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Biomedical subjects

C Macarthur

Publications and source records attributed to C Macarthur.

At least 37 records · Page 2Linked to original sources
PubMed1999

Evaluation of the quality of an injury surveillance system.

The sensitivity, positive predictive value, and representativeness of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were assessed. Sensitivity was estimated at four centers in June through August 1992, by matching independently identified injuries with those in the CHIRPP database. The positive predictive value was determined by reviewing all "injuries" in the database (at Montreal Children's Hospital) that could not be matched. Representativeness was assessed by comparing missed with captured injuries (at Montreal Children's Hospital) on demographic, social, and clinical factors. Sensitivity ranged from 30% to 91%, and the positive predictive value was 99.9% (i.e., the frequency of false-positive capture was negligible). The representativeness study compared 277 missed injuries with 2,746 captured injuries. The groups were similar on age, sex, socioeconomic status, delay before presentation, month, and day of presentation. Injuries resulting in admissions, poisonings, and those presenting overnight were, however, more likely to be missed. The adjusted odds ratio of being missed by CHIRPP for admitted injuries (compared with those treated and released) was 13.07 (95% confidence interval 7.82-21.82); for poisonings (compared with all other injuries), it was 9.91 (95% confidence interval 5.39-18.20); and for injuries presenting overnight (compared with those presenting during the day or evening), it was 4.11 (95% confidence interval 3.11-5.44). These injuries were probably missed because of inadequate education of participants in the system. The authors conclude that CHIRPP data are of relatively high quality and may be used, with caution, for research and public health policy.

Adolescent↗
PubMed1999

Sensitivity and representativeness of a childhood injury surveillance system.

OBJECTIVE: To determine the sensitivity and representativeness of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). SETTING: The study was conducted in the Ottawa-Carleton region of Ontario, Canada (June through August, 1992). METHODS: Surveillance system sensitivity was estimated by dividing the number of injured children attending the Children's Hospital of Eastern Ontario (the only CHIRPP center in Ottawa-Carleton) by the total number of emergency department attended childhood injuries in the region. CHIRPP representativeness was assessed by comparing the injuries missed by the system with those captured on social, demographic, and clinical factors. RESULTS: Sensitivity was 65% (1552/2386). Missed and captured injuries were similar on sex, day, time of presentation, injury intent, and delay before presentation. Children older than 14 years, however, were more likely to be missed by the system; adjusted odds ratio 3.52 (95% confidence interval (CI) 2.87 to 4.32). Conversely, children admitted to hospital were less likely to be missed; adjusted odds ratio 0.43 (95% CI 0.23 to 0.80). CONCLUSION: Given the systematic errors in capture, CHIRPP data should be used cautiously in studies of etiology.

Adolescent↗
PubMed1999

Helicobacter pylori infection and childhood recurrent abdominal pain: lack of evidence for a cause and effect relationship.

BACKGROUND: Recurrent abdominal pain is a common complaint among children and adolescents. Apley's criteria - at least three discrete episodes of abdominal pain of sufficient severity to interrupt normal activities that occur over a period of three or more months - are often used to define this chronic pain syndrome. OBJECTIVE: To summarize the extent and quality of the published evidence for a cause-and-effect relationship between Helicobacter pylori infection and childhood recurrent abdominal pain. MATERIALS AND METHODS: The MEDLINE bibliographic database (January 1983 to July 1998) was searched to identify pertinent (English language) studies. The search was restricted to prospective, controlled studies reporting empirical data on children up to 18 years of age. RESULTS: Six studies were identified. Five of the six were case-control studies, while the remaining study assessed the effectiveness of antibiotic therapy. Only one study was community based, with the remaining studies conducted in the tertiary hospital setting. The evidence for a causal relationship was inconsistent; of the five case-control studies reviewed, the odds ratios ranged from 0.32 to 1.80. Two studies demonstrated statistically significant results; however, the findings were conflicting. The only treatment trial was limited because of methodological flaws. CONCLUSIONS: Current evidence suggests no association between H pylori infection and recurrent abdominal pain in children. The evidence to date indicates that routine investigation for H pylori infection in children who present with the classical symptoms of recurrent abdominal pain based on Apley's criteria is not warranted.

Abdominal Pain↗
PubMed1999

Clinical practice guidelines and Helicobacter pylori infection in children.

The objective of this paper is to review the principles, methods and issues behind the development of clinical practice guidelines. Practice guidelines have been defined as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances". The ultimate goal of guidelines is to improve patient outcomes; however, they may also be used as tools to decrease health care costs, improve medical education and enhance quality assurance. Evidence-based guidelines use explicit methods to link recommendations to the quality of the underlying research. Following development of the guideline, implementation and evaluation are key steps. The ultimate aim of guideline development is to influence physician knowledge, attitudes and behaviour.

Child↗
PubMed1998

Evaluation of a bicycle skills training program for young children: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a skills training program in improving safe cycling behavior, knowledge, and attitudes in young children. METHODS: Grade 4 children from six elementary schools in East York (a borough of Metropolitan Toronto) participated. The intervention--playground based instruction on bicycle handling skills by certified instructors--was randomly allocated to three schools. Altogether 141 children participated: 73 in the intervention group and 68 in the control group, with follow up evaluations available on 117 (83%). The primary outcome was safe cycling behavior (straight line riding, coming to a complete stop, and shoulder checking before a left turn). A self report questionnaire collected data on knowledge and attitudes. Baseline assessments were made in June, with follow up evaluations in September, 1995. RESULTS: The prevalence of safe cycling behaviors at follow up in the intervention and control groups respectively, were: straight line riding (90% v 88%; p = 0.782), coming to a complete stop (90% v 76%; p = 0.225), and shoulder checking (0% v 2%; p = 1.000). Over time (from baseline to follow up) children in both groups were more likely to maintain straight line riding, less likely to ride on the sidewalk, and less likely to consider that a car had more right to the road. CONCLUSIONS: This brief skills training program was not effective in improving safe cycling behavior, knowledge, or attitudes among grade 4 children.

Accident Prevention↗
PubMed1997

Reliability and validity of proxy respondent information about childhood injury: an assessment of a Canadian surveillance system.

The reliability and validity of proxy respondent information in the Canadian Hospitals Injury Reporting and Prevention Program surveillance system was assessed. A standardized form was used to collect data on injury date, location, context (activity at the time), breakdown factor (what went wrong), mechanism, product involvement, safety precaution use, and motor vehicle involvement. The test-retest method determined reliability, with the kappa coefficient quantifying agreement between respondent information provided in the emergency department and later during a telephone interview. Of 421 eligible respondents, 325 (77%) completed the telephone interview, with a median time to interview of 33 hours (range 24-70 hours). Agreement was high for all items; kappa coefficients ranged from 0.79 (substantial agreement) to 1.00 (perfect agreement). Reliability was not significantly modified by respondent view of the injury event, age of the child, language of the form, or level of respondent education. Validity was determined by measuring the agreement between respondent information and that provided by an independent witness. Witness information was considered to represent the truth. Of the 140 injury events selected, 92 (66%) had the form completed by both the original respondent and an independent witness. Kappa coefficients were greater than 0.65 for all but one item (safety precaution use), and the positive predictive value of respondent information for item categories whose prevalence was > or = 0.25 ranged from 0.82 to 0.95. The authors conclude that proxy respondent data on childhood injury are both reliable and valid.

Adolescent↗
PubMed1997

A randomized controlled trial of penicillin vs clindamycin for the treatment of aspiration pneumonia in children.

OBJECTIVE: To compare the effectiveness of intravenous penicillin vs clindamycin for the treatment of aspiration pneumonia. DESIGN: A double-blind, randomized controlled trial. SETTING: A tertiary care pediatric hospital. PATIENTS: We enrolled 42 children, aged 6 months to 18 years, who were admitted to the hospital for the treatment of aspiration pneumonia. All of the children had underlying conditions that predispose to aspiration. INTERVENTION: The patients were randomly assigned to receive intravenous penicillin G sodium, 250,000 U/kg every 24 hours, or intravenous clindamycin phosphate, 30 mg/kg every 24 hours. MAIN OUTCOME MEASURE: The primary outcome measure was "time to ready for discharge" from the hospital. RESULTS: In an effectiveness (intention to treat) analysis, the median time (interquartile range) to ready for discharge from the hospital was 4.9 days (range, 2.8-6.5 days) in the penicillin-treated group and 3.4 days (range, 2.3-6.8 days) in the clindamycin-treated group (P = .66). Results were not markedly altered when adjusted for the age difference of the groups or in the efficacy analysis (after the exclusion of 9 patients who withdrew from the trial). Rates for readmission to the hospital were similar in the 2 groups. CONCLUSION: Penicillin and clindamycin seem to be equally effective for the treatment of aspiration pneumonia in children hospitalized for this illness.

Adolescent↗
PubMed1997

Effectiveness of prophylactic inhaled steroids in childhood asthma: a systemic review of the literature.

BACKGROUND: There has been no systematic appraisal of the evidence regarding the effectiveness of prophylactic inhaled steroids in childhood asthma. OBJECTIVE: We sought to evaluate the effectiveness of prophylactic inhaled steroids in childhood asthma. METHODS: A MEDLINE search from January 1966 through December 1996 was used to identify pertinent English-language publications. All randomized, double-blind, placebo-controlled trials of prophylactic inhaled steroid therapy for childhood asthma that included data on clinical outcomes (symptom scores and concomitant drug use) or laboratory outcomes (peak expiratory flow rate) were included. RESULTS: In total, 24 of 93 studies retrieved met the inclusion criteria. The overall weighted relative improvement in mean total symptom score (inhaled steroid vs placebo) was 50% (95% confidence interval [CI]: 49%, 51%), the overall weighted relative decrease in mean concomitant beta2-agonist use (inhaled steroid vs placebo) was 37% (95% CI: 36%, 38%), and the overall weighted relative decrease in mean concomitant oral steroid use (inhaled steroid vs placebo) was 68% (95% CI: 66%, 70%). The overall weighted absolute improvement in mean peak expiratory flow rate (inhaled steroid vs placebo) was 38 L/min (95% CI: 34.3 L/min, 41.7 L/min). CONCLUSIONS: Prophylactic inhaled steroids are effective, compared with placebo, in improving both clinical and laboratory outcomes in childhood asthma.

Child↗
PubMed1997

Effect of a pediatric observation unit on the rate of hospitalization for asthma.

STUDY OBJECTIVE: To determine the asthma admission rate and the rate of repeat visits to the emergency department for asthma within 72 hours before and after the introduction of an observation unit (OU). When necessary, admission to the ward from the OU is usually made within 12 hours. METHODS: We conducted a before-and-after study with retrospective data collection in an urban tertiary care pediatric ED. Our subjects were patients aged 1 to 18 years who presented to the ED with asthma. The pre-OU group comprised patients seen between July 1, 1991, and June 30, 1992, before the opening of the OU. The post-OU group consisted of children seen between July 1, 1993, and June 30, 1994, after the opening of the OU. RESULTS: The pre- and post-OU groups had 1,979 and 2,248 asthma visits, respectively. The admission rate decreased from 31% in the pre-OU group to 24% in the post-OU group (P < .01). The frequency of inpatient admissions of less than 24 hours decreased from 17% in the pre-OU group to 10% in the post-OU group (P < or = 01). The rate of repeat ED visits within 72 hours was 3% in the pre-OU group and 5% in the post-OU group (P = .01). CONCLUSION: The use of an OU in the ED was associated with a reduction in the hospitalization rate for children with acute asthma exacerbation. However, we also noted an increased rate of repeat visits to the ED after the introduction of the OU.

Adolescent↗
PubMed1997

Is epidural anesthesia in labor associated with chronic low back pain? A prospective cohort study.

UNLABELLED: The association between epidural anesthesia during labor and subsequent postpartum low back pain remains unclear. The objective of this follow-up cohort study was to determine whether epidural anesthesia was associated with chronic back pain 1 yr after delivery. We contacted 329 women by telephone and asked them to complete a standardized questionnaire 1 yr (+/-1 mo) after delivery. One hundred sixty-four women had received epidural analgesia for labor and delivery, and 165 had not. Subjects were asked to quantify their back pain (yes/no, numeric rating score, and interference with daily activities). Differences between the two groups were tested by using the chi2 test and the Mann-Whitney U-test, and logistic regression was used to control for confounding variables. The response rate was 244 of 329 (74%). Responders and nonresponders were similar in their demographic and clinical characteristics. There was no difference in the prevalence of back pain between women who had received epidural anesthesia (12 of 121, 10%) and those who had not (17 of 123, 14%). The adjusted relative risk of low back pain at 1 yr (epidural versus nonepidural) was 0.63 (95% confidence interval 0.25, 1.56). There were also no differences between the two groups on numeric rating scores or level of interference with activities. This prospective follow-up study demonstrated no association between epidural anesthesia for labor and delivery and chronic back pain 1 yr after delivery. IMPLICATIONS: We evaluated the presence of low back pain 1 yr after delivery in two groups of women-those who chose epidural analgesia for labor and those who did not. There was no increased risk of back pain in women who had used epidural analgesia. This finding is consistent with those of other North American studies.

Adult↗
PubMed1997

Where do children go? Comparing the after-hours availability of family physicians and primary care pediatricians in four Canadian cities.

OBJECTIVE: To describe and compare family physicians' and pediatricians' after-hours availability for pediatric care in four Canadian cities. DESIGN: Cross-sectional telephone survey. SETTING: Winnipeg, Toronto, Ottawa, and Montreal pediatric and family practices. PARTICIPANTS: All primary care pediatricians and an equal number of family physicians randomly selected from the membership list of the College of Family Physicians of Canada were matched by postal code. Sixty-four (10%) of 282 family physicians and 296 primary care pediatricians were excluded, most because no office telephone number was found. MAIN OUTCOME MEASURES: "After hours" was defined as between 1800 and 0700 hours on weekdays and 0900 to 2400 hours on weekend days. Outcomes included demographics, year of graduation, day of call, time of call, and availability of physician. RESULTS: Availability varied markedly by city rather than by physicians were available after hours: 92.4% in Winnipeg, 56.0% in Toronto, 65.5% in Ottawa, and 26.9% in Montreal. Winnipeg, Toronto, and Montreal showed no significant differences between specialties in availability. Only Ottawa pediatricians were significantly more available than family physicians when age was taken into account (adjusted relative risk = 2.17, 95% confidence interval = 1.51 to 3.12). Stratified analysis showed no differences by day of call, time of call, or physicians' sex. Physicians graduating before 1975 in both groups tended to be more available in all cities than younger physicians. CONCLUSIONS: Regional differences appear to influence after-hours availability more than specialty. Older physicians from both groups were more available than younger physicians.

Child↗
PubMed1996

Recent corticosteroid use and the risk of complicated varicella in otherwise immunocompetent children.

OBJECTIVE: To determine whether recent corticosteroid use was associated with an increased risk of complicated varicella-zoster virus infection in otherwise immunocompetent children. STUDY DESIGN: A case-control study design was used because the outcome of interest, complicated varicella-zoster virus infection, is rare. SETTING: Cases and controls were selected from the population of children aged 2 months to 18 years admitted to two hospitals, between January 1979 and July 1994 in one and between January 1974 and July 1994 in the other, with diagnosis codes that indicated chickenpox. POPULATION: Cases were defined as children with invasive varicella-zoster virus infection or associated invasive bacterial infection. Controls were defined as children with uncomplicated varicella admitted for elective surgery, fracture or burn management, psychiatric or social evaluation, treatment of simple dehydration, or evaluation of fever or rash not yet diagnosed. Exclusions included varicella-zoster virus infection in neonates and immunocompromised children. METHODS: A priori criteria were formulated on the basis of a comprehensive literature review to define complicated varicella-zoster virus infection. Recent corticosteroid exposure was defined as corticosteroid use of any sort within 30 days of onset of the chickenpox rash. Data were abstracted by medical chart review. RESULTS: In total, 167 cases and 134 controls were identified. Only three children (two cases and one control) had a history of recent corticosteroid therapy. Recent corticosteroid exposure was therefore not statistically associated with an increased risk of complicated varicella-zoster virus infection (odds ratio, 1.6; 95% confidence interval, 0.2 to 16.9). No differences between cases and controls were found in sex, history of asthma, or length of hospital stay. The mean age of cases was greater than that of controls (6.0 vs 4.7 years; P<.01). CONCLUSIONS: Recent corticosteroid therapy in otherwise immunocompetent children does not appear to be associated with a statistically increased risk of complicated varicella. A conservative estimate of risk, using the upper limit of the 95% confidence interval, is markedly lower than previously published risk estimates.

Adolescent↗
PubMed1996

Variability in physicians' reported ordering and perceived reassurance value of diagnostic tests in children with 'growing pains'.

OBJECTIVES: To determine the variability in the reported ordering of tests and treatment and to determine physicians' perceptions of the reassurance value to families of diagnostic tests in children with "growing pains." DESIGN: Cross-sectional survey using a mailed questionnaire. SETTINGS: Primary care and referral practices in Toronto, Ontario. PARTICIPANTS: University-affiliated primary care pediatricians and family physicians were surveyed, as well as all pediatric orthopedic surgeons and pediatric rheumatologists in Ontario. Pediatric orthopedic surgeons and pediatric rheumatologists were combined into a single group. MAIN OUTCOME MEASURES: Frequency of office visits because of growing pains, frequency of diagnostic testing, management strategies for these children, and physicians' perceptions of the reassurance value of diagnostic tests. RESULTS: Of 205 eligible physicians, 181 (88.3%) responded. The median reported frequency of office visits because of growing pains was 1%. Compared with the other physician groups, family physicians were significantly more likely to order a determination of the hemoglobin level (P = .003), erythrocyte sedimentation rate (P = .01), white blood cell count (P = .01), and differential blood cell count (P = .003), but not imaging tests. Family physicians were also more likely to order diagnostic tests when they were under parental pressure to do so (P = .001) or for the child with repeated visits (P = .02). In total, 86% of pediatric orthopedic surgeons and pediatric rheumatologists, 95% of pediatricians, and 100% of family physicians perceived normal test results to be reassuring to parents. Treatment strategies were similar across the 3 physician groups. CONCLUSIONS: The frequency of diagnostic testing varied among physician groups. Virtually all physicians perceived normal test results to be reassuring to families.

Adult↗
PubMed1996

Development of a clinical asthma score for use in hospitalized children between 1 and 5 years of age.

The objective of this study was to develop a clinical asthma score (CAS) for use in hospitalized children between 1 and 5 years of age. Formal approaches to item selection and reduction, reliability, discriminatory power, validity, and responsiveness were used. The final CAS consisted of five clinical characteristics: respiratory rate, wheezing, indrawing, observed dyspnea, and inspiratory-to-expiratory ratio. Interrater reliability was high (weighted kappa = 0.82), and the CAS was discriminatory (Ferguson's delta = 0.92). The CAS was valid, with a strong correlation with length of hospital stay (Spearman's correlation = 0.47, p < 0.05) and drug dosing interval (Spearman's correlation = -0.58, p < 0.01). The CAS was responsive, with a significant change in CAS from admission to discharge (Wilcoxon signed rank test, p < 0.01). This score, for use in hospitalized preschool children, is reliable, discriminatory, valid, and responsive.

Asthma↗
PubMed1995

Epidural anaesthesia and low back pain after delivery: a prospective cohort study.

OBJECTIVE: To determine whether epidural anaesthesia during labour and delivery is a risk factor for postpartum back pain. DESIGN: Prospective cohort study with follow up at one day, seven days, and six weeks after delivery. SETTING: Teaching hospital in Montreal. SUBJECTS: 329 women who delivered a live infant(s) during the study period. Exclusion criteria were back pain before pregnancy and delivery by elective caesarean section. INTERVENTION: Epidural anaesthesia during labour and delivery. MAIN OUTCOME MEASURES AND RESULTS: The primary outcome variable was development of postpartum low back pain. Back pain was quantified with self reports (yes/no), a pain score (numeric rating scale), and degree of interference with daily activities. Of the 329 women, 164 received epidural anaesthesia during labour and 165 did not. The incidence of low back pain in epidural v non-epidural group was 53% v 43% on day one; 21% on day seven; and 14% v 7% at six weeks. The relative risk for low back pain (epidural v non-epidural) adjusted for parity, delivery, ethnicity, and weight was 1.76 (95% confidence interval 1.06 to 2.92) on day one; 1.00 (0.54 to 1.86) on day seven; and 2.22 (0.89 to 5.53) at six weeks. There were no differences between the two groups in pain scores or the frequency of interference with daily activities. Similar results were obtained in the subgroup of women with low back pain of new onset--that is, those women with no back pain during their pregnancy. CONCLUSIONS: Postpartum low back pain was common but decreased considerably over the short term. The association between epidural anaesthesia and postpartum low back pain was inconsistent over time with a significantly increased risk of low back pain (epidural v non-epidural) noted only on the first day after delivery.

Anesthesia, Epidural↗
PubMed1995

Helicobacter pylori, gastroduodenal disease, and recurrent abdominal pain in children.

OBJECTIVE: To assess the evidence for a cause-and-effect relationship between Helicobacter pylori infection and antral gastritis, peptic ulcer disease, and recurrent abdominal pain in children. DATA SOURCES: A MEDLINE search from January 1983 through July 1994 was used to identify pertinent English-language publications. Current Contents and selected specialty journals were searched manually. Editorials, reviews, case reports, abstracts, and letters to the editor were excluded. STUDY SELECTION: All studies in children (ie, 0 to 18 years) were included. DATA EXTRACTION: Hill's criteria for causal inference were used to determine the strength of the evidence for a causal relationship. DATA SYNTHESIS: In total, 45 studies (case series, cross-sectional surveys, and treatment trials) were retrieved. The rate ratio of antral gastritis in children with H pylori infection (compared with uninfected children) ranged from 1.9 to 71.0 (median, 4.6). The prevalence of H pylori infection in children with duodenal ulcer was high (range, 33% to 100%; median, 92%) compared with children with gastric ulcer (range, 11% to 75%; median, 25%). Prevalence rates of infection in children with recurrent abdominal pain were inconsistent (range, 0% to 81%; median, 22%), with lower rates in children meeting Apley's criteria (range, 0% to 9%; median, 6%). CONCLUSIONS: There is strong evidence for an association between H pylori infection and antral gastritis and duodenal ulcer disease in children; however, data from randomized, double-blind, placebo-controlled treatment trials are required. There is weak evidence for an association with gastric ulcer and weak or no evidence for an association with recurrent abdominal pain.

Abdominal Pain↗