significantly less frequently (24.2%) than those wearing smooth-sole footwear (51.8%; P less than 0.001). Rubber-sole footwear was less frequently associated with LOF (n = 488, 28.6%) than were other sole materials (n = 457, 53.8%; P less than 0.001). Our data suggest a potential injury prevention strategy involving utilization of rough-sole footwear.

Accidental Falls↗
PubMed1991

Pediatric emergency transport and the private practitioner.

A mail survey of 182 pediatricians and 92 family practitioners in Pennsylvania was conducted to determine their methods of transport of seriously ill children from their offices to referral centers and their involvement with professional transport services. Although most physicians (93.1%) stated that they had professional services available to them (at their office location), more than half (53.8%) indicated that the patient's family automobile was their most commonly used method of transport of ill children to tertiary care centers. This was true regardless of the disease entity involved, including suspected epiglottitis. Practice setting had little influence on transport method. However, in general, younger children were judged to need ambulance transport more often than older children. Reasons cited for not using professional transport from the office included a perceived better efficiency of the family car (61.8%), the prohibitively high expense of professional transport (9.8%), and failure to consider professional transport (6.5%). Further study of this component of office preparedness is suggested.

Child↗
PubMed1991

Police involvement in pediatric prehospital care.

One hundred fourteen emergency medical services agencies and 76 police chiefs throughout the United States were prospectively surveyed to ascertain the current utilization of police personnel within the prehospital care system. More than three fourths (77%) of the surveys mailed were completed. Respondents indicated the following: (1) a majority (92%) of police personnel were trained in cardiopulmonary resuscitation and basic first aid, (2) only half (57%) of police were trained in moving or transporting patients, and (3) few (36%) police were provided ongoing training in emergency pediatric medical skills. In spite of this, police were reportedly present at calls activating emergency medical services systems between 24% and 69% of the time, and the majority of these were trauma related. Police chiefs surveyed indicated that their officers played a large role in medical management prior to arrival of emergency medical services personnel; 87% would initiate cardiopulmonary resuscitation and 93% would begin basic first aid. Sixty-one percent of police chiefs indicated that officers would occasionally "scoop and run" with a critically ill child rather than await emergency medical services arrival. The data indicate that, right or wrong, police personnel are actively involved in their prehospital care system at present. In many instances, their help may be needed. Further thought should be given toward defining an exact emergency medical services role for police personnel and toward providing adequate initial and ongoing basic medical training for these individuals.

Allied Health Personnel↗
PubMed1991

Fire hydrant play: injuries and their prevention.

A total of 86 children treated for injuries that occurred while playing in water from fire hydrants are described. Patients were urban (100%), minority (97%) children with few alternative means for keeping cool. Injuries occurred on extremely hot summer days (mean maximum temperature 36.3 degrees C [97.5 degrees F]). Laceration of the foot on broken glass was the most common injury and was prevented by wearing footwear (P less than .001). Motor vehicles caused all serious injuries. Sprinkler attachments on the hydrants were associated with significantly fewer motor vehicle-related injuries (P less than .001) and water pressure-related injuries (P = .02). Adults were present at more than 90% of injury scenes, but had no effect on the safety of fire hydrant play. Public policy should be directed toward increasing the availability of alternative means for keeping cool, increasing the number of hydrants equipped with sprinklers, and reducing the amount of broken glass in the streets. Public education targeting adults to remove glass from the street, insist that children wear footwear, and open only those hydrants that have sprinklers could further reduce injuries to urban children who play in water from fire hydrants.

Adolescent↗
PubMed1991

Dog bites in urban children.

As a result of a perceived increase in pit bull injuries, all children who presented to The Children's Hospital of Philadelphia during 1989 for evaluation of dog bite injuries were prospectively studied. Epidemiologic information was collected from parents, either at the time of visit or by phone on the following day. A total of 168 children were enrolled; the mean age was 8 years. Males outnumbered females 1.5:1. Most (61%) injuries occurred in or around the home and involved dogs known to the patient (77%). Types of injuries included abrasions (33%), punctures (29%), and lacerations (38%). Thirteen bites had associated complications; nine developed infection. Twelve (7%) children required admission to the hospital. More than 12 different purebreeds or cross-breeds were identified as perpetrators, including German shepherds (n = 35), pit bulls (n = 33), rottweilers (n = 9), and Dobermans (n = 7). Most (54%) animals were contained (ie, leashed, fenced, in-house) at the time of injury. Fewer (46%) were provoked prior to biting. Significantly more pit bull injuries (94% vs 43%, P less than .001) were the consequence of unprovoked attacks and involved freely roaming animals (67% vs 41%, P less than .01). Children aged 5 or younger were more likely to provoke animals prior to injury than were older children (69% vs 36%, P less than .001). It is recommended that families with young children be the target of pet safety education and that measures be sought that would lead to early identification of a potentially dangerous dog and restrict ownership.

Age Factors↗
PubMed1990

Lacerations in urban children. A prospective 12-January study.

We prospectively investigated the epidemiologic characteristics of all lacerations (N = 2834) repaired at the Children's Hospital of Philadelphia (Pa) during 1987 and identified common hazards and possible avenues of intervention. Two-year-old children incurred most injuries; males outnumbered females 2:1. Almost two thirds (61.8%) of all lacerations occurred from May through September, and 62.2% between 3 and 9 PM. Most injuries occurred indoors (47.0%), on the sidewalk or street (22.5%), or in the residential yard (13.0%). Injuries usually occurred during play (42.3%) or daily activity (32.1%); 1247 (44.0%) involved some sort of fall. Vectors most frequently causing injury were broken glass bottles (15.0%), wooden furniture (12.0%), and asphalt or concrete (11.0%). Broken glass bottles also most frequently inflicted injuries resulting in functional impairment (0.2%), hospitalization (0.9%), or both. Complications were seen in 8% of all lacerations. Our data confirm the importance of injury-prevention strategies aimed at reduction of discarded glass objects (ie, recycling legislation), improved furniture design, and improved municipal services (ie, street repair).

Adolescent↗
PubMed1990

Bunk bed injuries.

Bunk beds are commonly used in American households, yet to our knowledge, no studies have been done to determine if they are safe. We prospectively studied the incidence, epidemiology, and outcome of injuries related to bunk beds. We interviewed all patients with such injuries who presented to the emergency department between February 1987 and February 1988. A control group of children who use bunk beds but who came to the emergency department for another reason were also interviewed. There were 68 injured children and 54 controls during the 1-year study period. There were 47 injured children (70% of this group) and 26 control children (48% of this group) younger than 6 years, which is below the age recommended by the Consumer Product Safety Commission for bunk bed use. Carpeted floors were significantly more common in the control group, 67% (36 children) vs 42% (26 children). Injuries occurred most often when the child fell from the top bed (38 children [58%]), fell off the ladder (7 children [11%]), or fell off the bottom bed (8 children [12%]). Injuries occurred during sleep (19 children [29%]), getting in or out of the bunk bed (13 children [20%]), or playing in or near the beds (28 children [43%]). Of those injured while asleep, 13 of 19 children were younger than 6 years. Head injuries accounted for half the trauma (35 children [52%]), and extremities were involved in 16 patients [24%]. The most common injuries were lacerations (27 children [40%]) and contusions (19 children [28%]), but 8 children (12%) had concussions and 7 children (10%) had fractures. Six children (9%) required admission to the hospital. Head and face injuries were significantly more likely if the top bed had no side rails. These data suggest injuries could be prevented if side rails were mandatory for all top beds, young children were not permitted to sleep in bunk beds, and all children were encouraged not to use the beds for play.

Accident Prevention↗
PubMed1990

The management and outcome of lacerations in urban children.

We prospectively studied the management and outcome of 2,834 children, aged 1 month to 18 years, who presented to the emergency department of the Children's Hospital of Philadelphia for laceration repair. Patients with bite wounds were excluded from the study. Eight percent (239) of all patients had complications on initial evaluation; the most common was the presence of a foreign body (55). Infection on presentation was diagnosed in 22 cases (0.8%). All of these patients had delayed their initial care beyond 18 hours (range, 18 to 288 hours; mean, 18 hours). Other factors significantly associated with infection on presentation included occurrence of the injury outdoors (16; P less than .001), injury due to broken "street" glass (seven; P less than .02), and injury of an extremity (18; P less than .01). The rate of prerepair infection was not influenced by the size of the wound. Infections developed subsequent to initial repair in 34 cases (1.2%). Factors associated with development of subsequent infection included use of prophylactic antibiotics, use of subcutaneous sutures, laceration length of more than 5.0 cm, glass or ice as a causative agent, and upper- or lower-extremity involvement. The majority of injuries were repaired by ED personnel without surgical consultation. Postrepair infection rates were not influenced by the specialty of the physician managing the case. Although our study was not designed to specifically test the issue, prophylactic antibiotics were of no proven benefit in reducing infection rates in any group of patients analyzed.

Adolescent↗
PubMed1990

Failure of infant observation scales in detecting serious illness in febrile, 4- to 8-week-old infants.

All infants aged 29 to 56 days with rectal temperatures in excess of 38.2 degrees C who presented to the Emergency Department of The Children's Hospital of Philadelphia from July 1987 through July 1988 were studied. Each infant was scored (1 to 5) on each of the six items in the Yale Observation Scale by an Emergency Department attending physician before history and physical examination. Individual scores were then added to yield a total score for each patient. An observation score of 10 or less was indicative of a generally well-appearing child, and a score of 16 or more represented an ill-appearing child. Of 126 infants enrolled, 37 (29%) had serious illness; 12 (9.5%) had culture-proven bacterial disease. Of all infants with an observation score less than or equal to 10 (n = 91), 22% had serious illness, and of all infants with an observation score greater than or equal to 16 (n = 20), only 45% had serious illness. The findings suggest that even in experienced hands, the Yale Observation Scale alone does not provide sufficient data to identify serious illness in febrile, 1- to 2-month-old infants.

Bacterial Infections↗
PubMed1989

Povidone iodine as a cause of factitious hematuria and abnormal urine coloration in the pediatric emergency department.

The observation of a cola-colored dipstick positive for "hematuria" was made in an 11-year-old black male who presented to the emergency department with a chief complaint of dysuria. Thorough questioning eventually revealed the source of these two abnormalities to be the addition of povidone iodine to the urine sample. The reported causes of abnormal urine coloration and of false positive dipstick hematuria are summarized.

Child↗
PubMed1989

High-frequency homologous recombination between duplicate chromosomal immunoglobulin mu heavy-chain constant regions.

Homologous recombination was used in a previous study to correct a 2-base-pair deletion in the third constant domain (Cmu3) of the haploid chromosomal mu gene in a mutant hybridoma cell line by transfer of a pSV2neo vector bearing a subfragment of the normal Cmu region (M.D. Baker, N. Pennell, L. Bosnoyan, and M.J. Shulman, Proc. Natl. Acad. Sci. USA 85:6432-6436, 1988). In these experiments, both gene replacement and single reciprocal crossover events were found to restore normal, cytolytic 2,4,6-trinitrophenyl-specific immunoglobulin M production to the mutant cells. In the cases of single reciprocal recombination, the structure of the recombinant mu gene is such that the normal Cmu region, in its correct position 3' of the expressed 2,4,6-trinitrophenyl-specific heavy-chain variable region, is separated from the mutant Cmu region by the integrated vector sequences. I report here that homologous recombination occurs with high frequency between the duplicate Cmu regions in mitotically growing hybridoma cells. The homologous recombination events were easily detected since they generated hybridomas that were phenotypically different from the parental cells. Analysis of the recombinant cells suggests that gene conversion is the most frequent event, occurring between 60 and 73% of the time. The remaining events consisted of single reciprocal crossovers. Intrachromatid double reciprocal recombination was not detected. The high frequency of recombination, the ability to isolate and analyze the participants in the recombination reactions, and the capacity to generate specific modifications in the immunoglobulin Cmu regions by gene targeting suggest that this system will be useful for studying mammalian chromosomal homologous recombination. Moreover, the ability to specifically modify the chromosomal immunoglobulin genes by homologous recombination should facilitate studies of immunoglobulin gene regulation and expression and provide a more convenient of engineering specifically modified antibody.

Animals↗
PubMed1989

Immunoglobulin molecular genetics: the prospects for mutational analysis of the chromosomal immunoglobulin genes.

Homologous recombination between transferred and chromosomal DNA can be used to effect precise, predetermined modifications of the chromosomal genes. Ultimately this phenomenon should allow the assessment of genetic regulatory elements as they function in the normal chromosomal environment. We have previously described a system for isolating mutant hybridoma cells that are defective in immunoglobulin (Ig) production, with a view toward using these mutants to define cis-acting elements that influence Ig gene expression. Here we describe results that indicate that homologous recombination between transferred and chromosomal Ig genes can be used to map Ig mutations by marker rescue.

Animals↗
PubMed1979

The statutory noise level in South Africa.

Noise legislation in South Africa was introduced in 1974. However, in industry, compliance with the recommended maximum equivalent noise level of 85 dB(A) is poor. The subject of noise exposure is reviewed briefly and a tentative proposal for a temporary raising of the statutory limit is put forward.

Hearing Loss, Noise-Induced↗