Showing papers by "Michael D. Cabana published in 2000"
TL;DR: Efforts to improve adherence to asthma guidelines should consider the range of barriers that pediatricians face, such as lack of awareness, familiarity, or agreement, and external barriers owing to environmental, guideline, or patient factors.
Abstract: Objective To describe barriers to the successful use of the 1997 National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines. Methods We conducted 3 focus groups to understand barriers to the use of 4 recommendations within the NHLBI guidelines (prescription of inhaled corticosteroids, recommendation of daily peak flowmeter use, smoking cessation screening and counseling, and allergen exposure counseling). Participants Twenty-one pediatricians and 1 nurse practitioner, who each followed an average of 47 patients with asthma, participated. Six participants (27%) had a faculty or adjunct appointment at a medical school. Nineteen (90%) of the 21 pediatricians were board certified. Results We identified 171 comments about barriers to adherence. Type of recommendation and physician year of graduation from medical school were related to which barrier was prominent. For corticosteroid prescription, senior physicians mentioned lack of agreement, whereas younger physicians described lack of confidence in dosing or recognizing contraindications. For peak flowmeter use, senior physicians emphasized lack of training. Only senior physicians described the inertia of previous practice as a barrier. All groups mentioned time limitations. Conclusions Efforts to improve adherence to asthma guidelines should consider the range of barriers that pediatricians face, such as lack of awareness, familiarity, or agreement, and external barriers owing to environmental, guideline, or patient factors. In addition, this study documents barriers not previously considered, such as lack of self-efficacy, lack of outcome expectancy, and inertia of previous practice, that prevent adherence. Because type of recommendation and physician demographics are related to which barriers are prominent, interventions to improve NHLBI guideline adherence should be tailored to these factors.
251 citations
TL;DR: It is suggested that PIE can have an insidious onset and that a delayed presentation of PIE should be included in the differential for respiratory distress in a former preterm infant recovering from severe RDS even after hospital discharge.
Abstract: Pulmonary interstitial emphysema (PIE) is a well-described complication of positive-pressure mechanical ventilation and respiratory distress syndrome (RDS) in the newborn.' Although PIE is a common diagnosis in the neonatal intensive care unit (NICU), we are not aware of any reports documenting its presentation in an outpatient setting.2 We present a case of PIE in a former premature infant that occurred 1 month after extubation and 1 week after discharge with no subsequent evidence of respiratory distress until presentation. This patient suggests that PIE can have an insidious onset and that a delayed presentation of PIE should be included in the differential for respiratory distress in a former preterm infant recovering from severe RDS even after hospital discharge.
10 citations
TL;DR: A 14 month old African American girl with a history of Wolff-Parkinson-White (WPW) syndrome presented to the emergency department apnoeic, cyanotic, and without a pulse and was pronounced dead.
Abstract: A 14 month old African American girl with a history of Wolff-Parkinson-White (WPW) syndrome presented to the emergency department apnoeic, cyanotic, and without a pulse. She had suddenly become limp and unarousable. She did not respond to resuscitative efforts and was pronounced dead.
The patient had been diagnosed with WPW when she was 6 months old, after an irregular rhythm was noted in a routine examination. ECG showed normal sinus rhythm with infrequent preventricular contractions, a delta wave, a PR interval of 0.06 seconds, and a QRS interval …
6 citations