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Biomedical subjects

Richard A Falcone

Publications and source records attributed to Richard A Falcone.

15 recordsLinked to original sources
PubMed2007

Increased heritability of certain types of anorectal malformations.

PURPOSE: Various lines of evidence point to genetic causes for the diverse spectrum of anorectal malformations (ARMs); we therefore studied patterns of heritability in a large case series. METHODS: We searched our ARM database for all patients having family members with congenital anomalies. This group was analyzed to determine the type of ARM and the specific anomalies in affected family members. RESULTS: Thirty-nine of 1606 patients (2.4%) had a family member with a congenital anomaly. The associated non-ARM anomalies included sacral masses and gynecologic, hematologic, esophageal, duodenal, renal, and spinal anomalies. Of these, 24 patients (1.4%) had 1 or more family members with an ARM. Among females with a positive family history, 73% of patients had either a vestibular or perineal fistula, compared with only 36% in patients without a family history (P = .0004). Among males, 35% had perineal fistulas compared with only 10% of those without affected family members (P = .0051). CONCLUSIONS: A positive family history in 1.4% is supportive of a strong genetic component to ARM. The risk of having an affected family member is significantly increased in the presence of a vestibular or perineal fistula. These new data allow for more informed counseling of families with an ARM and support the need for further genetic studies.

Anal Canal↗
PubMed2007

The epidemiology of infant injuries and alarming health disparities.

PURPOSE: Injury epidemiology is the underappreciated foundation of injury prevention and control strategies. Given the substantial disparity of infant injury-related mortality between African Americans (AA) and whites in our region, we sought to better understand the epidemiology of infant injury-related mortality rates. METHODS: Our trauma database was reviewed for all infant injuries over a 10-year period. The mortality rates were analyzed based on race, mechanism, and health insurance type. RESULTS: From 1995 to 2004, 1270 infants were identified. Sixty-nine percent were white, 26% AA, and 5% were other. Overall mortality was 4.8%. There were significant disparities in mortality comparing AA to whites: overall, 9.6% vs 2.8%*; abuse, 15% vs 4%*; suffocation, 100% vs 55%* (*P < .05). Although 75% of AA vs 40% of whites were insured by Medicaid, when separated by insurance type, the disparity in mortality rates between races remained significant. CONCLUSIONS: African-American infants have 3.5 times increased risk of death from preventable injuries compared to white infants. This disparity persists despite controlling for type of health insurance, a surrogate for socioeconomic status. Understanding these disparities and developing injury-prevention programs targeting high-risk mechanisms of injury such as abuse and suffocation among AA is critical toward eventually eliminating these preventable deaths.

Black or African American↗
PubMed2006

Pediatric trauma nurse practitioners provide excellent care with superior patient satisfaction for injured children.

PURPOSE: Work hour restrictions for house staff have forced a reevaluation of the traditional roles of all health care providers. In 2001, our level I pediatric trauma center augmented the role of our trauma pediatric nurse practitioners (PNPs) to include in-patient management. We hypothesized that a PNP can provide injured children a level of care commensurate with a resident (RES). METHODS: All children between 2 months and 17 years old admitted to the Trauma Service were considered for the study. Patients were randomized to PNP or RES care groups. Types of injuries, injury severity score, missed injuries, readmissions, hospital length of stay (LOS), and cost were recorded. Satisfaction surveys were administered to all families. RESULTS: A total of 76 children were enrolled. During the study period, there were no missed injuries or readmissions. The PNP group had a significantly shorter LOS and received significantly higher satisfaction survey scores with regard to information on injuries, tests and treatment, and frequency of visits provided to the patient/family. CONCLUSIONS: PNPs provide equivalent care for injured children with significantly shorter LOS and higher patient satisfaction than RESs. In-patient trauma nurse practitioners provide added value to the care of the injured child in the era of reduced RES work hours.

Adolescent↗
PubMed2006

The effect of a right-sided aortic arch on outcome in children with esophageal atresia and tracheoesophageal fistula.

UNLABELLED: During repair of an esophageal atresia with tracheoesophageal fistula (EA/TEF), a right-sided aortic arch (RAA) presents a technical challenge. We reviewed our experience with EA/TEF focusing on the impact of RAA. METHODS: A retrospective review of patients with EA/TEF at our institution from 1990 to 2004 was performed. Of 61 patients, 53 had a left aortic arch (LAA) and 8 had RAA. RESULTS: The mean gestational age and birth weight were similar between patients with LAA and RAA. There were more vascular rings in patients with RAA than with LAA (37.5% vs 3.8%, P = .009). A preoperative echocardiogram correctly identified the location of the arch in all with LAA but only 62.5% of those with RAA. Operative complications occurred in 25% of patients with RAA and 11% of patients with LAA. CONCLUSIONS: Management of a child with RAA and EA/TEF is technically challenging. Preoperative identification of the great vessel anomalies may impact operative decision making. Therefore, careful diagnostic evaluation of a patient with an aortic arch that cannot be easily defined by ECHO should be considered before definitive repair.

Aorta, Thoracic↗
PubMed2006

A case report of severe tracheal obstruction requiring extracorporeal membrane oxygenation.

The authors describe the case of a near-fatal airway obstruction requiring extracorporeal membrane oxygenation. The patient presented with severe respiratory distress owing to a bean impacted in the distal trachea. The foreign body could not be removed by bronchoscopy because of instability of the patient. The patient was placed on extracorporeal membrane oxygenation for temporary pulmonary support, and the foreign body was removed using a rigid bronchoscope. The patient had a full recovery and suffered no neurologic sequelae.

Airway Obstruction↗
PubMed2006

Development, implementation and evaluation of a unique African-American faith-based approach to increase automobile restraint use.

OBJECTIVE: Despite generalized intervention programs, restraint use among African Americans remains below national levels, especially among children. This study describes the development and implementation of a community participatory faith-based youth injury prevention program. METHODS: Through a partnership with the African-American faith-based community and our injury prevention group, a unique multigenerational intervention program was developed targeting motor vehicle restraint use. Once developed, the program was initially evaluated by comparing outcomes between control and intervention churches. The main objective was to observe adult and pediatric restraint use before and after program implementation. RESULTS: Overall, there was excellent recognition and participation in the program. Following program implementation, significant improvements were observed in restraint use compared to control churches. In particular, there was a 72% reduction in unrestrained children, a 25% increase in children being secured in the rear-seat position and a nearly 20% increase in driver restraint use. CONCLUSIONS: The development and implementation of a culturally sensitive intervention program can significantly improve restraint use in a minority population. Partnering with the community in all phases of the program is essential to its success.

Accidents, Traffic↗
PubMed2005

Necrotizing fasciitis: a rare complication of neonatal necrotizing enterocolitis.

Necrotizing fasciitis is a rapidly spreading soft tissue infection affecting the subcutaneous tissue and underlying fascial layers. Although this infection pattern is commonly seen in adults, it is rarely seen in the neonatal population. Herein, we describe a patient who developed extensive necrotizing fasciitis of the abdominal wall after intestinal resection for necrotizing enterocolitis (NEC).

Abdominal Wall↗
PubMed2004

Tailgut cyst in a child.

Tailgut cyst, or retrorectal cystic hamartoma, is a rare congenital lesion found in the presacral space. The lesion has been infrequently reported in the literature. We report the MRI findings of a tailgut cyst in a 2-year-old girl who presented with a sacral dimple and skin discoloration.

Child, Preschool↗
PubMedDate not supplied

Diffuse pancreatic adenocarcinoma identified in an adult with annular pancreas.

Annular pancreas is a congenital anomaly resulting from malrotation of the pancreatic ventral bud. Although annular pancreas in the adult is rare, it may be recognized with increased frequency as a result of more liberal use of pancreatic imaging studies in patients with chronic abdominal pain and suspected chronic pancreatitis. Malignancy in the setting of annular pancreas is an uncommon event that has been reported previously but has almost always been related to the annular (ventral) segment. We report an interesting case in which pancreatic adenocarcinoma diffusely involving the dorsal (nonannular) segment presented in a middle-aged female patient. This unusual presentation points out the importance of considering neoplasia as part of the differential diagnosis and the possibility of pancreatic pathology in the dorsal, nonannular segment when there is no obvious duodenal or biliary obstruction involving the annular ventral segment.

Adenocarcinoma↗
PubMedDate not supplied

Family perception: quality of life following a child's traumatic injury.

This prospective research study evaluated the parent's perception of their child's quality of life at 1 and 6 months following injury, using the Child Health Questionnaire to measure outcomes. At both 1 and 6 months postinjury, the physical summary and psychosocial summary scores were significantly lower than US norms for all levels of injury severity. Predictors of lower physical and psychosocial scores, such as the Injury Severity Score and specific location of injury, were determined. This study demonstrates the long-term impact of injury and validates the need for earlier intervention and anticipatory guidance for the child and family.

Abbreviated Injury Scale↗
PubMedDate not supplied

Mild traumatic brain injury in children: just another bump on the head?

Mild traumatic brain injury (MTBI) is frequently encountered in pediatrics and challenges healthcare practitioners to provide safe, consistent, cost-effective care. Clinical management of children who sustain MTBI poses dilemmas for healthcare practitioners. This article will provide an overview of pediatric MTBI including definition, issues impacting diagnosis and management, risk factors for intracranial injury, indications for diagnostic imaging, disposition, and return to sports/activity. Knowledge and understanding of MTBI in children aid healthcare practitioners to make informed competent recommendations for care. Clinicians must have a thorough understanding and working knowledge of pediatric MTBI to aid clinical decisions and optimize patient outcomes.

Activities of Daily Living↗
PubMedDate not supplied

Pediatric trauma nurse practitioners increase bedside nurses' satisfaction with pediatric trauma patient care.

PURPOSE: Our Level I Pediatric Trauma Center employs pediatric nurse practitioners (PNP) to manage inpatients. We hypothesized that the involvement of a PNP would lead to increased nursing staff satisfaction with patient care. METHODS: Children admitted to the trauma service were randomized to PNP or resident care groups. Nurses caring for these children were asked to fill out a satisfaction survey regarding the care that the child received. FINDINGS: Sixty-five nurses participated. Nurses scored the PNP group significantly higher in human qualities, information given about the tests, management of the child's pain, and response time to pages/questions. CONCLUSIONS: Involvement of the PNP leads to higher nursing satisfaction scores compared with residents while providing equivalent care for injured children.

Attitude of Health Personnel↗
PubMedDate not supplied

Effect of safety education on classmates of injured children: a prospective clinical trial.

We hypothesized that using the teachable moment associated with an injured classmate, school-aged children would demonstrate improved retention of injury prevention education. The injured child's class and one control with presentation class received an injury prevention presentation. Prospective evaluation was performed using pre, immediate post, and 1-month posttesting. Immediately following the presentation, 83% of classes in both groups demonstrated significant improvement in test scores. At 1 month, 100% of the injured child's and only 66% of control with presentation classrooms maintained significant improvements. This unique program results not only in immediate but also in long-term retention of injury prevention information.

Academic Medical Centers↗