Superior transperitoneal dissection for inserting artificial sphincter bladder neck cuffs.
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Adolescent↗
Biomedical subjects
D McGillivray
Publications and source records attributed to D McGillivray.
Critical pediatric equipment availability in Canadian hospital emergency departments.
STUDY OBJECTIVE: Of all child visits to emergency departments, 1% to 5% involve critically ill children who require cardiopulmonary resuscitation. Numerous versions of pediatric equipment lists for EDs have been published. Despite these efforts, many EDs remain unprepared for pediatric emergencies. The objectives of this study were to assess the availability of pediatric resuscitation equipment items in Canadian hospital EDs and to identify risk factors for the unavailability of these items. METHODS: Using the updated database of the Canadian Association of Emergency Physicians (CAEP), a questionnaire survey was sent to 737 Canadian hospital EDs with a maximum of 3 mailings to nonresponders. On-site visits to a selected subset of hospital EDs were completed to validate the results obtained by the mailed questionnaire. RESULTS: The response rate was 88.3% (650/737). Results showed the following overall equipment unavailability: intraosseous needle, 15.9%; pediatric drug dose guidelines, 6.6%; infant blood pressure cuff, 14.8%; pediatric defibrillator paddles, 10.5%; infant warming device, 59.4%; infant bag-valve-mask device, 3.5%; infant laryngoscope blade, 3.5%; 3-mm endotracheal tube, 2.5%; and pediatric pulse oximeter, 18.0%. Low percentage of pediatric visits, lack of an on-call pediatrician for the ED, and lack of a pediatric advanced life support-trained physician on staff were independently associated with equipment unavailability. CONCLUSION: This study demonstrated that essential pediatric resuscitation equipment is unavailable in a disturbingly high number of EDs across Canada and has identified several determinants of this unavailability.
Canada↗
Urine culture from bag specimens in young children: are the risks too high?
OBJECTIVE: To compare the risks of contaminated culture results and consequent adverse clinical outcomes in urine specimens obtained by "clean-voided" bag method versus catheterization. STUDY DESIGN: Hospital-based cohort study of all children </=24 months with outpatient urine cultures (n = 7584) obtained from January 1993 to December 1995. Medical records were followed up for all children with contaminated culture results who had 1 or more additional cultures within 7 days of the original culture. Contamination rates of bag urine cultures from the emergency department and a pediatric test center were compared. RESULTS: Contamination rates were 62.8% and 9.1% (P <.001) in bag versus catheter specimens, respectively. Contamination rates of bag urine specimens collected in the emergency department and pediatric test center were 56.4% versus 69. 25%, respectively. Of the 3440 contaminated urines, 132 (1.7%) resulted in 1 or more adverse clinical outcomes. Adjusted odds ratios (and 95% CI) for these outcomes in bag versus catheter specimens were as follows: 4.9 (2.3 to 10.5) for unnecessary recall, infinite for delayed diagnosis and treatment, 4.8 (1.8 to 12.4) for unnecessary treatment, 15.6 (2.1 to 116.8) for unnecessary prolonged treatment, 4.1 (1.4 to 12.1) for unnecessary radiologic investigation, and 12.4 (1.6 to 95.5) for unnecessary hospital admission. CONCLUSIONS: The risks of the "noninvasive" bag urine culture appear to exceed its benefits.
Cell Culture Techniques↗
Clinical decisionmaking based on venous versus capillary blood gas values in the well-perfused child.
STUDY OBJECTIVE: In children aged 1 month to 18 years, we sought to examine the correlation between venous and arterialized capillary blood gas values, and to determine whether the source of blood sample influenced the interpretation of the acid-base status and clinical management. METHODS: In a cross-sectional study, venous and capillary blood gas values were simultaneously obtained in acutely ill well-perfused patients treated in a pediatric emergency department. Intraclass correlation coefficients for capillary and venous measured gas values were calculated. Crude agreement and intraobserver concordance were calculated for responses of 2 intensivists to the interpretation and clinical management questions, based on capillary and venous gas results. RESULTS: Intraclass correlation coefficients for 78 capillary and venous paired measured gas values were.92 (pH), .80 (PCO 2 ), and .67 (PO 2 ). The alpha of concordance values between capillary and venous blood gas values, with 95% confidence intervals (CIs) were as follows, respectively, for physician A and B: interpretation, .61 (.47 to .73) and .48 (.41 to .55); need for bicarbonate,.85 (.73 to.97) and.80 (.72 to.88); and need for intubation .73 (.64 to .82), and .83 (.75 to .91). CONCLUSION: In the well-perfused patient, we believe that venous samples are an acceptable alternative to capillary blood samples for determination of blood gas values and for making clinical management decisions.
Acid-Base Equilibrium↗
No room for compromise. Bill C-22.
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Canada↗
Inappropriate use of antibiotics in croup at three types of hospital.
Despite recent suggestions that bacterial infection is an increasingly important cause of serious croup, most authorities still consider croup a viral disease in which antibiotic therapy is unnecessary. To assess the frequency of antibiotic use in croup among children in hospital, we reviewed the records at three types of hospital in Ontario. Children with evidence of a concurrent infection that might be bacterial were considered to have received antibiotics appropriately. Whereas only 6% of cases at a university-affiliated children's hospital were inappropriately treated with antibiotics, the proportions at a small rural community hospital staffed by general practitioners and a general hospital staffed by both pediatricians and general practitioners in a medium-sized city were 63% and 38%. Possible reasons for these differences are discussed.
Anti-Bacterial Agents↗
Characterization and chromosome assignment of the human homolog of int-2, a potential proto-oncogene.
int-2 is one of two cellular genes (int-1 and int-2) currently implicated in the genesis of mammary carcinomas by mouse mammary tumor virus and may constitute a novel cellular proto-oncogene. Using low-stringency hybridization with mouse int-2 probes, we established that homologous genes exist in a variety of mammalian species, including humans, but failed to detect related sequences in other classes and phyla. Recombinant bacteriophage clones and a single cosmid encompassing the human int-2 gene were isolated and characterized by restriction enzyme mapping. A survey of nine primary human breast tumors, three breast tumor cell lines, and three normal individuals revealed no evidence for gross amplification or rearrangement of the int-2 locus. Three distinct restriction fragment length polymorphisms were observed which could prove useful in future linkage studies. By a combination of in situ hybridization of metaphase chromosomes and somatic cell genetics, the human int-2 gene was mapped to chromosome 11, band q13.
Animals↗
Gonococcal arthritis: a report of six cases.
Six cases of gonococcal arthritis are described. Three presented during the initial "bacteremic stage" with polyarthralgia, fever, skin lesions and sterile synovial fluid. Two presented during the "septic joint stage" with positive synovial culture, and one presented during the "stage of residual deformity". Transient electrocardiographic changes were noted in two of the six cases. All responded to antibiotic therapy. One required additional surgical intervention.The condition is common, coinciding with the rising incidence of symptomatic and asymptomatic gonorrhea. Gonococcal infection must be considered in the differential diagnosis of migratory polyarthralgia, tenosynovitis, oligoarthritis, fever or unusual skin lesions. Criteria for diagnosis, lines of treatment and relevant literature are reviewed.
Adolescent↗
Worth vs Polarized four-dot test.
A direct comparison between the Worth four-dot (W4D) and Polarized four-dot (P4D) flashlights is reported in a randomized trial on 107 unselected patients greater than 2.5 years old. The primary outcome variable was the interpretable response rate. Secondary outcomes were response time and age of test failure. There were 29 patients who failed to complete the W4D test, but only 10 patients who could not complete the P4D test, giving interpretable response rates of 73% and 91%, respectively (p < .001). The P4D test was found to be less dissociative and easier to administer. It also had a higher detection rate for fusion. We recommend its use as a tool in the clinical evaluation of binocular sensorial states.
Adolescent↗