OBJECTIVES. The Hawaii Child Asthma Research to Elevate Standards (CARES) Program implemented an emergency department (ED)-based education and management program to facilitate National Asthma Education and Prevention Program (NAEPP) guideline understanding among asthmatic children and their families, ED staff, and health care providers.METHODS. The multipronged approach used: (1) 2-phased prospective tracking system of ED asthma patients; (2) ED-based educational intervention for patients/ families; and (3) asthma education for ED staff and community-based health care providers. Data were collected across 4 EDs during phase I (October 8, 2002, to October 1, 2003 and phase II (October 1, 2003, to July 8, 2004. Follow-up data were collected by telephone 3 weeks (phase I), and 3 weeks and 3 months (phase II) after the ED encounter. The patient/family intervention was delivered throughout phase II. During phase I, ED and community-based health care professionals developed strategies for building an integrated asthma care system. ED staff training was delivered before phase II. Continuing medical education for health care providers was delivered before and during the first month of phase II.RESULTS. Tracking data on 706 phase I and 353 phase II patient encounters revealed that the majority of patients with persistent asthma did not use long-term controller medications and did not possess a written asthma action plan. From preintervention to postintervention, the number of patients possessing a written asthma action plan increased from 48 to 322. Of 186 persistent asthmatics, 34 were using controller medications daily, 34 as needed, and 118 not at all. Daily use increased to 80 3 weeks postintervention and to 68 3 months postintervention. A LTHOUGH THERE IS no cure for asthma, self-management can prevent acute asthma exacerbations and irreversible damage to airway function, and improve patients' quality of life (QoL). 1,2 Accordingly, children and their families need to be a key focus for self-management education. 3 National Asthma Education and Prevention Program (NAEPP) guidelines provide a blueprint for such education. 1 To evaluate the status of childhood asthma and its care, assess health care provider adherence to guidelines, and create an integrated system of asthma care, the Hawaii Child Asthma Research to Elevate Standards (CARES) program was developed. The program was directed from the University Tertiary Care Pediatric Teaching Center at the John A. Burns School of Medicine, Kapi'olani Medical Center for Women and Children. Because the medically underserved areas of northeast and west Oahu coincide with the highest incidence of asthma within Honolulu County, 4 medical institutions serving these communities were invited to develop the program jointly. A multiethnic, culturally sensitive approach to data collection was developed to obtain accurate information from this diverse population to develop and implement an emergency department (ED)-based asthma education program for patients, families, and ...

Summary SUBJECTS A N D METHODSThe differences in the immediate (30 sec or 1 min) and late (5 min) ventilatory response to high and low Oz have not been SUBJECTS quantitated in preterm infants and adult subjects using the sameWe compared the results obtained in nine "healthy" preternl methods. It was thought that these differences might explain the infants studied during the first days of life with those of paradoxical ventilatory response to COz at various O2 concentrations in preterm infants (12). Thus, 9 preterm infants and 10 adult healthy adult subjects studied at a mean age (+SE) of 27 + 3 yr. subjects were given 21% Oz to breathe and then 100 or 15% Oz for Infants had a mean gestational age (+SE) of 33.5 + 0.5 weeks and 5 min each. Adults also breathed 15% Oz before 100% Oz or 12% mean birth weight of 1490 + 80 g. Adult subjects had a mean Oz in order to make their resting arterial POz more comparable weight of 65 + 5 kg.to those of infants breathing 21% Oz. The ventilatory response to 100% 0 2 was the same in preterm infants and adult subjects, but METHODS the late response to 15% Oz remained paradoxical, ventilation decreasing at by 18% in infants and increasing by 19% in The system to measure ventilation has been described previadults. The authors conclude: 1) the traditional concept of the o u s '~ ('7 9, lo). in we used a and screen ventilatory response to 100% oz being different in infants and flowmeter to measure respiratory minute volume and alveolar adult subjects is false; 2) the notion that the response to low Oz is gases' We eliminated valves and reduced dead 'pace using a paradoxical in infants is correct; and 3) the data do not explain constant background flow which was electrically balanced to an why the to coz under various background concentrations artificial zero. The infant breathed through the nostril adapters of Oz in infants is the reverse of that in adult subjects, but the and added Or substracted (inspiration) the depressed ventilatory response to hypoxia in infants may justify, background flow. The flow signal was integrated at least in part, their flatter response to COz during low Oz give volume. breathing.Breath to breath POz and PCOz was monitored as outlined elsewhere (12). In adults, a similar system was used with the following differences: I) the background flow was 30 liter/min Speculation instead of 2.7 liter/min; 2) a Fleisch pneumotach no. 4 was used The findings suggest that the response of preterm infants to instead of the Monel screen flowmeter; and 3) a mouthpiece high and low 0 2 per se is not the cause of the paradoxical response replaced the nostril adapters. to COz under various background concentrations of Oz. If it were, Infants were studied on the Ohio Neonatal Intensive Care Unit it would be expected that the response to low and high Oz would shortly after a feed. Abdominal skin temperature was kept at 36.5 differ in infants and adults. This was true for hypoxia only, the + 0.03OC. Xylocaine ointment was used to anesthetize the skin response to hyperoxia bein...

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