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Biomedical subjects

J M Langley

Publications and source records attributed to J M Langley.

At least 19 recordsLinked to original sources
PubMed2001

Unique epidemiology of nosocomial urinary tract infection in children.

BACKGROUND: Nosocomial urinary tract infection (NUTI) occurs with varying frequency in children and is thought to be associated with urethral instrumentation. In response to changing infection control resources at our facility, we reviewed NUTI to determine whether the frequency of NUTI, associated complications, or presence of a remediable risk factor (instrumentation) justified ongoing routine infection control surveillance. METHODS: Prospective surveillance was conducted on all wards 8 months per year from January 1991 through December 1997 by an infection control nurse coordinator. NUTI was defined by laboratory evidence according to Center for Disease Control and Prevention definitions and detected 48 hours after admission. Urinary catheterization in the previous 7 days was categorized as continuous/indwelling or intermittent. RESULTS: NUTI was the fifth most common nosocomial infection (129/1375; approximately 9%) and decreased in frequency during the decade from 0.9 to approximately 0.6 cases/1000 patient days. Incidence was equal among men and women. Only 50% of cases had prior instrumentation of the urinary tract. NUTI occurred disproportionately in newborns and infants (P <.001). The most common pathogen was Escherichia coli (28%; 38/132), followed by Candida sp (18%; 24/134), Enterococcus (13%; 18/134), gram-negative nonfermenters (13%; 17/132), Enterobacter (approximately 10%; 13/134), Pseudomonas (9.7%; 13/134), and other (16%; 22/134). Three cases of secondary bacteremia occurred (2.3%; 95% confidence interval 0.5-6.6); there was no mortality. CONCLUSIONS: NUTI poses a less significant burden of illness (incidence, associated morbidity) than other nosocomial infection in children. If resources do not permit hospital-wide surveillance, high-risk children with urethral instrumentation and newborns and infants could be targeted. Although E coli remains the most common cause of pediatric NUTI, fungi have become the second most common pathogen in this tertiary care population. Risk factors for NUTI in noncatheterized children remain to be delineated.

Adolescent↗
PubMed2001

Evaluation of the notification of hepatitis C risk to children who received unscreened blood or blood products.

Parents of children who received blood or blood products between 1984 and 1990 were notified about the potential risk of hepatitis C virus (HCV) infection. Data were collected about knowledge, attitudes and intended behaviours to determine the acceptability of the notification process. Demographic variables that may predict responses to notification were also recorded and analysed. Recipients were sent couriered letters explaining HCV risk, and the survey questionnaire. Sera were screened for HCV antibody and reactive samples confirmed with a recombinant immunoblot assay (RIBA). Four letter recipients were RIBA positive for a prevalence of 1.1% (4/358) in the notification group. Thirty-two percent of respondents did not know their child had been transfused and 58% did not know about the potential risk of HCV infection. Although 90% (165/185) felt the notification was valuable, 65% reported emotional distress (fear, worry, anger, very depressed). Responders were similar to non-responders except for HCV testing rate (76.2% v. 59.8%, p < 0.0002). Parents of children at risk of transfusion-acquired HCV virus approved of notification programs, but experienced some emotional distress. Awareness of transfusion history or risk of HCV was not universal, indicating the need to address notification to individuals, rather than through public education campaigns alone.

Adolescent↗
PubMed2000

Canadian Acute Respiratory Illness and Flu Scale (CARIFS): development of a valid measure for childhood respiratory infections.

Although acute respiratory infection (ARI) is the most frequent clinical syndrome in childhood, there is no validated measure of its severity. Therefore a parental questionnaire was developed: the Canadian Acute Respiratory Illness Flu Scale (CARIFS). A process of item generation, item reduction, and scale construction resulted in a scale composed of 18 items covering three domains; symptoms (e.g., cough); function (e.g., play), and parental impact (e.g., clinginess). The validity of the scale was evaluated in a study of 220 children with ARI. Construct validity was assessed by comparing the CARIFS score with physician, nurse, and parental assessment of the child's health. Data were available from 206 children (94%). The CARIFS correlated well with measures of the construct (Spearman's correlations between 0.36 and 0.52). Responsiveness was shown, with 90% of children having a CARIFS score less than a quarter of its initial value, by the tenth day.

Acute Disease↗
PubMed2000

Variation in risk for nosocomial chickenpox after inadvertent exposure.

Inadvertent exposure to chickenpox in the healthcare setting results in time-consuming and expensive infection control management strategies. In households, secondary cases occur in up to 96% of susceptibles, but transmission risk after exposure in an occupational setting is less well defined. In this prospective cohort study of inadvertent exposures in a 180-bed paediatric hospital, the secondary transmission rate was 4.5% (4/89; 95% confidence interval 1.2, 11.1%). Fourteen index cases exposed 158 patients and 93 healthcare workers over a 36-month study period. Exposures occurred in inpatient and ambulatory settings, with patients, staff and siblings serving as index cases. Transmission only occurred when the index case and contacts were in the same room and not in a multi-room setting (12% v. 0%, Fisher exact test, P = 0.02). Occupational exposures present a lesser transmission risk than those in households. Definition of those exposure variables that increase risk of transmission in the occupational setting should be explored in future studies.

Adult↗
PubMed1999

Variable morbidity of respiratory syncytial virus infection in patients with underlying lung disease: a review of the PICNIC RSV database. Pediatric Investigators Collaborative Network on Infections in Canada.

OBJECTIVE: We wished to compare outcomes of respiratory syncytial virus (RSV) infection in children with bronchopulmonary dysplasia (BPD) with those with other pulmonary disorders: cystic fibrosis, recurrent aspiration pneumonitis, pulmonary malformation, neurogenic disorders interfering with pulmonary toilet, and tracheoesophageal fistula. METHODS: Children with RSV infection hospitalized at seven Canadian pediatric tertiary care hospitals in 1993 through 1994 and 9 hospitals in 1994 through 1995 were enrolled and prospectively followed. This study is a secondary analysis of data from this prospective cohort. RESULTS: Of the 1516 patients enrolled the outcomes of 159 with preexisting lung disorders before RSV lower respiratory tract infection constitute this report. There were no significant differences among the 7 groups (BPD, cystic fibrosis, recurrent aspiration pneumonitis, pulmonary malformation, neurogenic disorders interfering with pulmonary toilet, tracheoesophageal fistula, other) for the morbidity measures: duration of hospitalization, intensive care unit (ICU) admission, duration of ICU stay, mechanical ventilation and duration of mechanical ventilation. Patients using home oxygen were more likely to be admitted to the ICU than those who had never or previously used home oxygen (current 57.1%, past 23.8%, never 33.3%, P = 0.03). CONCLUSIONS: Children with other underlying diseases have morbidity similar to those with BPD. Prophylactic interventions against RSV should also be studied in these groups.

Bronchopulmonary Dysplasia↗
PubMed1999

A randomized, placebo-controlled trial of erythromycin estolate chemoprophylaxis for household contacts of children with culture-positive bordetella pertussis infection.

CONTEXT: Household contacts of patients with pertussis are at increased risk of acquiring infection. Chemoprophylaxis has been recommended to decrease transmission, particularly to young infants who are at increased risk of severe disease. Although epidemiologic investigations of outbreaks have suggested a benefit, there have been no prospective studies evaluating the efficacy of chemoprophylaxis in preventing secondary cases of pertussis. OBJECTIVE: To determine whether erythromycin estolate chemoprophylaxis is effective in household contacts of children with culture-positive pertussis. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Community based. SUBJECTS: All household contacts of 152 children with culture-positive pertussis who provided consent (n = 362). After withdrawals, there were 135 households with 310 contacts. Exclusions included pregnancy, age <6 months, already receiving an erythromycin-containing antibiotic, and erythromycin allergy. INTERVENTUINS: Erythromycin estolate (40 mg/kg/day in 3 divided doses; maximum dose 1 g) or placebo for 10 days. Nasopharyngeal cultures, pertussis antibodies, and clinical symptoms were assessed before and after treatment. PRIMARY OUTCOME: Measure efficacy of erythromycin estolate chemoprophylaxis calculated by the proportion of households in each group with a member who developed a nasopharyngeal culture positive for Bordetella pertussis. RESULTS: There was no difference in the development of respiratory tract symptoms compatible with a case definition of pertussis in the erythromycin- and placebo-treated groups. There were 20 households with secondary culture-positive cases of pertussis; 4 households in the erythromycin-treated group and 15 in the placebo-treated group (efficacy of erythromycin chemoprophylaxis for bacterial eradication 67.5% [95% confidence interval: 7.6-88.7]). However, medication-associated adverse reactions were reported by 34.0% of erythromycin and 15.7% of placebo recipients. CONCLUSIONS: Under the conditions of this study, erythromycin estolate prevented culture-positive pertussis in household contacts of patients with pertussis but did not prevent clinical pertussis.

Adolescent↗
PubMed1998

Parental willingness to enter a child in a controlled vaccine trial.

OBJECTIVE: To determine the reasons that motivate parents to enrol or not enrol their child in a randomized, controlled vaccine trial. DESIGN: Cross-sectional survey. SETTING: Offices of primary care physicians in Dartmouth, Nova Scotia, and Montreal, Quebec. PARTICIPANTS: At the 2 sites, parents of 2-month-old infants at their first immunization visit who had decided to enrol (221) or not enrol (208) their child in 2 randomized pertussis vaccine trials. OUTCOME MEASURES: Rates of enrolment in vaccine trials; attitudes about medical research; sources of information about pertussis. RESULTS: Enrolment rates were 68% and 43% at the 2 sites. All parents agreed to answer questions about their decision to enrol or not enrol their child. The most common concerns resulting in nonenrolment were extra immunization 54% (26/48) and blood procurement 42% (20/48). Parents who did enrol their children were motivated to participate by the desire to contribute to medical knowledge (77% [170/221]), the desire to help others (48% [106/221]) and by the participation of their family physician (54% [120/221]). The enrollees' major sources of information about pertussis was health professionals or study personnel rather than the media. CONCLUSIONS: Altruistic reasons motivate parents' decision to enrol a child in a randomized, controlled vaccine trial. Nonparticipating parents seem most concerned about painful procedures in the study. Parents' decisions regarding participation do not appear to be affected by adverse media attention regarding the purported adverse sequelae of pertussis vaccines.

Attitude to Health↗
PubMed1997

Economic evaluation of respiratory syncytial virus infection in Canadian children: a Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study.

OBJECTIVES: To quantify the cost and distribution of health care resources consumed annually in management of Canadian children from birth to 4 years of age with respiratory syncytial virus (RSV) infection. STUDY DESIGN: Estimates of direct medical expenditures (in 1993 U.S. dollars) were collected from a prospective cohort study of hospitalized children with RSV and from national and provincial databases. RESULTS: The annual cost of RSV-associated illness was almost $18 million. The largest component of direct expenditures (62%) was for inpatient care for the estimated 0.7% of all infected children ill enough to require admission. Physician fees comprised only 4% of inpatient expenses. Expenditures for ambulatory patients accounted for 38% of direct costs. CONCLUSIONS: The greatest reductions in the economic cost of RSV infections will be found in interventions that reduce duration of or prevent hospital stay. Costs for management of RSV infection in children in the Canadian health care system are considerably less than charges reported in the United States.

Absenteeism↗
PubMed1997

Seven days of erythromycin estolate is as effective as fourteen days for the treatment of Bordetella pertussis infections.

OBJECTIVE AND METHODS: Although 14 days of erythromycin is recommended for the treatment of Bordetella pertussis infection, there have been no prospective controlled studies to support the contention that this long course of therapy is required to eradicate the microorganism from the nasopharynx or to prevent bacteriological relapse. We randomly allocated children and adults with culture-positive community-acquired pertussis to either 7 or 14 days of erythromycin estolate treatment (40 mg/kg/d; maximum dose 1 g/d). Nasopharyngeal aspirate cultures were obtained by study nurses during home visits before and at the end of treatment, and 1 week after the completion of treatment. B pertussis-specific antibodies were measured before treatment and 1 month later. Information about clinical symptoms, adverse reactions, and compliance were collected at each scheduled contact. RESULTS AND CONCLUSIONS: A total of 168 participants were eligible for analysis (74 treated for 7 days and 94 treated for 14 days). Bacteriological persistence (positive end of therapy culture) occurred once in each group, and bacteriological relapse (positive culture 1 week after completion of treatment) occurred in one participant treated for 7 days. The overall failure rate (persistence plus relapse) of 2.70% in the 7-day group was not different than the rate of 1.06% in the 14-day group. The study had a power of 99.99% at the 5% level to detect a difference in failure rates of 10% and a power of 80% to detect a difference of 5%. We conclude that 7 days of erythromycin estolate is as effective as 14 days for the eradication of B pertussis.

Adolescent↗
PubMed1997

Nosocomial respiratory syncytial virus infection in Canadian pediatric hospitals: a Pediatric Investigators Collaborative Network on Infections in Canada Study.

OBJECTIVE: To determine nosocomial transmission of respiratory syncytial virus (RSV) in Canadian pediatric hospitals, outcomes associated with nosocomial disease, and infection control practices. DESIGN: A prospective cohort study in the 1992 to 1994 winter respiratory seasons. SETTING: Nine Canadian pediatric university-affiliated hospitals. PARTICIPANTS: Hospitalized children with symptoms of lower respiratory tract infection (at least one of cough, wheezing, dyspnea, tachypnea, and apnea) and RSV antigen identified in a nasopharyngeal aspirate. RESULTS: Of 1516 children, 91 (6%) had nosocomial RSV (NRSV), defined as symptoms of lower respiratory tract infection and RSV antigen beginning >72 hours after admission. The nosocomial ratio (NRSV/[com-munity-acquired RSV {CARSV})] + NRSV) varied by site from 2.8% to 13%. The median length of stay attributable to RSV for community-acquired illness was 5 days, but 10 days for nosocomial illness. Four children with NRSV (4. 4%) died within 2 weeks of infection, compared with 6 (0.42%) with CARSV (relative risk = 10.4, 95% confidence interval: 3.0, 36.4). All sites isolated RSV-positive patients in single rooms or cohorted them. In a multivariate model, no particular isolation policy was associated with decreased nosocomial ratio, but gowning to enter the room was associated with increased risk of RSV transmission (incidence rate ratio 2.81; confidence interval: 1.65, 4.77). CONCLUSIONS: RSV transmission risk in Canadian pediatric hospitals is generally low. Although use of barrier methods varies, all sites cohort or isolate RSV-positive patients in single rooms. Children with risk factors for severe disease who acquire infection nosocomially have prolonged stays and excess mortality.

Canada↗
PubMed1996

Rating authors' contributions to collaborative research: the PICNIC survey of university departments of pediatrics. Pediatric Investigators' Collaborative Network on Infections in Canada.

OBJECTIVES: To determine how department chairs in pediatrics rate involvement in medical research and to determine whether faculty deans' offices have written criteria for evaluating research activity when assessing candidates for promotion or tenure. DESIGN: Cross-sectional mailed survey and telephone survey. SETTING: Canadian faculties of medicine. PARTICIPANTS: Chairs of the 16 Canadian university departments of pediatrics and deans' offices of the 16 university medical faculties. MAIN OUTCOME MEASURE: Weight assigned by department chairs to contributions to published research according to author's research role and position in list of authors and the method of listing authors. RESULTS: Fifteen of 16 chairs responded. Twelve submitted a completed survey, two described their institutions' policies and one responded that the institution had no policy. Eleven reported that faculty members were permitted or requested to indicate research roles on curricula vitae. There was a consensus that all or principal investigators should be listed as authors and that citing the research group as collective author was insufficient. The contribution of first authors was rated highest for articles in which all or principal investigators were listed. The contribution of joint-principal investigators listed as first author was also given a high rating. In the case of collective authorship, the greatest contribution was credited to the principal investigator of the group. Participation of primary investigators in multicentre research was rated as having higher value than participation in single-centre research by seven respondents and as having equal value by four. Only one dean's office had explicit written criteria for evaluating authorship. CONCLUSIONS: Most departments of pediatrics and medical faculty dean's offices in Canadian universities have no criteria for assessing the type of contribution made to published research. In view of the trend to use multicentre settings for clinical trials, guidelines for weighting investigators' contributions are needed.

Authorship↗
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

Effect of inactivated poliovirus vaccine on the antibody response to Bordetella pertussis antigens when combined with diphtheria-pertussis-tetanus vaccine.

To determine if inactivated poliovirus vaccine combined with diphtheria and tetanus toxoids and whole-cell pertussis vaccine interferes with the immunogenicity of pertussis vaccine, we performed a randomized trial of diphtheria and tetanus toxoids and pertussis vaccine combined with inactivated poliovirus vaccine given as a single injection or as two separate injections at the same visit to infants immunized at 2, 4, and 6 months of age. A total of 84 infants were enrolled in the study; 44 received the single injection, and 40 received separate injections. Before immunization, there were no differences in antibody values between the two groups. After two vaccine doses, infants immunized with the single injection had significantly lower values of antibody to filamentous hemagglutinin (8.3 vs. 23.7 ELISA units; P < .001), fimbriae (266.5 vs. 771.8 ELISA units; P < 0.01), and the 69-kD membrane protein (442.2 vs. 1,352 ELISA units; P < .001). After the third dose, these differences persisted, and differences were also detected for antibody to pertussis toxin (10.0 vs. 35.5 ELISA units; P < .001) and a whole-bacteria antigen preparation (2,667 vs. 3,829 ELISA units; P < .05). We conclude that there is a diminished antibody response to the pertussis vaccine when inactivated poliovirus vaccine is combined with the diphtheria and tetanus toxoids and pertussis vaccine.

Antibodies, Bacterial↗