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Biomedical subjects

D Stephens

Publications and source records attributed to D Stephens.

At least 109 records · Page 6Linked to original sources
PubMed1997

PICNIC (Pediatric Investigators Collaborative Network on Infections in Canada) study of the role of age and respiratory syncytial virus neutralizing antibody on respiratory syncytial virus illness in patients with underlying heart or lung disease.

OBJECTIVE: To determine the effects of age and respiratory syncytial virus (RSV) antibody status on frequency and severity of RSV infections in children with underlying heart or lung disease. DESIGN: Cohort study conducted during two consecutive RSV seasons. SETTING: Ambulatory patients at eight Canadian pediatric tertiary care centers. METHODS: Subjects under 3 years old with underlying heart disease who were digoxin-dependent or had not received corrective cardiac surgery or with underlying lung disease were enrolled. Demographic information and an acute sera for RSV neutralizing antibody was obtained on enrollment. Weekly telephone follow-up consisting of a respiratory illness questionnaire was followed with a home visit to obtain a nasopharyngeal aspirate when there was new onset of respiratory symptoms. The specimen was used to detect RSV antigen. RSV illnesses were grouped as upper or lower respiratory tract infection (LRI) based on clinical and radiographic findings. RSV hospitalizations were considered to be those RSV infections that resulted in hospitalization. RESULTS: Of 427 enrolled subjects, 160 had underlying lung disease only, 253 had underlying heart disease only, and 14 had both. Eleven percent and 12% of lung and heart disease groups, respectively, had an RSV LRI. Three percent and 6% of lung and heart disease groups, respectively, were hospitalized with RSV infection. A significant decrease in frequency of RSV LRI and RSV hospitalization occurred with increasing age, with a major drop in those older than 1 year vs those younger than 1 year. Acute sera were available from 422 subjects. Geometric mean RSV antibody titers demonstrated a U-shaped distribution with increasing age. The trend to lower antibody concentrations in premature infants did not reach statistical significance. The frequency of RSV infection and RSV LRI was lower in patients with antibody at a titer more than 100, although the difference for RSV hospitalization was not statistically significant. These differences remained significant after age adjustment. CONCLUSION: Both age and RSV antibody status impact on RSV illness and LRI. Reduction in illness frequency with increasing age may lead to more informed targeting of those children most likely to benefit from RSV immune globulin prophylaxis.

Age Distribution↗
PubMed1997

Profound permanent hearing impairment in childhood: causative factors in two European countries.

A collaboration between Denmark and Wales was established in order to evaluate any differences between countries in factors causing permanent childhood hearing impairment (PCHI). Two identical 6-year birth-cohorts from 1975-1980 suffering from a permanent hearing loss > or = 90 dB HL in the better hearing ear, averaged across 0.5-4 kHz (BEHL), were included in the analysis. The overall estimated prevalence of children with this loss was 0.41/live births in Wales (n = 59). In Denmark the overall prevalence was 0.45/1,000 live births (n = 34), there being no significant differences in prevalence between the two countries. Both cohorts were subjected to a multidisciplinary investigation protocol. No significant differences were found between countries in the proportion of hearing impairment caused by the various factors, when based on uniform criteria and identical birth-cohorts. The proportion of inherited hearing loss is 47-50% in the two countries. Within inheritance the proportion of non-syndromal/syndromal inheritance differs slightly, as non-syndromal inheritance comprises 50% in Wales, and 76% in Denmark. The reported proportion of 16-34% of unknown factors causing profound PCHI emphasises the need for appropriate protocols for aetiological evaluation.

Child↗
PubMed1997

The association between visual incompetence and spinal derangement: an instructive case history.

OBJECTIVE: To discuss the difficulties encountered in the diagnosis of concentric narrowing of the visual fields. CLINICAL FEATURES: A 13-yr-old child was referred to a chiropractic clinic after an ocular examination concerning a 6-month period of minor headaches, which culminated in a more severe attack, during which she had to lie down. Her examination was essentially normal, with the exception of the presence of constricted visual fields when measured to a small stimulus. INTERVENTION AND OUTCOME: Standard outpatient spinal adjustments were followed by recovery of vision. DISCUSSION: The recovery of constricted fields of vision with spinal manipulation has now been discussed with greater frequency in the chiropractic literature. The diagnosis of constriction of the visual fields is often the factor that may decide the further management of the patient. In this instance, constriction of the visual fields could easily have been missed, even though clinical examination of the visual fields had been done. CONCLUSION: Elements in the history and physical examination will suggest when a sensitive assessment of the visual fields may be of benefit to the patient.

Adolescent↗
PubMed1997

Persistent pulmonary hypertension of the newborn: case study and pathophysiology review.

Pulmonary hypertension, though quite normal in the fetus while the burden of oxygenation is on the maternal placenta, can be rapidly fatal if severe resistance to pulmonary blood flow continues as the infant attempts to make the transition to extrauterine life. This article reviews the pathophysiology of and current management priorities for persistent pulmonary hypertension of the newborn.

Female↗
PubMed1996

Study of interobserver reliability in clinical assessment of RSV lower respiratory illness: a Pediatric Investigators Collaborative Network for Infections in Canada (PICNIC) study.

Randomized trials of ribavirin therapy have used clinical scores to assess illness severity. Little information on agreement for these findings between observers has been published. We decided to determine interobserver agreement for (1) a history for apnea or respiratory failure; (2) assessment of cyanosis, respiratory rate, retractions, and oximetry; and (3) determination of reason for hospitalization (requirement for medications, supportive care, underlying illness, poor home environment). At eight centers 137 RSV-infected patients were assessed by two observers blinded to the assessments by others with no interventions made between assessments. Observations were categorized, and agreement was summarized as percentage of observed agreement, Pearson correlation, or as a kappa statistic. Observed agreement for a history of either apnea or a respiratory arrest was at least 90% at all centers, with seven of the eight centers in total agreement. At all centers except one, the agreement on the reason why the patient remained in hospital was at least 80%. The observed agreement for assessing cyanosis was at least 94% at all eight centers. The correlation coefficient for respiratory rate varied from 0.42 to 0.97 across centers. The kappa values for agreement beyond chance for retractions varied from 0.05 to 1.00. The kappa values for oxygen saturation measures varied from 0.31 to 0.70. Although not statistically significant, there appeared to be more variation as the time between assessments increased. In conclusion, agreement for historical findings and assessment of cyanosis was high. However, there was wide variation in agreement in the other assessments. Training to ensure consistent and reproducible assessment by different examiners will be necessary if these findings are to be used as outcome variables in clinical trials.

Antiviral Agents↗
PubMed1996

Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of admission and management variation in patients hospitalized with respiratory syncytial viral lower respiratory tract infection.

OBJECTIVE: To describe differences in patients hospitalized with respiratory syncytial virus (RSV) lower respiratory tract infection (LRI) at nine Canadian tertiary care hospitals. In addition, this study describes the variation in use of drug and other interventions. METHODS: Data on patients hospitalized with RSV LRI and their outcomes were prospectively collected. Demographic data were obtained on enrollment by center study nurses. Data recorded daily included clinical assessment, oxygen saturation determination, and interventions (bronchodilators, steroids, ribavirin, antibiotics, intensive care, and mechanical ventilation) received during the day. Patients were divided into those with underlying diseases including congenital heart disease, chronic lung disease, immunodeficiency, or multiple congenital anomalies and those who were previously healthy. Mean RSV-associated length of stay and the proportion of patients receiving each intervention in each group were determined by hospital. RESULTS: A total of 1516 patients were enrolled at nine hospitals during January 1 to June 30, 1993, and January 1 to April 30, 1994. Significant differences were observed among hospitals in the proportion of patients with underlying disease, postnatal age less than 6 weeks, hypoxia, and pulmonary infiltrate on chest radiograph. The mean length of stay varied among hospitals from 8.6 to 11.8 days and 4.6 to 6.7 days in compromised and previously healthy patients, respectively. Except for receipt of bronchodilators, compromised patients were significantly more likely to receive interventions than previously healthy patients. There was variation among hospitals in receipt of most interventions in compromised and previously healthy patients. This variation was statistically significant for previously healthy patients but not statistically significant in those with underlying disease, because the numbers of patients in the latter group were much smaller. The magnitude of the variation for each intervention, however, was not different between those with underlying disease compared with previously healthy patients. CONCLUSION: Differences exist among tertiary pediatric hospitals in the nature of the patients admitted with RSV LRI. Variation occurred in the use of five interventions among the hospitals, regardless of whether the patient had underlying illness or was previously healthy. Given their current widespread use, high cost, and potential side effects, randomized clinical trials are needed to determine the efficacy of different drug treatments used to treat infants hospitalized with RSV.

Adrenal Cortex Hormones↗
PubMed1996

Family and physicians' views of surrogate decision-making: the roles and how to choose.

Physicians and family members were compared on the roles played in surrogate decision-making and their views as to how choices should be made by surrogate decision-makers. Thirty-six family members of patients with Alzheimer's disease, 35 family members of patients with schizophrenia, and 34 physicians from a diversity of specialties were the respondents. There was general agreement that shared decision-making was preferred. Physicians seem to make surrogate decisions in accordance with contemporary views about their roles. Families believed they had a strong subjective appreciation of the patient's overall good. The burden of decision-making was greater for families, but that depended to some degree on the diagnosis of the patient.

Activities of Daily Living↗
PubMed1996

Hearing impairment: special needs of the elderly.

Within this paper we have considered some of the particular disabilities and handicaps commonly experienced by elderly hearing-impaired people as compared with younger individuals. We examined their ratings of their disability and handicap and found that both disability and handicap increased more rapidly with increasing hearing loss in younger than in older patients. We have finally considered the strategies used by older people to cope with hearing loss and found them more likely to withdraw from difficult listening situations or to interrupt the speaker, but less likely to position themselves to hear better.

Aged↗
PubMed1996

Determinants of speech-hearing disability in King-Kopetzky syndrome.

King-Kopetzky syndrome is characterized by auditory disability with a clinically normal hearing threshold. The main reported disability is hearing speech in the presence of background noise. The degrees of speech-hearing disability in patients with King-Kopetzky syndrome have been investigated with the use of the Social Hearing Handicap Index (SHHI), and the relationships between the SHHI scores and a number of physiological, psychoacoustical and psychological factors determined in 109 patients. The significantly higher (worse) SHHI scores in patients with King-Kopetzky syndrome indicate that this group suffer a considerable degree of speech-hearing disability. In our study, the main findings are that some psychological factors, performance of the sentence in noise test and auditory thresholds are significantly correlated with the SHHI scores. We were unable to find any relationships between the SHHI and frequency resolution or EOAEs. In a multiple stepwise regression, somatic anxiety and the performance of the sentence in noise test are the significant predictors of SHHI scores. These two variables appear to be the main determinants of speech-hearing disability in King-Kopetzky syndrome.

Adolescent↗
PubMed1996

Hearing complaints of patients with King-Kopetzky syndrome (obscure auditory dysfunction).

The hearing complaints in patients with King-Kopetzky syndrome were studied by use of the open-ended hearing problem questionnaire. The main findings are that complaints were commonly focused on the categories of 'live speech' and 'electronic speech' difficulties in patients with King-Kopetzky syndrome, particularly the auditory difficulties of speech in noise and group conversation. However, they reported problems with warning signals significantly less frequently than a control 'audiological rehabilitation' group and the patients studied by Barcham and Stephens (1980). In addition, main psychological problems were related to anxiety (e.g. irritability, nervousness and moodiness) in patients with King-Kopetzky syndrome. The open-ended hearing problem questionnaire appears to be a useful tool that can be used to high-light the speech hearing disability encountered by patients with King-Kopetzky syndrome.

Adolescent↗
PubMed1996

Reported benefits and problems experienced with bone-anchored hearing aids.

Within this study we have examined the self-reported benefits and shortcomings experienced by patients fitted with bone-anchored hearing aids using an open-ended approach developed for hearing aid users. Reports were obtained from 39 patients who, between them, listed 165 benefits and 105 shortcomings. Benefits and shortcomings could be sub-divided into four main groups: practical, acoustical, psychological and medical, in that order of frequency. The most commonly reported benefits included hearing better and clearer, ease of use, inconspicuousness, and the fact that it made the individual more confident. The main shortcomings were difficulties with the telephone, wind noise and hearing speech in noise.

Acoustics↗
PubMed1996

Hearing rehabilitation in a psychosocial framework.

This paper is primarily concerned with handicap, which emphasises the psychosocial consequence of hearing loss, its development and a framework for its alleviation. The development of handicap is considered, taking as a starting point the World Health Organization Definitions of disablements and their application to audiology by Stephens and Hétu (1991). This is extended in the light of recent work on the role of significant others and of positive experiences arising from the hearing loss. This approach is then incorporated into an update of the Goldstein/Stephens (1981) management model of audiological rehabilitation which provides a framework applicable in any sociomedical situation.

Adaptation, Psychological↗
PubMed1995

Reported use of strategies by surgeons to prevent transmission of bloodborne diseases.

OBJECTIVE: To determine how often surgeons use strategies to prevent the transmission of bloodborne diseases and what factors are associated with the use of these strategies. DESIGN: Cross-sectional mail survey. SETTING: Secondary and tertiary care teaching hospitals affiliated with the University of Toronto. PARTICIPANTS: Of 539 active surgical staff and residents who were eligible, 503 (93.3%) responded. OUTCOME MEASURES: Current preventive practices, attitudes toward transmission of bloodborne diseases, perceived risk of infection and willingness to adopt preventive strategies. RESULTS: On average, surgeons reported using double- or triple-gloving in 32.2% of procedures, facial protection (including regular corrective eyewear) in 74.2% and goggles or face shields in 19.4%. Use of strategies to prevent sharp injuries, in addition to barrier precautions, was reported by 259 (51.5%) of the respondents. Factors associated with greater use of preventive strategies included resident position, subspecialty, greater number of years in surgical practice and a high perceived risk. Most of the respondents thought that patients should be routinely screened for HIV antibodies before surgery (68.2% [343/503]), that there was too little research into ways to reduce the risk of transmission of bloodborne diseases (55.3% [278/503]) and that there was too little effort on the part of organizations to reduce the risk of transmission (58.8% [296/503]). The perceived lifetime risk was reported to be moderate or high by 191 (38.0%) of the respondents and low or insignificant by 308 (61.2%). In all, 463 (92.0%) indicated a willingness to change the way they performed surgery to prevent transmission of bloodborne diseases. CONCLUSION: Surgeons expressed varying degrees of concern about the transmission of bloodborne diseases and reported infrequent use of preventive strategies. Efforts to reduce the risk of transmission between patients and surgeons will need to include informing surgeons of their personal risk and the availability of preventive strategies, improving the comfort of barrier precautions and minimizing how preventive strategies interfere with surgery.

Adult↗
PubMed1995

Testing models predicting severity of respiratory syncytial virus infection on the PICNIC RSV database. Pediatric Investigators Collaborative Network on Infections in Canada.

OBJECTIVES: To determine the sensitivity and specificity of published prognostic models to predict morbidity resulting from lower respiratory tract disease caused by respiratory syncytial virus in an independent pediatric population and to assess the accuracy of single risk factors in predicting adverse outcome. DESIGN: All articles obtained from a MEDLINE search that used the terms prognosis or sequelae and respiratory syncytial virus, and from the references of these articles, were reviewed. Studies were included if risk factors and outcomes were defined and if information was available in a database of prospectively enrolled patients with respiratory syncytial virus infections. A probability of adverse outcome was assigned to each patient in the cohort using prognostic models described in the articles. A test was considered positive if the probability of the adverse outcome was 5% or more. PATIENTS: Six hundred eighty-nine patients hospitalized with respiratory syncytial virus in seven tertiary care centers across Canada were prospectively enrolled in the Pediatric Investigators Collaborative Network on Infections in Canada database. MAIN OUTCOME MEASURES: The sensitivity and specificity of single predictors and of models in predicting severe disease were determined. RESULTS: The sensitivity of single predictors varied from 17% to 46%. A model that used age and oxygen saturation at admission in previously well infants had a sensitivity of 98% and a specificity of 47% when predicting intensive care unit admission. Another model that included age at hospitalization, gestational age, presence of an underlying condition, and respiratory syncytial virus subtype used to predict the outcome of a high severity index had a sensitivity of 77% and a specificity of 76%. When the above model was modified by exclusion of viral subgroup, sensitivity increased to 94%, but specificity decreased to 46%. CONCLUSION: Previously described prognostic models were generalizable to an independent study population.

Canada↗
PubMed1995

Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection.

OBJECTIVE: To provide information on disease attributable to respiratory syncytial viral lower respiratory tract infection (RSV LRI) and to quantify the morbidity associated with various risk factors. DESIGN: Prospective cohort study. SUBJECTS: Patients hospitalized with RSV LRIs at seven centers were eligible for study if they were younger than 2 years of age, or hospitalized patients of any age if they had underlying cardiac or pulmonary disease or immunosuppression. MEASUREMENTS AND RESULTS: Enrolled (n = 689) and eligible but not enrolled (n = 191) patients were similar in age, duration of illness and proportion with underlying illness, use of intensive care, and ventilation. Of the enrolled patients, 156 had underlying illness. The isolates from 353 patients were typeable: 102 isolates were subgroup A, 250 were subgroup B, and one isolated grouped with both antisera. The mean hospital stay attributable to respiratory syncytial virus (RSV) was 7 days; 110 patients were admitted to intensive care units, 63 were supported by mechanical ventilation, and 6 patients died. Regression models were developed for the prediction of three outcomes: RSV-associated hospital duration, intensive care unit admission, and ventilation treatment. In addition to previously described risk factors for an increased morbidity, such as underlying illness, hypoxia, prematurity and young age, three other factors were found to be significantly associated with complicated hospitalization: aboriginal race (defined by maternal race), a history of apnea or respiratory arrest during the acute illness before hospitalization, and pulmonary consolidation as shown on the chest radiograph obtained at admission. The RSV subgroup, family income, and day care attendance were not significantly associated with these outcomes. CONCLUSIONS: Hypoxia on admission, a history of apnea or respiratory arrest, and pulmonary consolidation should be considered in the management of children with RSV LRIs. Vaccine trials should target patients with underlying heart or lung disease or of aboriginal race.

Antigens, Viral↗
PubMed1995

Effects of hearing impairment on the patient's family and friends.

A modified version of the Problems Questionnaire was administered to significant others, (SOs) usually spouses, of patients attending audiological rehabilitation clinics. The SOs were asked to list the problems they experienced because of the patient's hearing loss. They were also asked to list the problems the patient was experiencing. In addition the patients were asked to list the problems they experienced and those encountered by their SOs. SO problems concentrated more on difficulties with live speech and psychosocial problems compared with those listed by patients. They also featured more responses indicating dependence. The latter were found particularly among the SOs of male patients whose SOs also emphasised the need to repeat phrases. The SOs of female patients emphasised psychosocial problems.

Adolescent↗
PubMed1995

Assessment of the Vital Signs Quality of Life Questionnaire in three studies on hypertension.

The Vital Signs Quality of Life Questionnaire is a patient survey developed to assess the effects of treatment on 25 variables associated with a sense of well-being and perceptions of general health, mental functioning and social performance. Data collected from this questionnaire in three studies on hypertension were analysed and are presented here. In study 1, low-dose verapamil significantly reduced office and ambulatory diastolic (DBP) and systolic (SBP) blood pressure (P < 0.01) in patients with mild hypertension. In study 2, verapamil and nifedipine significantly and similarly reduced office DBP and SBP in patients with mild to moderate hypertension. In study 3, significantly greater reductions in ambulatory DBP and SBP were observed with verapamil compared with placebo (P < 0.01) in elderly patients with mild to moderate hypertension. Reported adverse experiences were not different from those known to be associated with the study drugs. There was significant improvement in the intensity of quality of life (QOL) variables (P = 0.03) and in the total (sum of frequency and intensity) QOL score (P = 0.02) following treatment in study 1. In study 2, there were no significant changes in QOL scores following treatment with either verapamil or nifedipine. In study 3, QOL scores remained statistically unchanged for both treatment groups; however, there was a trend toward improvement with verapamil and worsening with pacebo. Taken together, the data show no negative effects of verapamil on QOL, even though verapamil demonstrated significant anti-hypertensive effectiveness. The questionnaire displayed a high level reliability, as measured by Cronbach's alpha (0.91 for both frequency and intensity).

Adult↗