Biomedical subjects
P Keenan
Publications and source records attributed to P Keenan.
Transition from pediatric to adult-oriented health care: a challenge for patients with chronic disease.
Pediatric providers can expect that 1 of every 10 patients they see will have a chronic, activity-limiting health condition. Thanks to earlier diagnosis and improved therapies, most of these children will live well into adulthood. This means that eventually they will require care that focuses on adult health issues. Providers in the United States and around the world are recognizing the need for coordinated processes to transition adolescents and young adults with chronic conditions to adult health care. These models rely on the participation and input of the adolescent, his or her family, and pediatric and adult health professionals. This paper distinguishes medical transition from medical transfer; discusses potential barriers to transition; examines new initiatives to develop and study transition models; and reviews federal legislation influencing health care transitions.
Asymptomatic ascariasis infection in a child.
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Benefits of massage therapy and use of a doula during labor and childbirth.
This article reviews the most recent literature on touch support and one-to-one support during labor and childbirth. The positive and negative aspects of the traditional birth attendant are presented. Research in one-to-one care and touch support during labor is examined with respect to husband/partner, nurses, nurse-midwives, and doulas (trained labor attendants). According to recent studies, women supported by doulas or midwives benefit by experiencing shorter labors and lower rates of epidural anesthesia and cesarean section deliveries. Also, a smaller percentage of their newborns experience fetal distress and/or are admitted to neonatal intensive care units. Women whose husbands or partners massage them during labor experience shorter labors. Nursing one-to-one support results in no significant obstetric outcomes. Antenatal perineal massage was found to reduce the rates of tears, cesarean section, and instrumental deliveries. Research in perineal massage during labor has shown no benefit.
Speaking out.
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Denying treatment to Down's syndrome children.
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Methaemoglobinaemia associated with sodium nitrite in three siblings.
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A profile of attenders at the A&E Department of the Children's Hospital, Temple Street, Dublin.
The Department of Health state that the prime function of the A&E department is to provide for the reception and initial management of every variety of medical emergency, provided that the condition could not be treated by the General Practitioner. The A&E department in the Children's Hospital, Temple Street, Dublin receives an average of 55,000 visits annually. The study profiled attenders according to their: socioeconomic status; reasons for attendance; appropriateness of attendance; and outcome of attendance. Attenders parents were more likely to be unemployed (22%), single (26%) and GMS card holders (52%) than national average figures. Families who attended out of hours (i.e. after 5pm) and/or who were self-referred did not differ socio-economically from other attenders. 74% of all attenders were self-referred and the self-referred group were more likely to attend after 5pm. 54% of attenders had attended the department more than once in the previous twelve months. 37% of all attendance were due to accidents. Casualty doctors assessed that 39% of all attendance did not require hospital services. However, the percentage of 'GP referred' and 'self-referred' groups deemed to require hospital services were comparable (47% v 38%). Furthermore, only 19% of GP referrals were admitted. These figures suggest that a large number of children who attend the A&E department should be attending a medical paediatric out patient unit, rather than an A&E department.
Childhood needlestick injuries in the Dublin metropolitan area.
Childhood needlestick injuries and other risk exposures outside of hospital are becoming increasingly common. A retrospective review of casenotes to ascertain the incidence, epidemiology and adequacy of management and follow-up of exposures in the Dublin metropolitan area revealed 52 cases between July 1995 and October 1996. Median age of children was 7.4 years. Most occurred in inner city areas with a recognised high prevalence of i.v. drug use. Only 2 high-risk exposures were identified. On presentation all cases received Hepatitis B vaccination and 56% received Hepatitis B immunoglobulin. Following Hepatitis B virus, Hepatitis C virus and Human immunodeficiency virus testing, no seroconversions have been identified to date in 9 children with completed tests. General follow-up and Hepatitis B immunisation when initiated were not always complete. Standardised management protocols and wider availability of counselling are recommended.
Facilitating faculty communications using an electronic bulletin board to store and organize listserv messages.
The Center for Academic Informatics of the Medical College of Pennsylvania and Hahnemann University uses BULLETIN, a public-domain bulletin board system for VMS, to facilitate communication between our faculty and staff and their colleagues at other institutions. In conjunction with the VAX electronic mail program, BULLETIN can store and organize messages from Internet listserv mailing lists. The software allows us to set up individual folders within BULLETIN for each list of interest to our users. This means that they do not have to sift through "lists of lists" in order to find the ones that coincide with their interests. Another significant advantage is that users' electronic mailboxes do not become cluttered with postings from a variety of lists, interfering with their ability to read and respond to their "real" electronic mail. Yet they can still post to lists, and the posting will be sent from their user name and electronic address. BULLETIN also offers a natural structure for setting up interest groups where local users can post announcements, questions, and answers.
Acute febrile neutrophilic dermatosis in childhood (Sweet's syndrome).
We report a case of Sweet's syndrome in childhood. Our patients suffered from repeated fevers, chest infections and had characteristic erythematous plaques. The severity of his illness increased with age and warranted oral steroid treatment. We review 16 cases reported to date in the literature and comment on the management and prognosis of the disease in childhood.
A randomized trial of the efficacy and acceptability of a pen injector.
A controlled trial of pen injection of insulin was performed in 78 patients, with assessment of metabolic control and lifestyle. After a 6-week run-in period, during which control was optimized, the patients were randomized, either to stay on a twice daily insulin regimen (n = 37), or to change to a three times daily pen regimen with human ultralente at night (n = 41). Over the 20 weeks, there was no significant change in mean glycosylated haemoglobin (syringe, mean +/- SD, 11.1 +/- 2.5% to 10.9 +/- 2.0%; pen, 11.3 +/- 2.6% to 11.2 +/- 2.0%), in blood glucose profiles or in frequency of hypoglycaemic attacks in either group. A self-completed questionnaire demonstrated high patient satisfaction with the pen injector (NovoPen), 78% for effect on lifestyle and 81% for increased flexibility. Ninety-five percent preferred the pen injector regimen to conventional treatment and stayed on it.
A controlled study of prolonged study with semi-synthetic human insulin.
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Acute lymphatic leukaemia in childhood.
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Poisoning in a paediatric hospital.
BACKGROUND: Poisoning is a major cause of morbidity and mortality in children and adolescents. Pharmaceutical and household products are responsible for the majority of cases. AIM: To analyse poisoning cases presenting to a paediatric hospital. METHODS: A retrospective study of all poisoning cases presenting to the Accident and Emergency (A&E) department of one hospital over a nine-month period. Children from birth to 15 years of age were included. The cases were categorised into accidental or intentional with or without suicidal intention. Demographic features included age, gender, toxin, location of poisoning, need for admission and mortality. RESULTS: A total of 148 cases were recorded, 47% were male, 31% were hospitalised and there was no mortality. Of ingestions, 74% were between 1 and 4 years of age and 86% were accidental. Of the intentional, 33% were suicidal, all 12 years or older. CONCLUSIONS: Few unintentional ingestions in the paediatric group result in serious toxicity. Mortality is rare. There is increasing intentional poisoning and alcohol abuse in adolescents. Poison prevention should be part of all well child visits. Agencies catering for children should carry educational leaflets for parents on how to 'poison proof' a child's environment, as the majority of incidents occur at home.
An epidemic of roller-blade injuries in children.
Roller blading is a new and increasingly popular leisure activity in many countries. We reviewed 110 consecutive patients with roller-blade injuries between 1 January and 30 June 1996. The patients ranged from 4 to 14 years in age (mean 6.5 years). Eighty-three (75.4%) sustained injuries to the upper limb and 27 (24.5%) injured the lower limb. Fifty-six patients, were girls and 54 were boys. Of the 110 patients, 79 (72.7%) sustained fractures, 28 (25.4%) soft tissue injuries and 3 (2.7%) dislocations. Eighty-three (75.4%) of the patients wore no protective equipment on the limbs. Four months following injury 103 (93.6%) patients were fully recovered. The mean duration of school absence was 3 days. Subsequently 101 children returned to using roller-blades following injury. Seventy-three (66.3%) of these now use protective equipment. We found that injuries were unrelated to age or duration of roller-blading experience or to the brand-name of roller blades used, and that most of our patients wore no protective equipment at the time of injury.
Family conferences as an adjunct to total coronary care.
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Sunburn presenting to the accident & emergency department of two north Dublin hospitals.
A retrospective study was carried out in two North Dublin hospitals to determine how many patients attended the Accident & Emergency Departments of these hospitals with sunburn. 30 patients presented to Beaumont Hospital over a nine month period from January to September 1992, 28 of whom attended during the four months from 1st May 1992 to 31st August 1992. During the same four month period, 27 children attended the Accident & Emergency Department of Temple Street Hospital for treatment of sunburn. This was a marked increase from the previous year, when only six children presented to Temple Street Hospital with sunburn.