George Lister | Yale University (original) (raw)

Papers by George Lister

Clinics in Chest Medicine, 1983

SUMMARY The preceding discussion focused on some of the unique aspects of cardiopulmonary interac... more SUMMARY The preceding discussion focused on some of the unique aspects of cardiopulmonary interaction in the infant and child with congenital cardiac anomalies. We have extracted liberally from our previous reviews and have tried to select information from the literature that helps to elucidate mechanisms for many of the observed phenomena. Where data were not available, we attempted to draw inference from analogous conditions or speculated about the pathophysiology. We have grouped the cardiac lesions by virtue of their predominant pathophysiology. Our rationale was to provide the reader with a framework for understanding the genesis of respiratory problems caused by congenital heart disease and for anticipating untoward problems that could arise with a particular “therapeutic” maneuver. Finally, we hope to have stimulated interest in an area ripe for probing—the fascinating interdependence between the heart and the lung in the young child.

Pediatrics, May 1, 1974

... 5 May 1974 Oxygen Uptake in Infants and Children: A Simple Method for Measurement G. Lister, ... more ... 5 May 1974 Oxygen Uptake in Infants and Children: A Simple Method for Measurement G. Lister, MD, JIE Hoffman, MD, FRCP, and AM Rudolph, MD, FRCP, FACC From the Department of Pediatrics and Cardiovascular Research Institute, University of California-San Francisco ...

Archives of Neurology, 1986

• the precise origin of Reye's syndrome is unknown, therapeutic approaches to the disease hav... more • the precise origin of Reye's syndrome is unknown, therapeutic approaches to the disease have three major goals: intensive supportive care, correction of identifiable metabolic abnormalities, and control of intracranial pressure (ICP). 1 For mild cases (stages I and II), the patient should be observed closely in a pediatric intensive care unit (such patients are subject to rapid and sudden deterioration in neurologic status) and treated with intravenous hypertonic (10% to 15%) glucose solutions at normal maintenance volumes. There is evidence that administration of hypertonic glucose solution to patients in the early stages may prevent disease progression. 2 If the disease progresses to stage III or worse, more aggressive therapy is necessary. The following recommendations are for treatment of patients with severe Reye's syndrome (stages III through V). INTENSIVE SUPPORTIVE CARE Children with Reye's syndrome are subject to hyperthermia, even in the absence of detectable infection, and to sudden respiratory

Pediatric Research, 1993

Society for Pediatric Research Presidential Address 1993: Development of the Academic Pediatrician

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Pediatric Clinics of North America, 1987

In 1986, the pediatric intensive care unit (PleU) is a busy place. The child is exposed to consta... more In 1986, the pediatric intensive care unit (PleU) is a busy place. The child is exposed to constant visual, auditory, and tactile stimuli that are not part of his or her normal routine and are often emotionally and physically painful. It is a place where the child's autonomy and sense of self are often lost and the traditional roles of the family severely disrupted. It is a place where the common objective is to monitor patients closely in an environment where physiologic changes can be recognized and acted on rapidly. The Pleu has come to rely on doctors, nurses, social workers, and occupational, physical, and respiratory therapists with specific training in the care of critically ill children. It also relies heavily on invasive and noninvasive monitoring devices, invasive procedures, and constant manipulation and assessment of the child's condition. This degree of monitoring and observation, although playing a vital part in therapy and eventual outcome, carries with it inherent risks to the child. In some areas of medicine and even critical care, the risks and adverse occurrences have been clearly described and often quantified. 1, 21, 103, 120, 124 In contrast, and despite the burgeoning of pediatric critical care as a subspeciality, there is very little information addressing adverse occurrences in the realm of pediatric critical care. At present, therefore, we are often left to extract data gathered from the adult and neonatal literature and then translate and apply this information to the care of the young child-not a very satisfactory long-term approach! It is the aim of this article to review the literature describing adverse occurrences affecting children in the Pleu. By necessity, data from studies in adult patients will be cited when similar information in children is lacking and when these data are applicable. It will not be prudent to document all reported adverse occurrences referenced to children; there

Sleep, 1997

Infant polysomnography (IPSG) is an increasingly important procedure for studying infants with sl... more Infant polysomnography (IPSG) is an increasingly important procedure for studying infants with sleep and breathing disorders. Since analyses of these IPSG data are subjective, an equally important issue is the reliability or strength of agreement among scorers (especially among experienced clinicians) of sleep parameters (SP) and sleep states (SS). One basic issue of this problem was examined by proposing and testing the hypothesis that infant SP and SS ratings can be reliably scored at substantial levels of agreement, that is, kappa (K) 2: 0.6J. In light of the importance of IPSG reliability in the collaborative home infant monitoring evaluation (CHIME) study, a reliability training and evaluation process was developed and implemented. The bases for training on SP and SS scoring were CHIME criteria that were modifications and supplements to Anders, Emde, and Parmelee (10). The K statistic was adopted as the method for evaluating reliability between and among scorers. Scorers were three experienced investigators and four trainees. Interand intrarater reliabilities for SP codes and SSs were calculated for 408 randomly selected 30-second epochs of nocturnal IPSG recorded at five CHIME clinical sites from healthy full term (n = 5), preterrn (n = 4), apnea of infancy (n = 2), and siblings of the sudden infant death syndrome (SIDS) (n = 4) enrolled subjects. Infant PSG data set I was scored by both experienced investigators and trained scorers and was used to assess initial interrater reliability. Infant PSG data set 2 was scored twice by the trained scorers and was used to reassess inter-rater reliability and to assess intrarater reliability. The KS for SS ranged from 0.45 to 0.58 for data set 1 and represented a moderate level of agreement. Therefore, rater disagreements were reviewed, and the scoring criteria were modified to clarify ambiguities. The KS and confidence intervals (CIs) computed for data set 2 yielded substantial inter-rater and intrarater agreements for the four trained scorers; for SS, the K = 0.68 and for SP the KS ranged from 0.62 to 0.76. Acceptance of the hypothesis supports the conclusion that the IPSG is a reliable source of clinical and research data when supported by significant KS and CIs. Reliability can be maximized with strictly detailed scoring guidelines and training.

Pediatrics, 2017

Over the past 20 years, hospitalists have emerged as a distinct group of pediatric practitioners.... more Over the past 20 years, hospitalists have emerged as a distinct group of pediatric practitioners. In August of 2014, the American Board of Pediatrics (ABP) received a petition to consider recommending that pediatric hospital medicine (PHM) be recognized as a distinct new subspecialty. PHM as a formal subspecialty raises important considerations related to: (1) quality, cost, and access to pediatric health care; (2) current pediatric residency training; (3) the evolving body of knowledge in pediatrics; and (4) the impact on both primary care generalists and existing subspecialists. After a comprehensive and iterative review process, the ABP recommended that the American Board of Medical Specialties approve PHM as a new subspecialty. This article describes the broad array of challenges and certain unique opportunities that were considered by the ABP in supporting PHM as a new pediatric subspecialty.

Pediatric Cardiology, 1986

Oxygen consumption of tissue, an organ, or the whole body is usually a function of metabolic dema... more Oxygen consumption of tissue, an organ, or the whole body is usually a function of metabolic demands, and it is not dependent on oxygen supply. With moderate reductions in systemic oxygen transport (SOT: the product of cardiac output in arterial oxygen content), there is usually sufficient reserve to maintain oxygen consumption (\( {\dot V_{{O_2}}} \): the product of cardiac output and arteriovenous oxygen content difference). Alternatively, if metabolic demands are increased, as with exercise or fever, there is sufficient transport to meet these needs [1].

Chronic Lung Disease in Early Infancy, 1999

Pediatric Pulmonology, 1998

Intrinsic properties of lung and chest wall tissues can lead to breathing rate (frequency [f]) an... more Intrinsic properties of lung and chest wall tissues can lead to breathing rate (frequency [f]) and amplitude (tidal volume [V T ]) dependence of respiratory system resistance (R) and elastance (E). To explore these dependencies on R and E within physiological limits of tidal volume and breathing frequencies during early childhood. we measured airway opening pressure (P ao) and flow (VЈ ao) in 15 anesthetized, paralyzed, intubated, and mechanically ventilated healthy children (age 1 day to 72 months; weight 2.5−21 kg) at multiple combinations of V T (6, 10, and 14 mL/kg) and frequency (10, 20, and 30 breaths/min). In each instance, R and E were estimated by multiple linear regression applied to the tracheal pressure, flow, and volume (V), assuming a simple series RE model. R decreased substantially with increasing frequency and weight (Wt), but was unaffected by changes in V T (R = 764Wt −0.91 и f −0.57). E decreased sharply with increasing Wt, was lower at higher V T , and was slightly, yet significantly, increased at higher frequency (E = 2,905Wt −1.38 и V T −0.18 и f 0.11). Such frequency dependence of R and E is consistent with stress adaptive, or viscoelastic, properties of respiratory tissues. The small V T dependence of E is similar to that observed in other species under healthy conditions and presumably reflects the combined nonlinear pressure-volume relationships of the healthy parenchymal and chest wall tissues. Lack of V T dependence of R at high inspiratory flow rates suggests that turbulent flows are either not an important form of energy dissipation in the lower airways of children or they are counterbalanced by a decrease in tissue damping at high V T. The above regression models represent the first attempt to quantify simultaneously the separate effects of lung growth as well as rate and amplitude of breathing on R and E. Similar equations based on a larger sample of healthy subjects can provide normative R and E values for comparison with mechanically ventilated children with lung disease.

Current Opinion in Pediatrics, 1999

Annals of Emergency Medicine, 2005

Pediatrics, 1977

A wide variety of artifacts may be found when monitoring the ECG in a neonatal intensive care uni... more A wide variety of artifacts may be found when monitoring the ECG in a neonatal intensive care unit. Many of the artifacts resemble arrhythmias, and unless they are recognized as artifacts they may lead to serious errors of diagnosis and therapy. Many of the artifacts are caused by patient movement such as seizures, tremulousness, or hiccups. Others may be introduced by the monitor itself or be caused by electrical equipment in the vicinity. A group of ECC tracings is presented to illustrate the various artifacts encountered. Features that distinguish the artifacts from the arrhythmias they mimic are described, as are suggestions for elimination of the artifacts.

Pediatrics, 1981

The effect of physical training on the exercise performance of 26 patients following surgical rep... more The effect of physical training on the exercise performance of 26 patients following surgical repair of tetralogy of Fallot (16 patients) and ventricular septal defect (ten patients) was evaluated. Base line exercise testing was performed on a bicycle ergometer using the technique of Godfrey. Patients were placed on a six-week alternate day submaximal interval home exercise program of varying duration and intensity. Work loads at 50%, 60%, and 70% maximum oxygen consumption were selected to maintain heart rates between 130 and 160 beats per minute. Subjects completed an average of 18 of the possible 21 training sessions (range 11 to 21). A 25% improvement (P < .001) was noted in maximum work capacity (747 to 935 km). Sixty-five percent of the patients performed at less than expected maximum work capacity prior to training, but only 31% performed at less than expected maximum work capacity after training. Repeat testing at work loads of one-third, one-half, and two-thirds the orig...

Pediatrics, 1987

There is significant controversy about the role of bronchodilator therapy for wheezing in infants... more There is significant controversy about the role of bronchodilator therapy for wheezing in infants. A double-blind, randomized trial of subcutaneous epinephrine v normal saline was conducted in children <24 months of age evaluated at Yale-New Haven Hospital. Respiratory assessments using a newly developed Respiratory Distress Assessment Instrument were made at baseline and 15 minutes after each of two injections. Relief of respiratory distress was assessed using strict a priori criteria based on changes in respiratory rate, wheezing, and retractions as scored in the Respiratory Distress Assessment Instrument. Significantly more children improved their respiratory status with epinephrine (nine of 16) than placebo (one of 14) (Fisher exact test, P = .0067). Paired data in individuals receiving placebo and then epinephrine confirmed this (Wilcoxon signed ranks test, P < .01). Sixty-three percent of patients <12 months and 92% of those 12 to 24 months improved with epinephrine, ...