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Acute rheumatic fever and poststreptococcal reactive arthritis: diagnostic and treatment practices of pediatric subspecialists in Canada.

https://arctichealth.org/en/permalink/ahliterature193938
Source
J Rheumatol. 2001 Jul;28(7):1681-8
Publication Type
Article
Date
Jul-2001
Author
N. Birdi
M. Hosking
M K Clulow
C M Duffy
U. Allen
R E Petty
Author Affiliation
Department of Pediatrics, University of Ottawa, Ontario, Canada.
Source
J Rheumatol. 2001 Jul;28(7):1681-8
Date
Jul-2001
Language
English
Publication Type
Article
Keywords
Acute Disease
Anti-Bacterial Agents - therapeutic use
Arthritis, Reactive - diagnosis - prevention & control - therapy
Canada
Child
Female
Humans
Male
Pediatrics
Professional Practice
Questionnaires
Rheumatic Fever - diagnosis - drug therapy - therapy
Abstract
We conducted a survey of pediatric specialists in rheumatology, cardiology, and infectious diseases to ascertain present Canadian clinical practice with respect to diagnosis and treatment of acute rheumatic fever (ARF) and poststreptococcal reactive arthritis (PSReA), and to determine what variables influence the decision for or against prophylaxis in these cases.
A questionnaire comprising 6 clinical case scenarios of acute arthritis occurring after recent streptococcal pharyngitis was sent to members of the Canadian Pediatric Rheumatology Association, and to heads of divisions of pediatric cardiology and pediatric infectious diseases at the 16 university affiliated centers across Canada.
There is considerable variability with respect to diagnosis in cases of ReA following group A streptococcal (GAS) infection both within and across specialties. There is extensive variability regarding the decision to provide prophylaxis in cases designated as ARF or PSReA. Findings indicated that physicians are most comfortable prescribing antibiotic prophylaxis in the presence of clear cardiac risk and are less inclined to such intervention for patients diagnosed with PSReA. When prophylaxis was recommended for cases of PSReA, the majority of respondents prescribed longer term courses of antibiotics.
The lack of observed consistency in diagnosis and treatment in cases of reactive arthritis post-GAS infection likely reflects the lack of universally accepted criteria for diagnosis of PSReA and insufficient longterm data regarding carditis risk within this population. There is a need for clear definitions and treatment guidelines to allow greater consistency in clinical practice across pediatric specialties.
PubMed ID
11469479 View in PubMed
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Head and neck manifestations of Kawasaki disease.

https://arctichealth.org/en/permalink/ahliterature198870
Source
Int J Pediatr Otorhinolaryngol. 2000 Apr 15;52(2):123-9
Publication Type
Article
Date
Apr-15-2000
Author
A. Yoskovitch
T L Tewfik
C M Duffy
B. Moroz
Author Affiliation
Department of Otolaryngology--Head and Neck Surgery, Montreal Children's Hospital, McGill University, Suite B-240, 2300 Tupper Street, Montreal, Canada.
Source
Int J Pediatr Otorhinolaryngol. 2000 Apr 15;52(2):123-9
Date
Apr-15-2000
Language
English
Publication Type
Article
Keywords
Aspirin - administration & dosage
Canada - epidemiology
Child
Child, Preschool
Drug Therapy, Combination
Female
Head
Humans
Infant
Injections, Intravenous
Male
Mucocutaneous Lymph Node Syndrome - diagnosis - drug therapy - epidemiology
Neck
Prevalence
Retrospective Studies
gamma-Globulins - administration & dosage
Abstract
Kawasaki disease, also known as acute infantile febrile mucocutaneous lymph node syndrome, is a self-limited vasculitic disease of infants and young children. The cause of the disease remains uncertain. Within the constellation of signs and symptoms, there are numerous otolaryngologic manifestations. The following represents the largest series of patients in the otolaryngology literature, involving 155 confirmed cases of Kawasaki disease as treated at our institution during the last 10 years. The demographic data, clinical pictures of the typical and atypical forms of the illness, as well as the laboratory values, therapy and complications are discussed.
PubMed ID
10767459 View in PubMed
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Home-based palliative care for children--Part 1: The institution of a program.

https://arctichealth.org/en/permalink/ahliterature229618
Source
J Palliat Care. 1990;6(1):11-5
Publication Type
Article
Date
1990
Author
M. Levy
C M Duffy
P. Pollock
E. Budd
L. Caulfield
G. Koren
Author Affiliation
Hospital for Sick Children, Toronto, Ontario, Canada.
Source
J Palliat Care. 1990;6(1):11-5
Date
1990
Language
English
Publication Type
Article
Keywords
Adolescent
Central Nervous System Diseases - nursing
Child
Child, Preschool
Feasibility Studies
Home Care Services - manpower - organization & administration
Hospitals, Pediatric
Humans
Infant
Infant, Newborn
Ontario
Patient care team
Terminal Care - methods - organization & administration
Abstract
To assess the necessity and feasibility of introducing a home-based palliative care program for children admitted to our neurosurgical unit and diagnosed as being terminally ill, we conducted an analysis of all such patients admitted to our unit over an 18-month period. Of a total of 30 patients, 22 (73.4%) had central nervous system tumors, 6 (20.0%) had myelomeningocele/hydrocephalus, and 2 (6.6%) had arteriovenous malformations. The mean duration +/- SEM of hospitalized days prior to death and the proportion of time spent hospitalized during the terminal phase of illness were 28.8 +/- 4.77 and 0.327 respectively, for the 23 patients who died and on whom adequate data were available. Sixteen (70.6%) of these 23 patients died in hospital. Nine (30.0%) of the total group of patients were studied prospectively during the last 6 months of this study to determine the extent of their symptoms and to ascertain whether it would be feasible for them to be managed at home. The most troublesome symptoms in this subgroup were feeding difficulties, gastrointestinal symptoms, breathing difficulty, and seizures. These symptoms were managed either by (a) medications administered orally or by feeding tube or rectally, or by (b) noninvasive procedures carried out by a nurse under the direction of the admitting neurosurgeon. This study suggests that prolonged hospitalization for children diagnosed as being terminally ill can be avoided by introducing a home-based palliative program with involvement from a nurse and a physician familiar with drug therapy for terminally ill children.
PubMed ID
2332818 View in PubMed
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Home-based palliative care for children--Part 2: The benefits of an established program.

https://arctichealth.org/en/permalink/ahliterature229633
Source
J Palliat Care. 1990;6(2):8-14
Publication Type
Article
Date
1990
Author
C M Duffy
P. Pollock
M. Levy
E. Budd
L. Caulfield
G. Koren
Author Affiliation
Hospital for Sick Children, University of Toronto, Ontario, Canada.
Source
J Palliat Care. 1990;6(2):8-14
Date
1990
Language
English
Publication Type
Article
Keywords
Central Nervous System Diseases - therapy
Child
Child, Preschool
Female
Home Nursing
Humans
Male
Ontario
Palliative Care - methods
Parents
Abstract
Thirty-four patients have been admitted to our palliative care program since its institution in March 1986. Five were unsuitable and were withdrawn soon after admission. Of the remainder, 22 (75.9%) had central nervous system (CNS) tumors, 5 (17.2%) had myelomeningocoele, 1 (3.45%) had an arteriovenous (AV) malformation, and 1 (3.45%) had a storage disease. Twenty-five (86.2%) have since died and 17 (68%) of these have died at home. In comparison with a similar group of 30 patients studied in a feasibility study prior to the institution of our program, patients admitted to our palliative care program were hospitalized for significantly fewer days during the terminal phase of their illness (p less than 0.05) and a significantly higher proportion died at home (p less than 0.001). Following a survey of the parents of 14 children diagnosed with CNS tumors who died while under our care, we determined that the overall level of satisfaction with the program was high compared to care provided prior to admission to the program (p less than 0.01). Components of the program deemed most satisfactory were (1) being able to care for the child at home (p less than 0.01), (2) having access to a palliative care nurse (p less than 0.05), and (3) having access to a pediatric clinical pharmacologist (p less than 0.05). The most troublesome symptoms occurring in this group of patients were pain, gastrointestinal symptoms, and seizures. Most problems were adequately managed by the parents under the supervision of the team. Eighty percent of the terminal care for these patients was provided at home.(ABSTRACT TRUNCATED AT 250 WORDS)
PubMed ID
1695951 View in PubMed
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Seasonal onset of systemic-onset juvenile rheumatoid arthritis.

https://arctichealth.org/en/permalink/ahliterature210979
Source
J Pediatr. 1996 Oct;129(4):513-8
Publication Type
Article
Date
Oct-1996
Author
B M Feldman
N. Birdi
J E Boone
P B Dent
C M Duffy
J E Ellsworth
B A Lang
R M Laxer
R M Lewkonia
P N Malleson
K G Oen
J D Paquin
A M Rosenberg
R. Schneider
E D Silverman
Author Affiliation
Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Source
J Pediatr. 1996 Oct;129(4):513-8
Date
Oct-1996
Language
English
Publication Type
Article
Keywords
Adolescent
Age of Onset
Arthritis, Juvenile - epidemiology - virology
Canada - epidemiology
Child
Child, Preschool
Female
Humans
Incidence
Infant
Infant, Newborn
Male
Seasons
Virus Diseases - epidemiology
Abstract
This study was undertaken to investigate the recent finding of a seasonal difference in the onset of systemic-onset juvenile rheumatoid arthritis (SoJRA). We hypothesized that a seasonal onset pattern might implicate on infectious agent as a cause of SoJRA.
The date of onset was collected from the records of all patients with SoJRA from 1980 to 1992 at presentation to pediatric rheumatology clinics across Canada. The onset pattern of SoJRA was then compared with incidence data on viral infections obtained for the same period.
Across Canada the onset of SoJRA was constant across the seasons. However, in the Prairie region there was a statistically significant seasonal pattern, with peaks in autumn and early spring. We could find no evidence that viral incidence correlated with disease incidence either throughout Canada or in the Prairie region.
If a seasonal infectious agent causes SoJRA, then it is likely only one of several causes and may act only in certain regions. Future studies should be carried out in those areas where SoJRA does have a seasonal onset pattern.
PubMed ID
8859257 View in PubMed
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