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Biomedical subjects

N MacDonald

Publications and source records attributed to N MacDonald.

At least 19 recordsLinked to original sources
PubMed1992

A controlled study of sustained-release morphine sulfate tablets in chronic pain from advanced cancer.

The purpose of this double-blind crossover study was to determine whether a sustained-release morphine sulfate (SRMS) tablet given orally every 12 hours could adequately replace immediate-release morphine sulfate solution (IRMS) given orally every 4 hours in hospitalized patients with chronic pain from advanced cancer. Of 33 patients entered, 27 completed the study and were included in the efficacy and safety analysis. Patients were initially randomized to receive either 30-mg SRMS tablets every 12 hours or IRMS at the same mg/24 hours dose, every 4 hours. After 2 days, a crossover was performed, and patients received the alternate treatment for 3 days. Pain and side effects were assessed using a standard 100 mm visual analogue scale (VAS). There were no statistically significant differences between the two treatment groups for mean VAS pain scores or scores for sleepiness, nausea, depression, and anxiety. The incidence of breakthrough pain was similar for both treatment groups, as was the incidence of confusion and constipation. The results demonstrated that SRMS is a safe, effective analgesic preparation for patients who require oral opioids for cancer pain. The data also support the conclusion that sustained-release morphine tablets administered every 12 hours can replace an immediate-release morphine solution administered every 4 hours.

Chronic Disease↗
PubMed1992

Lack of evidence of efficacy of cohorting nursing personnel in a neonatal intensive care unit to prevent contact spread of bacteria: an experimental study.

Nurse cohorting was investigated in a modern neonatal intensive care unit (NICU). During 99 days bacterial infection and colonization rates were determined in 100 infants experimentally assigned cohort or noncohorted care. Colonizing isolate identity was determined by plasmid profile analyses and biotyping in weekly surveillance cultures. Between Days 2 and 7, 3 infections occurred in cohorted infants but none in noncohorted ones. No secondary spread of infection or definitive colonization cluster occurred. The first colonization rate, at any site, was 0.53/patient-week in the noncohorted and 0.3 to 0.4 in the cohorted units (P greater than 0.05). Colonization ratios with species other than usual skin bacteria in the respiratory tract and with species other than Escherichia coli in the rectum were lower for noncohorted infants. Effective infection control practices in a modern NICU, including alcohol hand antisepsis, should obviate a need for cohorting.

Bacterial Infections↗
PubMed1991

Palliative care--the fourth phase of cancer prevention.

The prevention of suffering represents the fourth phase of a comprehensive cancer control program. The palliative care movement is responsible for the current development of programs which address the suffering of patients with advanced cancer and their families. Palliative care should be integrated with the other elements of cancer controls thus ensuring the continuity of excellent care for patients and strengthening the research and educational base of the palliative care movement.

Forecasting↗
PubMed1990

The sequelae of Haemophilus influenzae meningitis in school-age children.

BACKGROUND: Previous data on the consequences of Haemophilus influenzae type b meningitis for school-age children have been inconsistent, and much of the information on risk factors has been inconclusive. The present study was designed to evaluate the sequelae of this disease with a protocol for the comprehensive assessment of neuropsychological function. METHODS: Ninety-seven school-age children (mean age, 9.6 years), each of whom had a school-age sibling, were recruited from a survey of the medical records of 519 children treated for H. influenzae type b meningitis between 1972 and 1984 (at a mean age of 17 months) at the children's hospitals of Toronto, Ottawa, and Montreal. Of the 97 children, 41 had had an acute neurologic complication. Sequelae were assessed by comparing the index children with their nearest siblings on the basis of standardized measures of cognitive, academic, and behavioral status. RESULTS: Only 14 children (14 percent) had persisting neurologic sequelae: sensorineural hearing loss in 11 (unilateral in 6 and bilateral in 5), seizure disorder in 2, and hemiplegia and mental retardation in 1. Although the total sample of index children scored slightly below the siblings in reading ability, the 56 children without acute-phase neurologic complications (58 percent) were indistinguishable from their siblings on all measures. The differences between the groups were small even for the 41 pairs in which the index child had had an acute neurologic complication (mean full-scale IQ, 102 for the index children vs. 109 for the siblings). Sequelae were also associated with lower socioeconomic status and a lower ratio of glucose in cerebrospinal fluid to that in blood at the time of the meningitis. Behavioral problems were more prominent in index boys than index girls and in those who were older at the time of testing, but sex and age were not related to cognitive or academic sequelae. CONCLUSIONS: We find a favorable prognosis for the majority of children who are treated for meningitis caused by H. influenzae type b.

Adolescent↗
PubMed1990

Dichlorotetrafluoroacetone as a derivatisation reagent in the analysis of mandelic acids in human urine.

Dichlorotetrafluoroacetone has been used to prepare 4-substituted 2-bis (chlorodifluoromethyl)-1,3-dioxolan-5-one derivatives of mandelic acids which were found to be suitable for the analysis of these compounds by gas chromatography-negative-ion chemical ionisation mass spectrometry (GC-NICIMS). The high specificity of the derivatising agent facilitates the identification and quantitation of small amounts of mandelic acids in complex biological matrices. The derivatisation procedure was used to determine the concentrations of m- and p-hydroxymandelic acids and vanillylmandelic acid in to the urine of normal subjects. The method may also have application in the determination of isomeric phenylethylene glycols, the corresponding products of reductive metabolism of biogenic amines.

Acetone↗
PubMed1990

Clinical management of orbital cellulitis in children.

A prospective study was carried out by the Department of Ophthalmology and the Division of Infectious Disease at the Children's Hospital of Eastern Ontario to assess the outcome of our medical management of orbital cellulitis in children using a predetermined antibiotic regimen and to determine whether computed tomographic (CT) evidence of a subperiosteal abscess alone was an indication for surgical drainage. Between February 1985 and January 1988, 23 patients with true orbital cellulitis were admitted. CT scans were ordered routinely at the time of admission. The scans were cancelled for 13 children because they responded rapidly to medical management. CT showed edema nasal to the medial rectus, or thickening or displacement of the muscle in 8 of the 10 children who underwent the procedure. Three children required sinus and orbital drainage, but frank purulent material was found subperiosteally in only one. The results suggest that most children with orbital cellulitis can be managed with the prompt use of the appropriate intravenous antibiotics. Therapy with cloxacillin sodium and chloramphenicol or, in children under age 6 years, cefuroxime best covers the spectrum of organisms responsible for most cases of orbital cellulitis in children. CT should be used as an ancillary guide to the need for surgical exploration of the orbit in patients who do not rapidly respond to medical management.

Abscess↗
PubMed1989

Pain management.

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Canada↗
PubMed1989

Serologic and virologic analysis of type D simian retrovirus infection in a colony of Celebes black macaques (Macaca nigra).

Celebes macaques were tested for type D simian retrovirus (SRV) infection. SRV infection was first detected in one serum sample collected during 1980. By 1983, 32 of 46 monkeys (70%) were infected. Serotyping of the SRV isolates determined that 0/26 of the isolates were SRV-1; 24/26 were SRV-2; 1/26 was SRV-5; and 1/26 could not be typed. Restriction endonuclease mapping confirmed the SRV-2C and SRV-5 isolates. In addition, two SRV-2C variants were detected.

Animals↗
PubMed1988

Use of the subcutaneous route for the administration of narcotics in patients with cancer pain.

From February 1985 until January 1987, 108 consecutive patients with pain due to advanced cancer requiring parenteral narcotics were treated with a subcutaneous infusion of morphine (62 patients) or hydromorphone (46 patients). Mean maximal daily dose of morphine and hydromorphone was 305 mg (range, 80-3000 mg) and 310 mg (range, 40-4024 mg), respectively. The infusion was maintained for a mean of 31 +/- 16 days (range, 2-156). Seventy patients were treated with a portable pump. Of these patients, 33 (45%) were discharge home for a mean of 29 +/- 20 days. Eighty-six of one hundred eight (86/108, 80%) patients experienced adequate pain control (less than two extra doses of analgesics per day). The duration of the site of the infusion was 7 days (range, 2-31). The mean daily increase in those was 2.4 +/- 1.6% of the initial dose (only 15% of patients needed an increase more than or equal to 5% per day). Systemic toxicity consisted of respiratory depression in two patients, severe sedation in six, and confusion in three; all patients improved upon reduction of the daily dose of narcotics. Local toxicity consisted in infection in two patients, bleeding in one, and chemical irritation in six. Cost analysis shows that subcutaneous infusion reduced costs by either allowing home discharges, or replacing intravenous infusion. The authors conclude that this method is safe and effective in patients admitted and at home, and should be considered the first choice when parenteral analgesia is required.

Cost-Benefit Analysis↗