Biomedical subjects

M V Pusic

Publications and source records attributed to M V Pusic.

4 recordsLinked to original sources

PubMed2006

Effect of a clinical pathway on the hospitalisation rates of children with asthma: a prospective study.

AIM: To determine the effect of implementing a clinical pathway, using evidence-based clinical practice guidelines, for the emergency care of children and adolescents with asthma. METHODS: A prospective, before-after, controlled trial was conducted, which included patients aged 1-18 years who had acute exacerbations of asthma treated in a tertiary care paediatric emergency department. Data were collected for identical 2-month seasonal periods before and after implementation of the clinical pathway to determine hospitalisation rate and other outcomes. For 2 weeks after emergency visits, the rate at which patients returned to emergency care for worsening asthma was evaluated. A multidisciplinary panel, using national guidelines and a systematic review, developed the pathway. RESULTS: 267 patients were studied. The rate of hospitalisation was significantly lower in the post-implementation group (10/74; 13.5%) than in the pre-implementation control group (53/193; 27.5%; p = 0.02; number needed to treat 7.1). All reduction in hospitalisation occurred in children with moderate to severe asthma exacerbation. After implementation of the clinical pathway, the rate of administration of oral corticosteroids to patients with moderate or severe exacerbations increased from 71% to 92% (p = 0.01), and significantly more patients received beta2-agonists in the first hour (p = 0.02). No significant change in relapse to acute care occurred within 2 weeks (p = 0.19). CONCLUSIONS: An evidence-based clinical pathway for children and adolescents with moderate to severe exacerbations of acute asthma markedly decreases their rate of hospitalisation without increased return to emergency care.

Acute Disease↗

PubMed2001

E-mail amplification of a mock code teaching round.

To determine whether e-mail could be used to supplement a teaching round, we implemented the following educational intervention: each Monday, a mock code was presented. Two e-mails were then sent the same day to all residents. One summarized the main teaching points whereas the second solicited discussion. Each Friday, a third e-mail was sent that summarized the discussion. We collected all e-mails and surveyed the residents. Fifteen of 18 residents completed the questionnaire; two were not participants in the e-round. Forty percent (7/15) of the residents attended fewer than half of the mock codes but most participants (10/13) reported reading >95% of the e-mails. A majority reported storing (11/13), printing (7/13), and reading e-mails a second time (12/13). Seven of 13 reported learning as much or more from the e-mails as from the mock code itself. We conclude that e-mail can increase learning from a traditional mock code teaching round.

Computer Communication Networks↗

PubMed1999

Ipratropium bromide added to asthma treatment in the pediatric emergency department.

OBJECTIVE: To determine if the addition of ipratropium bromide to the emergency department (ED) treatment of childhood asthma reduces time to discharge, number of nebulizer treatments before discharge, and the rate of hospitalization. METHODS: Patients >12 months of age were eligible if they were to be treated according to a standardized ED protocol for acute asthma with nebulized albuterol (2.5 mg/dose if weight <30 kg, otherwise 5 mg/dose) and oral prednisone or prednisolone (2 mg/kg up to 80 mg). Subjects were randomized to receive either ipratropium (250 microg/dose) or normal saline (1 mL/dose) with each of the first three nebulized albuterol doses. Further treatment after the first hour was determined by physicians blinded to subject group assignment. Records were reviewed to determine the length of time to discharge home from the ED, number of doses of albuterol given before discharge, and the number of patients admitted to the hospital. RESULTS: Four hundred twenty-seven patients were randomized to ipratropium or control groups; these groups were similar in all baseline measures. Among patients discharged from the ED, ipratropium group subjects had 13% shorter treatment time (mean, 185 minutes, vs control, 213 minutes) and fewer total albuterol doses (median, three, vs control, four). Admission rates did not differ significantly (18%, vs control, 22%). CONCLUSIONS: The addition of three doses of ipratropium to an ED treatment protocol for acute asthma was associated with reductions in duration and amount of treatment before discharge.

Administration, Inhalation↗

PubMed1998

Pediatric residents: are they ready to use computer-aided instruction?

OBJECTIVE: To assess pediatric residents' readiness to use computer-aided instruction (CAI). DESIGN: Survey. SETTING: Pediatric residency program based in a tertiary care children's hospital. PARTICIPANTS: Four pediatric residency classes. ASSESSMENT INSTRUMENT: Self-administered questionnaire. MAIN OUTCOME MEASURES: Residents' access to computers and the Internet, experience with CD-ROM and World Wide Web computer tutorials, and attitudes toward CAI. Responses were stratified by age, training level, sex, and previous computer education. RESULTS: Fifty-one (69%) of the residents owned a computer. Men were more likely than women to own a computer (20 [87%] of 23 men vs 31 [61%] of 51 women; P=.02). Medical education software was used by 18 (28%) of 65, but only 2 (4%) of 74 had ever purchased CAI. Twenty-seven (36%) of 74 regularly accessed medical education World Wide Web sites. Nineteen (26%) of 74 had never accessed the Internet. Of those who had, 50 (91%) of 55 continued to do so at least weekly. Eighteen (95%) of the 19 residents who had never accessed the Internet were female (P=.005). Men were twice as likely to have Internet access at home (P=.01) and were more likely to regularly visit medical education World Wide Web sites (P=.02). Attitudes toward CAI were positive. Most respondents would be willing to use CAI developed at their institution. Most residents ranked CAI ahead of printed teaching materials but behind personal teaching by a pediatrician. Attitudes did not differ by sex. CONCLUSION: Despite positive attitudes toward CAI, pediatric residents are not yet universally ready to use CAI.

Adult↗