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M Denise Dowd

Publications and source records attributed to M Denise Dowd.

17 recordsLinked to original sources
PubMed2007

Emergency department management and short-term outcome of children with constipation.

BACKGROUND: Constipation is a common diagnosis made in the pediatric emergency department (ED). Specific evidence-based standards for evaluation and treatment are lacking. OBJECTIVE: To describe variation in evaluation and treatment of constipation and characteristics and treatments associated with improvement. METHODS: This single-site descriptive study examined constipated children discharged from the ED. Chart review provided history, examination, evaluation, and treatment. Symptoms and on-going treatment were assessed by telephone interview at 4 to 6 weeks. Patients were dichotomized to poor versus adequate responders. Poor responders had 2 or more of the following: overall constipation, persistent presenting symptom, bowel movement frequency of less than once every other day, painful defecation, and/or abdominal pain. RESULTS: The study group had 121 patients, with mean age of 6.4 years; 54% were female. Abdominal pain was the most common complaint (66%); 46% reported hard/infrequent stools. Most (67%) had symptoms for less than 1 week. Many (41%) previously sought care for the same problem. Most (70%) had abdominal radiographs. One third received an enema in the ED, and most patients were prescribed laxatives, most commonly polyethylene glycol (80%). After an enema, 28% were discharged without constipation medication. At follow-up, 35% were using laxatives, and 27% had sought additional care. Nearly half (42%) were poor responders. Poor responders were younger (5.1 vs. 7.3 years; P < 0.01). There was no difference in response based upon sex, duration of symptoms, or ED treatment. CONCLUSIONS: Although older children are more likely to improve, many constipated children continue to have symptoms. Type of ED therapy is unrelated to on-going symptoms at 4 to 6 weeks.

Chi-Square Distribution↗
PubMed2006

Child and provider restraints in ambulances: knowledge, opinions, and behaviors of emergency medical services providers.

BACKGROUND: Approximately 16,000 children are transported by ambulances each day, and there are an estimated 4,500 ambulance crashes each year. Information about emergency medical services (EMS) provider knowledge, opinions, and behaviors regarding occupant restraint is lacking. OBJECTIVES: To measure the knowledge, opinions, and behaviors of EMS personnel regarding child and provider restraint use in ambulances. METHODS: A survey was given to all EMS providers in two large ambulance-service organizations and in a hospital-based pediatric ambulance service in a midsized urban area. RESULTS: A total of 302 EMS providers were surveyed, for a return rate of 67.7%. Nearly half were involved in an ambulance crash at least once; of those, 7.6% were injured and 1% had patients in their care injured. The majority (91%) reported some training in child-restraint use in ambulances, and half reported that they know a lot or very much about securing a critically ill child for transport. However, 30% did not identify the correct method of transport for a stable 2-year-old, and 40% did not choose the correct method of securing a child seat to the ambulance cot. Securing a child seat to the cot was viewed by 81% to not take too much time from patient care, and 63% did not view caring for a child in a car seat as difficult. Although 80% of providers regularly transported children in a car seat, 23% transported them on an adult's lap at least sometimes. Specialized pediatric-transport providers were more likely to report safe pediatric and occupant restraint practices than were community EMS providers. Pediatric restraint behaviors were not associated with years of service or history of a crash. Two thirds of respondents reported not wearing their seatbelt on the squad bench while treating patients, and half believe that wearing a seatbelt interferes with patient care. A total of 95% report wearing seatbelts in the front seat of the ambulance. Provider seatbelt use in the patient compartment was not associated with years of service, with number of crashes, or with reporting correct use of pediatric restraints. CONCLUSIONS: This study indicates that the frequency of crashes in ambulances, and therefore the potential for injury, may be underappreciated. Current restraint practices of some of the study group are outside recommendations and may be placing at risk some children who are being transported by ambulances. This problem is complicated by the relative infrequency of pediatric ambulance transports compared with adults. Improved equipment and education may help providers safely transport pediatric patients. In addition, providers are risking their own safety by not wearing seatbelts in the rear ambulance compartment. Improved equipment may help alleviate this risk and allow providers to take care of patients safely.

Accidents, Traffic↗
PubMed2006

Impact of rapid influenza testing at triage on management of febrile infants and young children.

OBJECTIVE: To determine the impact of an emergency department (ED) triage protocol for rapid influenza testing of febrile infants and children on additional diagnostic testing, ED charges and patient time in the ED. METHODS: A trial of triage-based rapid influenza A and B testing of febrile infants and children 3 to 36 months of age presenting to an urban ED during December 2002 to March 2003 was performed. Children with a temperature of 39 degrees C or higher or history of fever 102 degrees F or higher at home were included. Those with obvious focal infection, potential immunodeficiency, and indwelling medical devices were excluded. The intervention group, tested for influenza at triage (TT) was compared with a nonintervention group consisting of those receiving usual care (SP). A subanalysis comparing influenza-positive children was performed. RESULTS: Of 1007 eligible subjects a total of 719 (71%) patients were in the SP group and 288 in the TT group. There were significant differences in respiratory syncytial virus rapid test (RSV; 18%-7%) and chest radiographs (CXRs; 26%-20%) tests in the TT group. In addition, significant increases in obtaining a complete blood count (relative risk [RR] 12.0; 95% confidence interval [CI] 2.9-49), blood culture (RR, 12.0; 95% CI, 3.0-51.0), RSV testing (RR, 0.9.2; 95% CI, 3.4-25.0), urinalysis (RR, 5.7; 95% CI, 2.0-16.0), CXR (RR, 2.2; 95% CI, 1.04-4.5), time in the ED (195 vs 156 minutes; 95% CI, of the difference 19-60), and medical charges ($666 vs $393; 95% CI, of the difference 153-392) were seen among those testing positive for influenza in the SP group. CONCLUSIONS: A triage protocol for rapid influenza testing for febrile infants and children appears to significantly decrease additional testing, time in the ED, and charges in children testing positive for influenza.

Child, Preschool↗
PubMed2006

Evaluation of a curriculum for intimate partner violence screening in a pediatric emergency department.

OBJECTIVE: We sought to describe the assessment of course participant changes in attitudes, self-efficacy, and behaviors after completion of the Its Time to Ask training curriculum for screening for intimate partner violence (IPV) in a pediatric emergency department (PED). METHODS: A 22-item Likert scale questionnaire was administered at baseline (before training), after training, and at 6-month follow-up to PED employee participants in a 2-hour IPV education program. Mean participant responses were compared between baseline/posttraining and baseline/6-month follow-up. Participants also completed a course-satisfaction survey. RESULTS: A total of 79 PED staff completed the baseline questionnaire before the training. Eighty-seven participants completed the posttraining questionnaire, and 48 completed the 6-month follow-up questionnaire. Participants had consistent, positive changes in attitudes after training that persisted at the 6-month follow-up for 5 items on the questionnaire. Attitudes that did not change showed baseline means already in disagreement with questionnaire statements. Participants reported significant, positive changes for all 7 self-efficacy statements at 1 or both of the posttraining evaluations. The only changes in behavior were observed at 6 months. The majority of participants were satisfied with the training and would recommend it to colleagues. CONCLUSIONS: Significant, self-reported changes in attitudes, self-efficacy, and behaviors/clinical practice regarding screening for IPV in a PED can be achieved through participation in a brief training curriculum.

Adult↗
PubMed2005

Resident efficiency in a pediatric emergency department.

OBJECTIVES: To measure the hourly rate of patients evaluated and treated by resident physicians in an academic pediatric emergency department (PED) and examine differences in the rate by subspecialty and year of training. METHODS: For all residents rotating in an academic, urban children's hospital PED, the rate of patients seen per hour over the course of their rotation was calculated using an electronic tracking system, EmSTAT, for calendar year 2000. Rates are reported as the mean number of patients seen per resident hour worked. Mean differences are reported for resident subspecialties (emergency medicine, pediatrics, and family practice) and postgraduate year (PGY1-PGY3), and subclass comparisons were made with an analysis of variance test with Tukey's post hoc analysis. RESULTS: A total of 153 residents (63.4% pediatric, 18.9% family practice, and 17.7% emergency medicine) saw 24,414 patients during the study period. The makeup of the group by training year was as follows: PGY1, 20.9%; PGY2, 41.2%; and PGY3, 37.9%. For all residents, the mean rate was 1.02 patients seen per hour (pph). Significant differences in the mean number of patients seen per hour by subspecialty existed, with emergency medicine residents seeing a mean of 1.12 pph, pediatrics residents seeing 1.02 pph, and family practice residents seeing 0.93 pph (mean difference, p < 0.05 for all comparisons). Rates increased by year of training, with PGY1 seeing a mean of 0.95 pph, PGY2 seeing 0.99 pph, and PGY3 seeing 1.09 pph (mean difference, p < 0.05 for all comparisons except PGY1 vs. PGY2). CONCLUSIONS: Significant differences in the rate of patients evaluated and treated in the PED exist by resident subspecialty and year of training. Knowing these rates is helpful in evaluation of resident performance, because it allows comparison with peers. Additionally, such information may be useful for residency program evaluators to gauge the amount of patient exposure for residents.

Educational Status↗
PubMed2005

Gun storage practices and risk of youth suicide and unintentional firearm injuries.

CONTEXT: Household firearms are associated with an elevated risk of firearm death to occupants in the home. Many organizations and health authorities advocate locking firearms and ammunition to prevent access to guns by children and adolescents. The association of these firearm storage practices with the reduction of firearm injury risk is unclear. OBJECTIVE: To measure the association of specific household firearm storage practices (locking guns, locking ammunition, keeping guns unloaded) and the risk of unintentional and self-inflicted firearm injuries. DESIGN AND SETTING: Case-control study of firearms in events identified by medical examiner and coroner offices from 37 counties in Washington, Oregon, and Missouri, and 5 trauma centers in Seattle, Spokane, and Tacoma, Wash, and Kansas City, Mo. CASES AND CONTROLS: Case firearms were identified by involvement in an incident in which a child or adolescent younger than 20 years gained access to a firearm and shot himself/herself intentionally or unintentionally or shot another individual unintentionally. Firearm assaults and homicides were excluded. We used records from hospitals and medical examiners to ascertain these incidents. Using random-digit dial telephone sampling, control firearms were identified by identification of eligible households with at least 1 firearm and children living or visiting in the home. Controls were frequency matched by age group and county. MAIN EXPOSURE MEASURES: The key exposures of interest in this study were: (1) whether the subject firearm was stored in a locked location or with an extrinsic lock; (2) whether the firearm was stored unloaded; (3) whether the firearm was stored both unloaded in a locked location; (4) whether the ammunition for the firearm was stored separately; and (5) whether the ammunition was stored in a locked location. Data regarding the storage status of case and control guns were collected by interview with respondents from the households of case and control firearms. RESULTS: We interviewed 106 respondents with case firearms and 480 with control firearms. Of the shootings associated with the case firearms, 81 were suicide attempts (95% fatal) and 25 were unintentional injuries (52% fatal). After adjustment for potentially confounding variables, guns from case households were less likely to be stored unloaded than control guns (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.16-0.56). Similarly, case guns were less likely to be stored locked (OR, 0.27; 95% CI, 0.17-0.45), stored separately from ammunition (OR, 0.45; 95% CI, 0.34-0.93), or to have ammunition that was locked (OR, 0.39; 95% CI, 0.23-0.66) than were control guns. These findings were consistent for both handguns and long guns and were also similar for both suicide attempts and unintentional injuries. CONCLUSIONS: The 4 practices of keeping a gun locked, unloaded, storing ammunition locked, and in a separate location are each associated with a protective effect and suggest a feasible strategy to reduce these types of injuries in homes with children and teenagers where guns are stored.

Adolescent↗
PubMed2003

Influence of the news media on diagnostic testing in the emergency department.

OBJECTIVE: To examine the association between mass media attention regarding invasive group A streptococcal (GAS) disease and testing for GAS in a pediatric emergency department (ED). DESIGN, SETTING, AND PARTICIPANTS: An observational analysis was performed of patients who had GAS tests done in a pediatric ED between December 1, 1999, and November 30, 2001. Data were analyzed by dividing each of the 2 years into 4 consecutive 90-day intervals. Data including age, date of the visit, presenting complaint, primary discharge diagnosis, whether a GAS test was obtained, and the results were collected from an electronic data repository. The date of the news stories, the station, and the duration of the broadcast were collected from electronic archives of the local newspaper and a broadcast monitoring service. MAIN OUTCOME MEASURE: The rate of GAS tests done per 1000 ED visits and the rate of positive tests per 1000 ED visits. RESULTS: An average of 103 GAS tests were performed per 1000 ED visits in the December through February period in year 2 compared with 55 GAS tests per 1000 ED visits in a similar period in year 1. This difference was statistically significant (difference, 48 tests; 95% confidence interval, 24-72 tests; P<.001). There were no significant differences in the proportion of positive tests (32% in year 1 vs 20% in year 2; mean difference, -11%; 95% confidence interval, -23% to 1%; P =.07). There were a total of 16 newspaper articles and 34 television stories on GAS during the 2-year study period. The peak in GAS tests and the peak in media events were concomitant. CONCLUSION: A surge in news stories regarding GAS disease was associated with an increase in testing for GAS in a pediatric ED.

Child↗
PubMed2002

Effect of rapid diagnosis of influenza virus type a on the emergency department management of febrile infants and toddlers.

BACKGROUND: Evidence shows that the rapid detection of influenza using an enzyme-linked immunosorbent assay decreases antibiotic use in the treatment of pediatric patients. To our knowledge, the effect on other diagnostic testing in an emergency department (ED) has not been examined. OBJECTIVE: To determine the effect of rapid diagnosis of influenza virus type A on the clinical management of febrile infants and toddlers in a pediatric ED at an urban children's hospital. MATERIALS AND METHODS: A retrospective review of ED records from an electronic database was performed. All children 2 to 24 months of age, with a temperature higher than 39 degrees C who had a positive influenza virus type A test result using an enzyme-linked immunosorbent assay from November 1, 1998, through April 30, 2000 (n = 72), were included in this study. Two groups were compared-those who had positive test results reported before discharge from the ED (early diagnosis) and those who had positive test results after discharge (late diagnosis). RESULTS: Forty-seven patients (65%) were in the early diagnosis group and 25 (35%) in the late diagnosis group. The groups were similar for age, temperature, and triage category. Fewer patients in the early diagnosis group received ceftriaxone sodium compared with those in the late diagnosis group (2% vs 24%, P =.006); there were fewer urinalyses (2% vs 24%, P =.006) and complete blood cell counts performed (17% vs 44%, P =.02). CONCLUSIONS: Rapid confirmation of influenza virus type A infection seems to decrease ancillary tests and antibiotic use in febrile infants and toddlers in the ED. A prospective study with a larger group is needed to confirm these findings.

Ceftriaxone↗
PubMed2002

Handgun safety: what do consumers learn from gun dealers?

OBJECTIVE: To explore the type and quality of handgun safety information a typical consumer would obtain from a licensed gun dealer. METHODS: Semistructured, interactional on-site interviews were conducted with licensed handgun dealers in 2 metropolitan areas. A variety of dealers (gun shops, pawnshops, general merchandise stores, and sporting goods stores) were visited. Investigators posed as customers interested in buying a handgun. During the interview, investigators expressed concern that as the parent of a 4-year-old child, they needed suggestions about keeping their child safe with a gun in the home. Information collected included basic dealer demographics, opinions on whether a 4-year-old child could pull a handgun trigger, handgun safety advice and recommendations, and the type of safety devices and handgun safety educational materials that were available in the store. RESULTS: There were 96 visits made to gun dealers. The typical salesperson was a man who appeared to be older than 40 years. Trigger locks were the most common safety devices available. When asked what a consumer should know about purchasing a handgun, 85% of salespeople did not mention safe storage. Only 9 (9%) offered advice that included all of the following: keeping the gun securely locked, keeping the gun unloaded, and storing the gun separately from the ammunition. One third answered "no" or "don't know" or "uncertain" when asked if a 4-year-old could pull the trigger. The majority (92%) did not have any handgun safe storage educational materials on site. CONCLUSIONS: Salespeople offered potential buyers little or no education about safe storage of handguns. The information provided was often inconsistent with the recommendations of the American Academy of Pediatrics.

Accident Prevention↗
PubMed2002

Mothers' and health care providers' perspectives on screening for intimate partner violence in a pediatric emergency department.

OBJECTIVE: To determine the attitudes, feelings, and beliefs of mothers and pediatric emergency department health care providers toward routine intimate partner violence screening. METHODS: This qualitative project employed focus groups of mothers who brought their children to a children's hospital emergency department for care, and physicians and nurses who staffed the same department. We held 6 ethnically homogeneous mother focus groups (2 white, 2 African American, and 2 Latina) and 4 provider focus groups (2 predominately female nurse focus groups and 2 physician groups: 1 male and 1 female). Professional moderators conducted the sessions using a semistructured discussion guide. All groups were audiotaped and videotaped, and tapes were reviewed for recurring themes. RESULTS: A total of 59 mothers, 21 nurses, and 17 physicians participated. Mothers identified intimate partner violence as a common problem in their communities, and most remarked that routine screening for adult intimate partner violence is an appropriate activity for a pediatric emergency department. However, many expressed concern that willingness to disclose might be affected by a fear of being reported to child protective services. They stressed the importance of addressing the child's health problem first, that screening be done in an empathetic way, and that immediate assistance be available if needed. Themes identified in the provider groups included concerns about time constraints, fear of offending, and concerns that unless immediate intervention was available, the victim could be placed in jeopardy. Many said they would feel obligated to notify child protective services on disclosure of intimate partner violence. CONCLUSIONS: Intimate partner violence screening protocols in the pediatric emergency department should take into consideration the beliefs and attitudes of both those doing the screening and those being screened. Those developing screening protocols for a pediatric emergency department should consider the following: (1) that those assigned to screen must demonstrate empathy, warmth, and a helping attitude; (2) the importance of addressing the child's medical needs first, and a screening process that is minimally disruptive to the emergency department; (3) a defined, organized approach to assessing danger to the child, and how and when it is appropriate to notify child protective services when a caregiver screens positive for intimate partner violence; and (4) that resources must be available immediately to a victim who requests them.

Adult↗
PubMed2002

Management of corneal abrasion in children: a randomized clinical trial.

STUDY OBJECTIVE: We compare percentage of healing, comfort, and complications in children with corneal abrasions treated with an eye patch versus no eye patch. METHODS: We performed a randomized clinical trial of patients aged 3 to 17 years who were diagnosed with isolated corneal abrasion. Patients were randomly assigned to an eye patch or no patch group. Abrasion size was documented with digital photographs and/or an eye template diagram at presentation and at 20- to 24-hour follow-up examination. A reviewer masked to treatment group determined percent healing by measuring presentation and follow-up abrasion sizes on the photographs/template. At follow-up, interference with activities of daily living (ADL) was measured with a visual analog scale and the number of pain medication doses taken since presentation was recorded. RESULTS: A total of 37 patients were enrolled: 17 with an eye patch and 18 with no eye patch. The mean patient age was 10 years, and two thirds of the patients were male. The majority (86%) of patients had 95% or more healing at follow-up, and there was no significant difference in percent healing between the 2 groups, even when adjusted for age and initial abrasion size (95% confidence interval [CI] for the difference in means -11 to 8 and -13 to 5, respectively). There was no difference between groups for number of pain medication doses required. Among measurements of interference with ADL, only the difficulty walking score was found to be significantly different between groups (patch mean 1.7 cm [SD 2.1 cm] versus no patch mean 0.3 cm [SD 0.7 cm]; 95% CI for the difference in means 0.3 to 2.5). CONCLUSION: This study suggests that eye patching in children with corneal abrasions makes no difference in the rate of healing. There was no difference in discomfort and interference with ADL, other than greater difficulty walking in the patch group, and there were no complications in either group.

Adolescent↗
PubMed2002

Epidemiology and prevention of childhood injuries.

Traumatic injury is the leading cause of death in children after infancy. The leading causes of childhood injury deaths are motor vehicle crashes, submersion injury, homicide, suicide, and fires. Injuries are not random events. Factors associated with injuries allow identification of high-risk populations and targeted interventions. Injury research includes development of conceptual models to include preinjury, event, and postevent features that can be modified to prevent or limit injuries. Successful prevention strategies often include multifaceted approaches such as education, incentives for safe human behavior, legislation/enforcement, and environmental changes. Preventive programs must weigh both societal and economic values and costs. Careful evaluation for effectiveness of injury prevention programs to decrease or limit injury continues to be a challenge. Generally, passive measure such as improved engineering are more effective than measures that require modification of human behaviors. Childhood injury prevention programs have reduced deaths from some causes such as motor vehicle crashes, but deaths from gun-related homicide and suicide remain high. Critical care providers can actively engage in both prevention efforts and improved acute care of the severely injured child.

Accidents, Traffic↗