Sick Children's surveys viral nosocomial infections.
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Biomedical subjects
Publications and source records attributed to M Patrick.
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A natural experiment in psychiatric education took place nationally between 1970 and 1976, when one group of residents entered psychiatry with an internship, and the other without one. In this study 22 psychiatry residents with an internship and 25 without one were compared during their first two years of training. Initial faculty evaluations of the two groups' responsibility, insight, teachability, and knowledge were virtually identical, as were those of their overall performance in inpatient, consultation, and emergency psychiatry. However, ratings of outpatient psychotherapy showed several significant and differences favoring the noninternship group. The authors find these results disquieting. They suggest that interferences with empathy may be an untoward side effect of the internship.
A large total population study of childhood saltwater immersion accidents is reported. A total of 49 cases (16 fatalities, 33 survivors) occurred in the five year period from 1971 to 1975 in southeastern Queensland. As a group, more children survive a potentially fatal saltwater immersion (67%) than do those who lose consciousness in freshwater (50%). The serious saltwater accident rate (loss of consciousness or death) in childhood (from 0 to 15 years inclusive, is 3.37/100,000 children per year at risk (fatality rate 1.12). This is low; comparison with freshwater data shows that although the surf presents special hazards to children, it is very much safer than other types of water. Age-specific and site-specific accident and survival rates for saltwater immersions are presented for the first time. Toddlers are disproportionately represented (33% of all children) and their survival rates are lowest. Boating and the use of surfboards, in current practice, are negligible threats to children. The saltwater immersion rate is increasing (although the absolute risk is small) and reasons for this are discussed. Childhood saltwater immersions were unaffected by tidal state. All but one case of immersion occurred during daylight hours, and in younger children immersion occurred often on weekends.
Three double-blind crossover trials were used to study the effects of single doses of flurbiprofen at night on pain at night, duration of morning stiffness and sleep disturbance in patients with active rheumatoid arthritis. Flurbiprofen (150 mg) was shown to be superior to placebo and 150 mg was no more effective than 100 mg. Serum levels of the drug were significantly higher with 150 mg but did not correlate with clinical effects.
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Two strains of reovirus (serotype 1 Lang/TIL and serotype 3 Dearing/T3D) were propagated in Vero cells grown in stationary or agitated cultures in a serum-free medium, M-VSFM. Solid microcarriers (Cytodex-1) were used to support cell growth in agitated cultures with a normal doubling time of 25 h. Cell yields of 1 x 10(6) cells/mL were obtained from an inoculum of 2 x 10(5) cells/mL in 4 days in microcarrier cultures. The growth profile and cell yield was not significantly different from serum-supplemented cultures. The virus titer increased by 3-4 orders of magnitude over a culture period of 150 h. The maximum virus titer in stationary cultures reached >1 x 10(9) pfu/mL for both strains of reovirus in M-VSFM. M-VSFM also supported high viral yields in microcarrier cultures. Both the specific productivity and final viral yield was higher in M-VSFM than serum-supplemented cultures. The high viral productivity suggests that this is a suitable system for the production of reovirus as an oncolytic agent for human therapeutic use.
Wilson's disease is due to a genetically determined defect inherited as an autosomal recessive trait. Most reported cases have been caucasoid. This report describes a case of Wilson's disease in an Australian Aboriginal girl, only the second such case reported.
Pre-operative nutritional support was studied in 28 children with end-stage liver disease awaiting orthotopic liver transplantation. Nasogastric supplemental administration of a standard semi-elemental enteral nutritional formula was compared with a similar formula enriched with branched chain amino acids, and with a group receiving oral nutrition only. The duration of treatment in all groups was similar (mean 90 days). Energy intakes in the supplemented groups were 120-150% of recommended daily intakes (RDI), whereas ad libitum intakes in the oral group ranged 58-100% RDI. A significant improvement in mean Z-score for body weight (denoting catch-up) was noted only in those children who received nasogastric supplements enriched with branched-chain amino acids. The standard enterally-fed group maintained their body weight and Z-scores did not change significantly. In contrast, body weight Z-scores in those fed orally declined significantly. Nutritional supportive therapy of malnourished children with end-stage liver disease can minimize or improve nutritional status in children awaiting liver transplantation. The use of nutritional formulae rich in branched-chain amino acids may have nutritional advantages in children with chronic liver disease which require further study and evaluation.
Post-liver transplant cytomegalovirus (CMV) infection (seroconversion or virus isolation) and CMV disease (infection plus clinical signs and symptoms) were studied in relation to pretransplant recipient and donor serology, age, nutritional status and the effect of paediatric versus adult (reduced size) grafts. Of 70 children receiving 79 transplants, 26 (37%) had evidence of CMV infection, and eight (11.5%) had evidence of CMV disease, four of whom died. The primary infection rate (where the recipients were CMV negative) was 71% with mortality of 7% with most receiving a CMV-positive graft. The active secondary infection rate (reactivation or reinfection, where the recipients were CMV positive) was 60% with mortality of 12.5%. No significant differences in infection or disease rates were found comparing malnourished versus well-nourished patients, or between those who received whole or reduced-size grafts. The high prevalence of CMV infections supports the view that clinical signs alone are inadequate to direct investigations for CMV. Both primary and active secondary CMV infection can result in serious morbidity and mortality in children receiving liver transplants. These data do not support the strategy of providing immunoprophylaxis to seronegative recipients only, at least in paediatric liver transplantation.
This study identified the knowledge base and practices of Registered Nurse, Certified Diabetes Educators (RN, CDEs) regarding their exercise teaching programs for elderly clients who have non-insulin-dependent diabetes mellitus (NIDDM). The random sample of 197 AADE members surveyed by questionnaire was a highly educated and experienced group. RN, CDEs who worked 30 or more hours per week in diabetes education or attended four or more continuing education (CE) programs per year had significantly more comprehensive exercise teaching program designs and instructional techniques to enhance elderly NIDDM clients' learning (P < .05). However, many CDEs do not teach their elderly clients about exercise due to lack of resources, lack of specific knowledge to prescribe exercise,and negative stereotypes of elderly clients' ability to exercise. Greater availability of educational programs for CDEs to explore curriculum development, program planning, evaluation, and exercise prescription for elderly clients with multisystem disease is recommended.
Overall, the data from the study show that nursing assistants who were planning to leave their present employment within the next three months were younger, had been in their positions less time, were paid less, and were better educated than those who were planning to stay in their present jobs. Also, the assistants who were planning to leave were not planning to stay in nursing as a life's career. They were planning to leave their present jobs because they had less input into the planning of care and conferences on care, attended fewer in-service programs, and ranked their own nursing skills lower than their peers. Changing patient assignments on a daily basis was more often associated with plans to leave than was changing patient assignments weekly or never. Finally, nursing assistants who were planning to leave cared for more patients per shift than those who were planning to stay. Nursing assistants who were planning to leave their jobs imminently had been employed for 12 or fewer months more frequently than nursing assistants who were planning to stay. The leavers were also in their first nursing job more frequently than the latter group and seemed to be a more critical group as well: 27% of those who were leaving reported that they criticized the policy or procedure of their facility sometimes or even frequently, a higher percentage than almost any other variable tested in the study. Another variable that was different between the two groups was what they considered most important to them.(ABSTRACT TRUNCATED AT 250 WORDS)
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