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Biomedical subjects

T Mayes

Publications and source records attributed to T Mayes.

15 recordsLinked to original sources
PubMed2004

Pediatric organ transplantation and the hispanic population: approaching families and obtaining their consent.

BACKGROUND: While the number of children on waiting lists for organ donation continues to increase, little data exists concerning Hispanic children and organ donation. For physicians who care for Hispanic children, it is important to understand the factors that may influence organ donation in this population. METHODS: This retrospective chart review included 88 cases of brain death that occurred between 1990 and 1999 in 3 pediatric intensive care units. The data set included brain death determination, age, ethnicity, whether the family was approached for organ donation, and rate of consent. RESULTS: Compared with non-Hispanic/Caucasian (NH/C) families, fewer Hispanic/Caucasian (H/C) families consented to organ donation (P < or = .03). H/C families were approached less often for organ donation than NH/C families, although the difference was not significant (P < or = .08). Even once approached, H/C families were probably less likely to consent to organ donation (P < or = .087). CONCLUSION: H/C families of children with brain death show a lower organ donation consent rate than do NH/C families. However, H/C families are less likely to be approached for organ donation and this may possibly explain the reason that fewer H/C families consent to organ donation.

Attitude to Health↗
PubMed2001

Are follow-up throat cultures necessary when rapid antigen detection tests are negative for group A streptococci?

The frequency of obtaining false-negative Group A Streptococcal (GAS) rapid antigen detection (RAD) tests utilizing currently available kits in a private practice setting and the cost effectiveness of requiring follow-up throat cultures were studied. Laboratory records of the Elmwood Pediatric Group (EPG), Rochester, NY, were retrospectively reviewed to identify all patients with pharyngeal RAD tests for GAS performed from January 1996 through May 1999. From January 1996 through October 1997 (study period 1), EPG physicians used either a RAD test or a throat culture to identify GAS; from November 1997 through May 1999 (study period 2), RAD tests were used as the primary test on all patients. Rapid antigen detection test negative results were confirmed with culture. During the 3-year study 11,427 RAD tests were performed. 8,385 (73.4%) were negative and 3,042 (26.6%) were positive. In study period 1, 3,547 (73.2%) were negative and 1,299 (26.8%) were positive; in study period 2 4,837 (73.5%) were negative and 1,743 (26.5%) were positive. Of the 8,385 negative tests, 8,234 (98.2%) were followed up with throat cultures. Of these, 200 (2.4%) were identified to have been negative RAD tests that were throat culture positive (132 [3.8%] of 3,474 in study period 1 and 68 [1.4%] of 4,764 in study period 2). A cost analysis was performed for study period 2, which showed that abandoning throat culture confirmation would generate a cost saving of $13,521 per year to the practice. Throat culture confirmation of RAD test negative results in pharyngitis patients may not be medically necessary for most patients with currently available RAD tests and is costly.

Adolescent↗
PubMed2000

Structured interview and uniform assessment improves diagnostic reliability.

OBJECTIVE: To compare a Childhood Uniform Assessment Package (CUAP), including a computerized structured diagnosis, with routine assessment and treatment in public mental health settings. DATA SOURCES/STUDY SETTINGS: Data was collected prospectively on 250 children and adolescents in both public mental health inpatient and outpatient settings in a large metropolitan area and a rural area. STUDY DESIGN: Subjects were randomized to either routine assessment and treatment as usual (ATU) or ATU plus an additional "gold standard" assessment battery Childhood Uniform Assessment Package (CUAP). Outcome measures were taken at admission (baseline), discharge, and again 6 months later. METHODS: The study was conducted at a State Hospital (CUAP, n = 75; ATU, n = 75) and a Community Mental Health center (CUAP, n = 50; ATU, n = 50). The "gold standard" diagnostic process was established at the Children's Medical Center-Dallas. Research focused on a comparison of the CUAP diagnostic process to the existing diagnostic process (ATU) and the service delivery system of an inpatient and outpatient public sector clinical treatment setting. PRINCIPAL FINDINGS: A bachelor's level individual can be trained to administer a highly reliable diagnostic battery to meet a "gold standard," suggesting a possible cost-effective way to assist in diagnostic evaluations. Higher reliability was found between this standardized assessment package (CUAP) and inpatient physicians than for outpatient physicians. The highest interrater reliabilities were found for attention deficit and substance abuse disorders, less so for the other behavior disorders. The use of CUAP results in more reliable diagnoses in public settings than those provided by typical clinical staff by identifying mood and anxiety disorders (disorders with the lowest reliability) with better reliability. The addition of "gold standard" diagnostic assessments (CUAP) did not appear to affect length of stay, number of medication changes, use of seclusion or restraints, and other behavioral interventions in the inpatient setting. Outpatient follow-up services did not differ for CUAP versus ATU either. CONCLUSIONS: A standard uniform assessment package that includes a structured diagnostic instrument can improve overall diagnostic reliability but may not have a significant overall impact in clinical treatment strategies or outcomes without additional intervention to assure proper use of the information. A well-trained bachelor's level assistant can administer such a battery.

Adolescent↗
PubMed2000

Penicillin failure in streptococcal tonsillopharyngitis: causes and remedies.

UNLABELLED: Penicillin administered for 10 days has been the treatment of choice for group A beta-hemolytic streptococcal tonsillopharyngitis since the 1950s. The bacteriologic failure rate of 10 days of penicillin therapy ranged from approximately 2 to 10% until the early 1970s. Beginning in the late 1970s bacteriologic and clinical failure rates with penicillin therapy began to increase steadily over time and are now reported to be approximately 30%. The primary cause of penicillin treatment failure in streptococcal tonsillopharyngitis may be lack of compliance with the 10-day therapeutic regimen. Other causes of penicillin treatment failure include reexposure to Streptococcus-infected family members or peers; copathogenicity, in which bacteria susceptible to a class of drugs are protected by other, colocalized bacterial strains that lack the same susceptibility; antibiotic-associated eradication of normal protective pharyngeal flora; and penicillin tolerance, whereby streptococcal bacteria repeatedly or continuously exposed to sublethal concentrations of antibiotic become increasingly resistant to eradication. Although 10 days of penicillin therapy is effective in the management of tonsillopharyngitis for many patients, multiple factors may, singly or together, cause treatment failure. A number of antibiotics, particularly the cephalosporins, have been demonstrated to be superior to penicillin at eradicating group A beta-hemolytic Streptococcus, and several are effective when administered for 4 to 5 days. CONCLUSIONS: Ten days of penicillin therapy may not be the best therapeutic choice for all pediatric patients. Other antibiotics, shortened courses of the cephalosporins in particular, may be preferable in some cases.

Cephalosporins↗
PubMed1997

Lack of effect of sleep on energy expenditure and physiologic measures in critically ill burn patients.

OBJECTIVE: Energy expenditure measurements, performed while patients are in standardized resting conditions, are often used as an indicator of care by which to evaluate the adequacy of nutrition support regimens. Little attention has been directed toward examining potential errors incurred by deriving daily energy needs based on a single 15- to 20-minute measurement. This study was designed to differentiate energy expenditure during periods of sleep (defined as time spent in any of the standard sleep stages) and wakefulness in pediatric burn patients. DESIGN: Twenty-four-hour indirect calorimetry, polysomnography, and physiologic assessments (mean arterial pressure, heart rate, body temperature, oxygen saturation, and respiratory rate) were conducted simultaneously in 14 patients, who were thermally injured and tracheally intubated, for a total of 45 24-hour intervals. SUBJECTS: Mean age of the patients was 10.8+/-1.2 years. Mean total body surface area of the injury was 55.7+/-4.7%, and mean full-thickness burn was 48.8+/-6.0%. STATISTICAL ANALYSES PERFORMED: A nested general linear analysis of variance model was used to evaluate the association between sleep, wakefulness, and energy needs; adjustments were made for postburn day and multiple test runs per patient. RESULTS: On average, subjects slept 699+/-46 minutes/day. They experienced a large number of awakenings from sleep (mean=53+/-6.3 awakenings per 24 hours). Patients had mean energy expenditure of 2,529+/-396 kcal/day while awake and 2,360+/-291 kcal/day while asleep, and these mean values did not differ significantly. No differences in physiologic measurements during the awake and sleep states were found. APPLICATIONS: There appears to be little difference in the metabolism of seriously injured burn patients while asleep and while awake. The study deemphasizes the importance of performing indirect calorimetry at rest in critically ill pediatric burn patients, and it supports the extrapolation of daily energy expenditure from a 15- to 20-minute steady-state measurement obtained during either sleep or wakefulness.

Adolescent↗
PubMed1997

An adaptation of hydrophobic interaction chromatography for estimation of protein solubility optima.

This study describes an adaptation of hydrophobic interaction chromatography (HIC) that can be used to estimate protein solubility optima. The method does not support determination of absolute, e.g. quantitative solubility, however it does provide a basis for identifying the salt concentration, pH, or additive concentrations that support the highest relative solubility. The magnitude of a given salt's effects are consistent with its ranking in the Hofmeister series. IgG in solutions of strong 'precipitating' salts exhibits a classical salting-in/salting-out curve, described by a solubility minimum at low ionic strength, increasing to a well-defined maximum, and then losing solubility with further elevation of salt concentration. The direct effect of pH on protein solubility, as well as its indirect effect via modification of the ionic equilibria of dissolved salts, can also be tracked. Cooperative effects of solubility modifiers such as amino acids can likewise be assessed. The technique can be a useful tool in the development of liquid formulations for protein pharmaceuticals.

Chemistry, Pharmaceutical↗
PubMed1997

Enteral nutrition for the burn patient.

In summary, thermal injury elicits numerous pathophysiological aberrations that affect nutritional status. The current recommendation for macronutrient provision postburn supports a high-calorie, protein and carbohydrate regimen and a reduction of the fat provision because of its apparent immunosuppressive properties. Early and continuous enteral feeding in the burn patient promotes optimal conditions for wound healing and immunocompetence. Because of its direct effect on morbidity and mortality, the introduction of early, continuous enteral feedings is recommended as standard therapy after burn injury. Finally, monitors for enteral placement and tolerance should be incorporated into routine care as well as the multidisciplinary Quality Management Program.

Burns↗
PubMed1996

Evaluation of predicted and measured energy requirements in burned children.

OBJECTIVE: The energy predictions of nine calculations for pediatric patients were compared with measured resting energy expenditure (MREE) by means of indirect calorimetry to determine the optimal means of energy projection in the burn population younger than 3 years of age. METHODOLOGY: Nutritional sufficiency and maintenance of preburn weight were factors in the confirmation of energy needs. Demographic factors were also studied: preburn weight, percent burn, percent third-degree burn, and age. Group 1 consisted of 24 patients younger than 3 years of age (range = 7 months to 2.6 years) with a percent burn of 30.6 +/- 2.0 and percent third-degree burn of 21.9 +/- 2.6. Group 2, consisting of 24 patients 5 to 10 years old matched by percent burn and percent third-degree burn, was included to determine whether differences between actual and projected needs were evident in older, prepubescent patients. STATISTICAL ANALYSIS: Analysis of variance was used to ascertain the most reliable multiplier for MREE needed to maintain at least 95% of preburn weight at discharge while ensuring adequate nutrition. Multiple regression analysis was used to determine the relationship between energy requirement and body weight, percent burn, and age. RESULTS: An additional 30% of MREE provided a consistent ratio of actual energy intake to required intake. MREE x 1.3 was used as a guide to study the existing calculations. For both groups, the four equations that predicted energy in healthy children most often underestimated MREE x 1.3, whereas the five formulas for children with burns tended to overpredict energy. Regression analysis yielded two new sets of equations using age, preburn weight, and percent burn (< 3 years = Mayes 1 [r2 = .71], 5 to 10 years = Mayes 3 [r2 = 70] or percent third-degree burn (< 3 years = Mayes 2 [r2 = .68], 5 to 10 years = Mayes 4 [r2 = .67]). CONCLUSIONS: The application of a 30% factor to MREE is supported in burn patients younger than 10 years of age. Standard energy projections do not provide an accurate assessment of energy needs in the pediatric burn population; thus, two sets of equations that more closely predict energy needs are proposed.

Analysis of Variance↗
PubMed1994

Meconium staining: is it related to maternal smoking?

The present study was undertaken to find if pregnant women's smoking habits were related to the presence of meconium in the amniotic fluid. The medical records of 58 women admitted to the OB service between January 1, 1992, and December 31, 1992, were reviewed. Data from the records was analyzed. Findings indicated that smoking was not related to the presence of meconium in the amniotic fluid. Some women who did not smoke had meconium stained amniotic fluid. Some women who smoked had no meconium staining. A relationship between meconium staining and maternal smoking habits was not supported.

Adolescent↗
PubMed1993

Significance of obesity on nutritional, immunologic, hormonal, and clinical outcome parameters in burns.

OBJECTIVE: The potential additive effect of obesity on selected nutritional, immunologic, hormonal, and clinical outcome parameters was evaluated. DESIGN: Fifteen obese patients were randomly matched for age, percentage of burn, percentage of third-degree burn, and inhalation injury to 15 nonobese patients. SETTING: Subjects were admitted to Shriners Burns Institute or University Hospital in Cincinnati, Ohio. RESULTS: The results of this study established a significant relationship between obesity and morbidity. Incidence of infection was greatest in the obese group (P < .03). Bacteremia (P < .008) and clinical sepsis (P < .005) occurred concomitant with obesity. The obese group required significantly (P < .05) more days on mechanical ventilatory support. Exogenous insulin supplementation (obese = 14.5 +/- 5.3 days, nonobese = 6.2 +/- 2.2 days) and antibiotic therapy (obese = 8.5 +/- 2.3 days, nonobese = 3.4 +/- 1.5 days) were required more than twice as many days in the obese group, although these trends did not reach statistical significance. Resting energy expenditure measurements were significantly higher in the obese group during weeks 1 (P < .0006) and 2 (P < .02), and the trend continued into weeks 3 and 4. Transferrin values for the obese group remained suppressed throughout the first 4 weeks after the burn, whereas the transferrin levels of the nonobese group were normal by week 4. Compared with normal-weight burn patients, obese burn patients had markedly lower alpha 2-macroglobulin values and higher glucagon levels throughout the study period. APPLICATIONS/CONCLUSIONS: The data demonstrate the many metabolic and biochemical aberrations associated with obesity, distinct from the burn injury itself, and suggest that the overweight burn patient is at increased risk of morbidity. Given the prevalence of obesity in the United States, greater attention clearly needs to be given to its prevention and management.

Acute-Phase Proteins↗
PubMedDate not supplied

Clinical nutrition protocols for continuous quality improvements in the outcomes of patients with burns.

Multiple guidelines for nutrition services in the postburn period exist. Given that nutrition intervention after burn injury affects outcome, it is appropriate to routinely consider methods for improving current practices. Effective nutrition therapies for the thermally injured individual are outlined in this article. Support for benchmarking these protocols is presented, and the completion of outcomes research in nutrition services for patients with burn injuries is encouraged.

Burn Units↗
PubMedDate not supplied

Nutrition intervention in pediatric patients with thermal injuries who require laparotomy.

Increased intra-abdominal pressure is a complication of thermal injuries that is most commonly noted during burn shock or sepsis. Severely elevated intra-abdominal pressure requires surgical treatment by laparotomy to avert cardiac, respiratory, and renal compromise. The purpose of this retrospective study was to examine the manipulation of the nutrition program and outcomes in response to such a procedure. Open laparotomy for increased intra-abdominal pressure was necessary for 6 patients admitted to a pediatric burn facility from March 1993 to April 1999. One patient was excluded from the review because he died 2 days after the burn injury (1 day after the laparotomy) and nutrition intervention was not initiated. Four of the five remaining patients received parenteral nutrition within 48 hours of surgery. One patient did not receive parenteral nutrition because the enteral regimen was at the goal by 5 days after the laparotomy. Trophic enteral feedings were initiated in all 5 patients within 48 hours of the operations. Tube feedings were gradually increased and the parenteral nutrition rate was decreased in accordance with gastrointestinal tolerance (abdominal girth, bowel motility). Enteral nutrition was started before abdomen closure in all of the patients. No mechanical, infectious, or mortality-related complications related to the initiation of enteral nutrition after open laparotomies were noted. Surgical intervention by open laparotomy interrupts the postburn nutrition regimen but does not preclude the safe postoperative delivery and advancement of enteral feedings.

Adolescent↗
PubMedDate not supplied

The 1994 Clinical Research Award. A prospective clinical study of the polysomnographic stages of sleep after burn injury.

Although subjective evidence suggests that patients with burns are deprived of sleep, previous clinical studies have been limited to observational data and have not to date included electroencephalographic or polysomnographic recordings. The purpose of this study was to characterize the sleep pattern of patients suffering from thermal injury. Biweekly 24-hour polysomnographic measurements (electromyography, electrooculography, and electroencephalography) were performed with 12 leads. This measuring permitted continuous recording of intrinsic electrical activity in skeletal muscles via chin electrodes, eye movement via outer canthal electrodes, and brain wave activity with the other bipolar electrodes. Determinations were obtained on 11 patients with thermal injuries for a total of 43 24-hour periods. The patients had a mean age of 8.31 +/- 1.5 years (range 1.4 to 16 years), a mean total body surface area burn of 55.1% +/- 16.5% (range 17.5% to 90.5%), and a mean full-thickness burn of 48.5% +/- 8.1% (range 10.5% to 90.5%). Although mean total sleep time was seemingly adequate (625.1 +/- 31.6 min/patient/24 hrs), large aberrations in sleep stage distribution were noted. Significant decreases in stage 3 + 4 and in rapid eye movement (deep sleep) and increases in stages 1 and 2 (light sleep) were noted, suggesting a cycling back to stages 1 or 2 after disruption of sleep. Overall, in 43 runs 40% of the subjects were completely lacking stage 3 + 4, and 19% were missing rapid eye movement during an entire 24-hour run.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗