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Biomedical subjects

C Macarthur

Publications and source records attributed to C Macarthur.

46 records · Page 3Linked to original sources
PubMed1995

Determinants of pediatric day surgery cancellation.

Currently, most elective pediatric surgery is performed on an out-patient basis. The objective of this case-control study was to identify potential determinants of patient cancellation at a children's hospital. Cases were defined as patients that were canceled on the day of surgery, whereas controls were those patients who underwent surgery on the scheduled date. Demographic and clinical data were collected using chart review. Approximately 10% of all day surgery patients were canceled on the day scheduled for surgery, half for reasons deemed preventable. Of the preventable cancellations, stepwise logistic regression analysis showed that patients attending only the surgeon's office prior to day surgery, were more likely to be canceled because of inadequate preparation, compared to those patients attending both the surgeon's office and the hospital preoperative clinic (adjusted odds ratio = 3.18; 95% CI: 1.32, 7.63).

Ambulatory Surgical Procedures↗
PubMed1995

Qualitative assessment of studies included in a meta-analysis: DES and the risk of pregnancy loss.

Meta-analysis, the qualitative and quantitative integration of available research information, is increasingly used in clinical research. This report examines the qualitative elements of meta-analysis through critical review of two published examples that assessed the effect of diethylstilboestrol (DES) on miscarriage and neonatal mortality, respectively. Our subjective review showed the internal validity of three of five trials aggregated in the former meta-analysis to be severely compromised. The remaining two trials (data from which were aggregated in the latter meta-analysis), while internally valid, studied different clinical populations. Therefore, pooling of their results may have been clinically inappropriate. In conclusion, meta-analysis involves substantial elements of subjective judgment. Qualitative assessment of studies is of pivotal importance, because the validity of any summary estimate of effect hinges on both the methodologic quality and the combinability of the aggregated studies.

Abortion, Spontaneous↗
PubMed1995

Randomised trial spacer v nebuliser for acute asthma.

Sixty hospitalised children with asthma aged 1-5 years were randomised to spacer or nebuliser. A clinical score was measured at baseline and every 12 hours. There were no differences between groups in the score over time, or secondary outcome measures. The spacer is an effective delivery method for young hospitalised asthmatic children.

Administration, Inhalation↗
PubMed1993

Nosocomial infection in pediatric surgical patients: a study of 608 infants and children.

We studied nosocomial infection in a group of 608 pediatric surgical patients over a 14-month period. All inpatients and outpatients who received an operation with an incision by the pediatric general surgical service were entered into the study. Demographic, nutritional, clinical, and laboratory data were collected. Surveillance was conducted for wound infection, septicemia, infections of the respiratory tract, urinary tract, and abdomen, and infectious diarrhea. A total of 676 operative procedures was performed. Nosocomial infection occurred in 38 of the 608 patients (6.2%). A total of 53 infectious complications was tabulated. The number and percent risk per operation were wound 17 (2.5%), septicemia 14 (2.1%), pulmonary 10 (1.5%), urinary tract 5 (0.7%), abdominal 5 (0.7%), diarrhea 2 (0.3%). Broviac catheter sepsis occurred in 7 of 61 lines (11.5%). The highest overall occurrence of infection was in the infant group (1 mo to 1 yr), (13/161, 8.1%). The probability of septicemia was highest in neonates (4.2%) compared with infants (3.1%) or older children (1.2%) (P < .05). The most common isolates were Staphylococcus epidermidis (10/17) from septic patients, and gram-negative enteric bacteria (27/50) from organ and wound infections. Infection was associated with impaired nutrition, multiple disease processes, and multiple operations. The risk of nosocomial infection in this population was comparable to that reported in adult surgical patients. These baseline data may aid the development of strategies to lower infection risk in children.

Age Factors↗
PubMed1992

Tuberculosis among institutionalized elderly in Alberta, Canada.

Previous studies in the US have suggested that the risk of tuberculosis is increased among elderly residents of nursing homes. This registry-based study determined and compared the tuberculosis incidence rate for the elderly in nursing homes and community dwellings in Alberta, Canada, over the 5-year period 1979-1983. Rate ratios (RR) using the community elderly rate as baseline, were estimated for all notified cases and for culture positive cases only. Adjustment was made for the variables age, sex, and ethnicity. The nursing home elderly in Alberta did not have an increased risk of tuberculosis: adjusted RR = 1.09, 95% CI : 0.38-1.80.

Aged↗
PubMed1990

Withdrawal of maintenance digoxin from institutionalized elderly.

Chronic use of digitalis is common amongst the institutionalized elderly. Associated with digitalis use is the potential for toxicity and/or adverse reactions. In this study maintenance digoxin was withdrawn from 14 elderly nursing home residents in sinus rhythm. Subjects were followed over 18 months for evidence of dysrhythmia or heart failure. One resident had an episode of supraventricular tachycardia which required digoxin to be restarted. One resident developed left heart failure, treated with oral diuretic. For 12 of the 14 residents, withdrawal of maintenance digoxin was achieved without deleterious effect. This study suggests that maintenance digoxin may be withdrawn safely in elderly nursing home residents in sinus rhythm and without history of atrial dysrhythmia.

Aged↗
PubMed1990

Multiple small-bowel carcinoids presenting with gastrointestinal hemorrhage: a case report.

Gastrointestinal hemorrhage from a small-bowel lesion can be a problem diagnostically and therapeutically. The authors present a case of multiple small-bowel carcinoids, which were the cause of multiple upper gastrointestinal hemorrhages over a 15-year period. Despite advances in endoscopy and diagnostic imaging, accurate localization and definitive diagnosis remain elusive in such cases. Optimal treatment depends on careful clinical evaluation and timely laparotomy.

Carcinoid Tumor↗
PubMedDate not supplied

Chronic airways obstruction leading to chronic hypoxemic respiratory failure: an estimate of the size and trend of the problem in Canada.

Chronic airways obstruction is a common cause of morbidity and mortality in Canada. It may progress to hypoxic respiratory failure and then to death. Only a few studies of the prevalence of chronic airways obstruction have been reported from Canada, but a number of studies have been reported from the United States and the United Kingdom, countries with similar socioeconomic conditions and ethnic compositions to those in Canada. The prevalence of chronic airflow limitation in these studies averages 9.3%. In each study, tobacco smoke exposure is the most prominent etiologic agent. Other contributing factors identified in the studies are air pollution, occupational exposure, respiratory infections and childhood respiratory illness. Endogenous modifiers of these risk factors demonstrated in the published studies include age, elevated peripheral blood leukocyte count and familial factors. Although epidemiologic studies have been able to identify the prevalence of functional impairment associated with chronic airways obstruction, risk factors associated with its development and modifiers of these risk factors, it is not possible to determine the prevalence of severe chronic airways obstruction resulting in hypoxemic respiratory failure. An estimate of this prevalence has been calculated based on certain assumptions. It was assumed that patients dying of chronic airways obstruction were likely, in a high proportion of cases, to have hypoxemic respiratory failure. It has been demonstrated that only one-half of all patients dying of chronic airways obstruction are correctly designated on death certificates. It was assumed, conservatively, that the median survival of patients with hypoxemic respiratory failure is two years. From these assumptions, it was estimated that the prevalence of hypoxemic respiratory failure in 1986 in Canada was 100 per 100,000 population. This is higher than the present rate of oxygen therapy, indicating that some patients currently eligible for this treatment may not be receiving it.

Canada↗
PubMedDate not supplied

Influenza vaccination of high-risk children: a survey of three physician groups.

OBJECTIVE: To determine the variability in physician knowledge, attitudes, and behaviours in relation to influenza vaccination of children. METHOD: A 17-item cross-sectional questionnaire, with follow-up mailings to non-responders, was mailed to a random sample of 100 family physicians and 100 community pediatricians within Metropolitan Toronto and all 130 subspecialists at The Hospital for Sick Children, Toronto. RESULTS: Of 315 eligible physicians, 243 (77%) responded. Of the three groups, community pediatricians were more likely than either family physicians or subspecialists, to recommend vaccination for all but one of the high-risk conditions. Pediatricians (54%) were also the most likely to use active strategies to contact families of high-risk children compared with family physicians and subspecialists (both 23%). Only 44% of all physicians were themselves vaccinated against influenza. CONCLUSIONS: Influenza vaccination is recommended by most physicians; however, the responsibility for vaccination appears to fall to those in the community. Physician education plus further research and a review of provincial strategies for improving vaccination are needed.

Adult↗