Garrett Adams

Parent relationships and compliance in cystic fibrosis

INTRODUCTION Marital adjustment, family characteristics, and parent-child stress and compliance with treatment were investigated in 41 families with a preadolescent child (age 3 to 11 years) who had cystic fibrosis (CF). METHOD Mothers completed the Dyadic Adjustment Scale, the Family Adaptability and Cohesion Evolution Scale, and the short form of the Parenting Stress Index. Parents and medical staff completed questionnaires assessing the childs compliance with diet/nutritional intake, vitamins, pancreatic enzymes, other medications (such as oral antibiotics), and chest physiotherapy. RESULTS Preadolescents with CF were viewed as generally cooperative with most aspects of treatment. Parental ratings of compliance with dietary and nutritional intake were associated with increased marital consensus and decreased parenting stress. Medical staff ratings of dietary compliance, medication compliance, and chest physiotherapy compliance were associated with lower parenting stress. DISCUSSION Parent-child stress and lack of agreement between parents is associated with problems in compliance with treatment, which may have an adverse impact on the disease and health status of the child with CF.

Measles-Mumps-Rubella Immunization of Susceptible Hospital Employees during a Community Measles Outbreak: Cost-Effectiveness and Protective Efficacy

OBJECTIVE To determine cost-effectiveness and protective efficacy of a program to identify and immunize susceptible hospital employees during a measles outbreak. DESIGN A cost analysis was made of blind measles-mumps-rubella (MMR) immunization versus directed MMR immunization based on 2,000 employees born after December 31, 1956. A directed MMR immunization program for susceptible employees was instituted. Actual costs of the program were calculated at the conclusion of the program. SETTING A medical center complex with more than 4,000 employees, two acute care community hospitals, and a tertiary care childrens hospital. RESULTS A directed MMR immunization program was projected to be less expensive than blind immunization (

Varicella exposure in a neonatal intensive care unit: Case report and control measures

23,106 versus

Emergence and control of methicillin-resistant Staphylococcus aureus in a children's hospital and pediatric long-term care facility

70,720). MMR vaccine was administered to 169 of 188 susceptible employees. Actual cost of the directed MMR immunization program was

Primary pneumococcal peritonitis complicated by exudative pleural effusion in an adolescent girl

25,384. CONCLUSIONS The directed MMR immunization program was cost-effective and prevented secondary cases among hospital employees during a community measles outbreak.

Restriction Endonuclease Fingerprinting of Herpes Simplex Virus DNA: A Novel Epidemiological Tool Applied to a Nosocomial Outbreak

Forty-six infants in a neonatal intensive care unit and 138 health care workers were exposed to a pediatric medical resident during the prodromal period and the early days of unrecognized varicella. An attempt was made to prevent an outbreak of additional cases by the institution of emergency control measures. These measures included rapid identification of varicella antibody status in exposed neonates, varicella antibody testing of health care workers with unknown or uncertain history of varicella, prompt administration of varicella zoster immune globulin to potentially susceptible persons, and cohorting neonates on the basis of exposure and antibody status. Passive maternal antibody was detected in 44 of the neonates. Of 27 health care workers who reported either a negative or an uncertain history of varicella, 26 had detectable antibody. No overt cases of varicella occurred in exposed patients or personnel.

NOSOCOMIAL HERPETIC INFECTIONS IN A PEDIATRIC INTENSIVE CARE UNIT

BACKGROUND After a 6-year quiescence, methicillin-resistant Staphylococcus aureus (MRSA) was isolated from 30 patients in a childrens hospital and a pediatric long-term care facility from November 1987 through April 1989. After six nosocomial cases had occurred at the childrens hospital, increased infection control measures directed at MRSA were initiated in August 1988. Because MRSA had been identified in three patients in the pediatric long-term care facility within 24 hours of their admission to the childrens hospital, other patients transferred from the pediatric long-term care facility to the childrens hospital were isolated and screened for MRSA. METHODS We reviewed the medical records of these patients and evaluated their response to therapy with rifampin alone or in combination with trimethoprim-sulfamethoxazole. RESULTS In the 8-month period after initiation of infection control measures, MRSA was identified in 10 residents of the pediatric long-term care facility; there was also one nosocomial childrens hospital case. Phage typing showed that one MRSA strain predominated in patients at the pediatric long-term care facility but did not implicate this strain as the source for MRSA introduction into the childrens hospital. Of 16 patients with MRSA who completed therapy and were available for follow-up, 13 (81%) had elimination of colonization. CONCLUSION Prompt institution of MRSA surveillance, barrier isolation, and therapy to eliminate colonization should be considered in hospitals with a new introduction of MRSA.

Ganciclovir therapy of congenital cytomegalovirus pneumonia.

A healthy, young adolescent girl developed primary pneumococcal peritonitis, an infection rarely reported in this age group in North America. Her course was further complicated by exudative pleural effusion and pneumonia despite receiving 10 days of clindamycin therapy. Laparascopy proved useful in making the initial diagnosis, but may have contributed to the pathogenesis of the pulmonary process. Case presentation, management, and etiology are discussed.