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Biomedical subjects

Robert B Mellins

Publications and source records attributed to Robert B Mellins.

11 recordsLinked to original sources
PubMed2006

Lung injury from smoke inhalation.

Significant morbidity and mortality from smoke inhalation occurs in victims of fire. Lung injury can be caused by chemical and thermal insults. A variety of noxious gases, irritants and asphyxiants are generated depending on the material burnt. Carbon monoxide is the predominant cause of death among fire victims. Treatment should be directed at reversing hypoxaemia as a result of asphyxia or carbon monoxide poisoning. There is no evidence that the routine use of corticosteroids or prophylactic antibiotics is beneficial. Through a better understanding of the pathophysiology of smoke-induced lung injury, the effects of exogenous surfactant, leukotriene inhibitors, antioxidants, nitric oxide synthase inhibitors and fibrinolytics suggest that these compounds may have a future therapeutic role in smoke-induced injury. Studies are needed to evaluate the safety and efficacy of these potential therapies before they are used clinically.

Burns, Inhalation↗
PubMed2006

Using school staff to establish a preventive network of care to improve elementary school students' control of asthma.

School-based asthma interventions delivered by nonschool staff have been successful but are limited in their reach because of the cost and effort of bringing in outside educators and their inability to establish improved communication about asthma between schools, families, and primary care providers (PCPs). To address these problems, Columbia University and the New York City Department of Education and the New York City Department of Health and Mental Hygiene undertook a randomized controlled trial to test the efficacy of a comprehensive school-based asthma program. In this intervention, school nurses were trained to facilitate the establishment of a preventive network of care for children with asthma by coordinating communications and fostering relationships between families, PCPs, and school personnel. PCPs also received training regarding asthma management. There was limited support for this model. While case detection helped nurses identify additional students with asthma and nurses increased the amount of time spent on asthma-related tasks, PCPs did not change their medical management of asthma. Few improvements in health outcomes were achieved. Relative to controls, 12-months posttest intervention students had a reduction in activity limitations due to asthma (-35% vs -9%, p < .05) and days with symptoms (26% vs 39%, p = .06). The intervention had no impact on the use of urgent health care services, school attendance, or caregiver's quality of life. There were also no improvements at 24-months postintervention. We faced many challenges related to case detection, training, and implementing preventive care activities, which may have hindered our success. We present these challenges, describe how we coped with them, and discuss the lessons we learned.

Absenteeism↗
PubMed2006

Validating an asthma case detection instrument in a Head Start sample.

Although specific tests screen children in preschool programs for vision, hearing, and dental conditions, there are no published validated instruments to detect preschool-age children with asthma, one of the most common pediatric chronic conditions affecting children in economically disadvantaged communities of color. As part of an asthma education intervention, a 15-item Brief Respiratory Questionnaire (BRQ) was developed to detect children with probable asthma in Head Start and subsidized preschool settings in communities with high asthma prevalence and associated morbidity. Preschool personnel administered the BRQ to consenting parents of 419 enrolled children. Trained interviewers administered validation interviews (VALs) to parents of 149 case-positive children and 51 case-negative children. Three physicians independently assessed deidentified summaries of the VALs that captured responses about signs and symptoms of asthma, diagnosis and treatment, and use of medical services. The physicians' assessments of the summarized VALs were the validated standard to which the BRQ classifications were compared. A simple algorithm of 4 items was identified that can be administered and scored by nonmedical preschool personnel in less than 5 minutes. The chance-corrected agreement between these 4 items of the BRQ and the VAL was good: kappa, .73 (95% confidence interval, 0.62-0.84); specificity, 96%; sensitivity, 73%; and positive predictive value, 97%. The BRQ appears to be a valid instrument for detecting children with probable asthma in Head Start and other subsidized preschool settings in communities with high prevalence of asthma.

Allergens↗
PubMed2006

Impact of physician asthma care education on patient outcomes.

OBJECTIVE: We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. METHODS: We conducted a randomized trial in 10 regions in the United States. Primary care providers were recruited and randomly assigned by site to receive the program provided by local faculty. The program included 2 interactive seminar sessions (2.5 hours each) that reviewed national asthma guidelines, communication skills, and key educational messages. Format included short lectures, case discussions, and a video modeling communication techniques. We collected information on parent perceptions of physicians' communication, the child's asthma symptoms, and patients' asthma health care utilization. We used multivariate regression models to determine differences between control and intervention groups. RESULTS: A total of 101 primary care providers and a random sample of 870 of their asthma patients participated. After 1 year, we completed follow-up telephone interviews with the parents of 731 of the 870 patients. Compared to control subjects, parents reported that physicians in the intervention group were more likely to inquire about patients' concerns about asthma, encourage patients to be physically active, and set goals for successful treatment. Patients of physicians that attended the program had a greater decrease in days limited by asthma symptoms (8.5 vs 15.6 days), as well as decreased emergency department asthma visits (0.30 vs 0.55 visits per year). CONCLUSIONS: The Physician Asthma Care Education program was used in a range of locations and was effective in improving parent-reported provider communication skills, the number of days affected by asthma symptoms, and asthma health care use. Patients with more frequent asthma symptoms and higher health care utilization at baseline were more likely to benefit from their physician's participation in the program.

Asthma↗
PubMed2005

Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure.

BACKGROUND/PURPOSE: Patient reports of preoperative exercise intolerance and improvement after surgical repair of pectus excavatum (Pex) have been documented but not substantiated in laboratory studies. This may be because no study has been large enough to determine if pulmonary function tests (PFTs) in the Pex population are significantly different from the normal population, and none has assessed improvement in pulmonary function after Nuss bar removal. METHODS: The authors studied PFT results in 408 Pex patients before repair and in a subset of 45 patients after Nuss procedure and bar removal. Significance of differences in percent predicted (using Knudson's equations) was tested using t tests (parametric) or sign tests (nonparametric). Normal was defined as 100% of predicted for forced vital capacity (FVC), forced expired volume in 1 second (FEV1), and forced expiratory flow (FEF25%-75%). RESULTS: Preoperatively, FVC and FEV1 medians were lower than the normal by 13%, whereas the FEF 25-75 median was lower than normal by 20% (all P < .01). The postoperative group had statistically significant improvement after surgery for all parameters. Patients older than 11 years at the time of surgery had lower preoperative values and larger mean post-bar removal improvement than the younger patients. An older patient with a preoperative FEF25-75 score of 80% of normal would be predicted by these data to have a postoperative FEF25-75 of 97%, indicating almost complete normalization for this function. CONCLUSIONS: These results demonstrate that preoperatively Pex patients as a group have decreased lung function relative to normal patients. After Nuss procedure and bar removal, we show a small but significant improvement in pulmonary function. These results are consistent with patient reports of clinical improvement and indicate the need for more in-depth tests of cardiopulmonary function under exercise conditions to elucidate the mechanism.

Adolescent↗
PubMed2004

Pediatric pulmonology: a developmental history in north america.

We describe the development of pediatric pulmonology in North America, from its rudimentary beginning in the early part of the 20th century. Milestones in the history of lung diseases affecting children, such as tuberculosis, cystic fibrosis, asthma, and neonatal lung disease, are discussed. Finally, maturation into a subspecialty recognized by the American Board of Pediatrics is described.

History, 19th Century↗
PubMed2004

Maximal expiratory flow at FRC (V'maxFRC): Methods of selection and differences in reported values.

We compared three methods of reporting maximal expiratory flow (V'maxFRC) measured in partial expiratory flow-volume curves (PEFVCs) at the point of functional residual capacity (FRC). PEFVCs were obtained with the rapid thoracoabdominal compression technique (RTC) on a total of 446 occasions in 281 HIV-negative, asymptomatic infants (4.8-28.1 months old). Three different expressions of V'maxFRC were recorded: 1) the highest measured flow (maxV'FRC), 2) the mean of the three highest flows (mean3V'FRC), and 3) the flow at FRC in a composite curve (compV'FRC) consisting of PEFVCs, obtained at different jacket pressures and superimposed at their distal limb. The numerical value of maxV'FRC was 7.4% (+/-5.6%) higher than the mean3V'FRC, and 11.9% (+/-17.7%) higher than the compV'FRC; the mean3V'FRC was 5% (+/-18.3%) higher than the compV'FRC. Bland-Altman analysis was used to evaluate the agreement between the three indices. The mean difference and 95% limits of agreement were: maxV'FRC -mean3V'FRC, 14 +/- 18 ml/sec; maxV'FRC - compV'(FRC), 23 +/- 58 ml/sec; and mean3V'(FRC) - compV'(FRC), 10 +/- 52 ml/sec. The differences between the slopes of the three indices (regressed against height) were statistically significant, although clinically unimportant. We conclude that despite their high correlation, the mean3V'FRC and maxV'FRC should not be used interchangeably, and that the composite analysis, although useful, does not improve the reproducibility of V'maxFRC, and thus it cannot be recommended for routine use in its current form.

Child, Preschool↗
PubMed2004

Asthma education: the adolescent experience.

Recent studies show that prevalence of asthma is higher among adolescents than children. Adolescents have poor asthma self-management skills resulting in a significant increase in the severity of asthma exacerbations and a reduction in their quality of life. Despite this, few self-management programs have been developed for adolescents. Adolescents experience developmental transitions that both hinder and facilitate asthma self-management. In this paper we discuss developmental transitions in cognition, knowledge, autonomy, identity development, and peer relations in terms of their influence on adolescents' management of asthma. Next, we describe the Asthma Self-Management for Adolescents (ASMA) program that incorporates developmental characteristics into an age-appropriate school-based asthma education program. Preliminary data is presented indicating that the program is successful in enrolling and engaging the interest of adolescents with persistent asthma.

Adolescent↗
PubMed2002

An individualized intervention to improve asthma management among urban Latino and African-American families.

We hypothesized that an educational intervention based on a readiness model would lead to improved health outcomes among patients with asthma. Within a randomized control design in an urban Latino and African-American community we conducted an intensive three-month pediatric intervention. A Family Coordinator provided patient education based on a readiness-to-learn model, and facilitated improved interactions between the patient and the doctor. Family education addressed the most basic learning needs of patients with asthma by improving their perception of asthma symptom persistence using asthma diaries and peak flown measures. The physician intervention focused cliniciancs' attention on patients' diary records and peak flow measures, and encouraged physicians to use stepped action plans. Patients were also tested for allergic sensitization and provided strategies to reduce contact with allergens and other asthma triggers. The results showed significant improvements by intervention group families on measures of knowledge, health belief, self-efficacy, self-regulatory skill, and adherence; decreases in symptom persistence and activity restriction; and increased prescription of anti-inflammatory medication by the physicians of the intervention group families.

Black or African American↗
PubMedDate not supplied

Successful techniques for retaining a cohort of infants and children born to HIV-infected women: the prospective P2C2 HIV study.

Retaining subjects from disadvantaged populations in long-term studies is necessary to obtain high-quality data. This article presents cumulative retention rates from a 5-year prospective cohort study, the Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection study. It also presents results of a cross-sectional qualitative survey about factors that induced caregivers to stay in the study. Although the repeated study visits were long and uncomfortable, cumulative retention among the 298 HIV-infected children was 80%. Incentives considered important by the caregivers included phone contact with nurse coordinators, nurse coordinators accompanying the caregiver and child during visits, phone reminders for appointments, help with scheduling, meals and transportation, access to health care, and relationships with staff. Thus, the high follow-up rate was in part due to nurses' efforts to reduce the study's burden on the families, provide tangible and intangible incentives, and establish personal relationships with families.

Adult↗