Creutzfeldt-Jakob disease guidelines: a regional approach.

Creutzfeldt-Jakob Disease (CJD) is an infectious, progressive, degenerative neurological disorder. Unique CJD Precautions must be adhered to as the infectious agent is difficult to destroy. A regional group in Hamilton-Burlington Ontario developed CJD guidelines based on critical review of the current evidence of transmission in a Canadian healthcare environment, current published standards of practice in North America, the United Kingdom and Australia; and principles of laboratory and patient care safety as well as expert opinion.

Use of the Pediatric Risk of Mortality score to predict nosocomial infection in a pediatric intensive care unit.

Objective: To define infection rates in patients with Pediatric Risk of Mortality (PRISM) scores greater than and less than 10 on admission to the pediatric ICU (PICU).

Design: Descriptive.

Setting: An 18-bed PICU admitting patients of all ages except nonsurgical neonates; within a 585-bed tertiary care pediatric hospital.

Early nosocomial infections in pediatric cardiovascular surgery patients.

All patients undergoing cardiovascular surgery between July 1, 1987 and February 29, 1988 were followed from admission to the pediatric ICU (PICU) daily by an intensivist/anesthetist. Patients were characterized by surgical procedure and PRISM score on ICU admission. Of 310 patients, 40 patients (nosocomially infected patient ratio 12.

The incidence of viral-associated diarrhea after admission to a pediatric hospital.

For determination of the incidence of viral-associated diarrhea after admission to a pediatric hospital, all patients admitted to general pediatrics, cardiology, and neurosurgery wards without diarrhea between January 1 and July 31, 1985 were followed 5 days per week for presence of diarrhea, etiologic agent, and possible risk factors. A total of 1,530 patients were followed for 3,642 days. Of these patients, 69 developed 80 nosocomial diarrhea episodes after 72 hours in hospital for a nosocomial diarrhea rate of 4.

Evaluation of a new method of detection of nosocomial infection in the pediatric intensive care unit: the Infection Control Sentinel Sheet System.

To improve the efficiency of nosocomial infection detection, a highly structured system combining initial reporting by the bedside night nurse of symptoms possibly related to infection with follow-up by the infection control nurse (ICN) was developed: The Infection Control Sentinel Sheet System (ICSSS). Between July 1, 1987 and February 28, 1988, a prospective comparison of results obtained through ICSSS and daily bedside observation/chart review by a full-time trained intensivist was undertaken in the pediatric intensive care unit (PICU). Ratios of nosocomial infections and nosocomially-infected patients were 15.

Epidemiologic study of 4684 hospital-acquired infections in pediatric patients.

During a 4-year period 4684 nosocomial infections occurred in a university pediatric hospital which admitted 78,120 patients (nosocomial infection rate (NIR) = 6.0). NIR varied from 0.

Nosocomial infections in a pediatric intensive care unit.

In a prospective 30-month study of nosocomial infections in a pediatric ICU (PICU), the incidence, sites, and causes of infection were determined. Factors associated with increased risk of infection were investigated. In 1,388 patients who remained in the PICU for a minimum of 72 h, 116 infections occurred (6.

Nosocomial Pseudomonas aeruginosa conjunctivitis in a pediatric hospital.

Conjunctivitis accounted for 5% of nosocomial infections occurring in a university-affiliated pediatric hospital between January 1984 and April 1986. Pseudomonas aeruginosa was recovered from the conjunctiva of 30 patients. The primary diseases of these patients were chronic and debilitating.

Normal values of maximal inspiratory and expiratory pressures with a portable apparatus in children, adolescents, and young adults.

Maximal inspiratory and expiratory mouth pressures (Plmax and PEmax) were measured over a wide age range using a cylindrical mouthpiece and a multiple trial procedure. Two hundred forty-three students and 30 adults were studied. In addition, a comparison of a cylindrical and a scuba-type mouthpiece was made in 16 subjects.

Isolation usage in a pediatric hospital.

In a prospective 12-month study at a university-affiliated pediatric hospital, isolation usage was quantitated by ward/service, season, isolation category and type of infection (community-acquired vs nosocomial). Such information may be helpful in designing hospitals, recognizing time utilization of the pediatric infection control nurse, and defining educational and isolation needs. Hospitals with multiple bed rooms and inadequate numbers of single rooms may be unable to meet current federal isolation guidelines.

Maximal inspiratory and expiratory pressures are reduced in hyperinflated, malnourished, young adult male patients with cystic fibrosis.

We measured maximal inspiratory and expiratory pressures (MIP and MEP, respectively) in 23 male patients with cystic fibrosis (CF), 16 to 35 yr of age (22.1 +/- 3.7), and in a control group of 33 male volunteers, 17 to 39 yr of age (22.

Dose-response characteristics of nebulized fenoterol in asthmatic children.

Fenoterol hydrobromide, a beta 2-selective bronchodilator, was administered by aqueous nebulization to 31 children with stable asthma. An initial comparison of 0, 100, 300, and 1000 micrograms drug in 20 of these patients showed a significant change in forced expiratory volume in 1 second for all three doses compared with change after placebo (P less than 0.0001).

Assessment of a new device (aerochamber) for use with aerosol drugs in asthmatic children.

We compared the pulmonary response to fenoterol delivered by a conventional MDI with the response after MDI plus the aerochamber (AC). Twelve children with moderate to severe asthma (mean age 10.8 years) participated in this double-blind crossover study.

Long-term evaluation of fenoterol by two different modes of administration (oral versus metered aerosol).

Thirteen asthmatic children were treated double-blind for 6 weeks each with either inhaled or oral fenoterol (a beta-2-selective adrenergic bronchodilator) three times a day. The oral dose regimen resulted in superior bronchodilation on the basis of peak expiratory flow rates, although clinical symptom scores did not differ with the route of administration. We conclude that oral fenoterol can be used on a chronic basis for the treatment of moderate asthmatics.

Pathophysiology of the ciliary motility syndromes.

The ciliary motility syndromes are characterised by specific and genetically determined defects of cilia with resulting impairment of mucociliary defense mechanisms in the respiratory tract. The ciliary pathobiology, clinical observations, serial pulmonary function and chest radiographs are reviewed and correlated for a series of 33 patients with the ciliary motility syndromes, aged from 0.5 to 75 years.

Comparison of the long-term effect of fenoterol hydrobromide and theophylline syrups in pre-school asthmatic children.

Eleven asthmatic children less than six years were treated double-blind for eight weeks with fenoterol, theophylline or placebo syrups. Both active drugs significantly decreased the incidence of cough compared to placebo. Nocturnal symptoms and wheezes were also reduced but were not improved to a statistically significant degree.

Comparison of three different preparations of disodium cromoglycate in the prevention of exercise-induced bronchospasm: a double-blind study.

In its usual form, disodium cromoglycate (DSG) contains lactose as a carrier (DSGL +). It has been suggested that lactose may effect irritant receptor sites, thus causing a degree of bronchoconstriction or less blocking of exercise-induced bronchospasm (EIB). This study was designed to assess and compare the ability of three different forms of DSG to block EIB.

The immediate effect of sodium cromoglycate on the airway.

The authors compared the bronchodilator effect of nebulized solutions of sodium cromoglycate (SCG), salbutamol, and saline (placebo) in 10 asthmatic children, measuring peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and forced expiratory flow from 25% to 75% of the forced vital capacity (FEF25%-75%) before and every five minutes to a maximum of 20 minutes after each aerosol. SCG produced significant bronchodilation compared with saline as measured by PEF. This effect was not seen with FEV1 or FEF25%-75%.

The validity of the transcutaneous oxygen tension method in children with cardiorespiratory problems.

Transcutaneous oxygen tension (tcPO2) was continuously monitored and compared with simultaneous arterial oxygen tension (PaO2) in 68 patients 1.5 to 23 yr of age (mean age, 7.7 yr) with cardiopulmonary disease.

Increased incidence of bronchial reactivity in children with a history of bronchiolitis.

To assess bronchial reactivity in children who have had bronchiolitis, we studied 48 children by challenging them with methacholine nine or ten years after admission to hospital with bronchiolitis. Pulmonary function was also evaluated. Fifty-seven percent of children studied had bronchial hyperreactivity.