Medicine and Health Sciences Commons^™

Borderline Personality Disorder: An Overview Of History, Diagnosis And Treatment In Adolescents, Linah Al-Alem, Hatim A. Omar

Pharmacology and Nutritional Sciences Faculty Publications

Borderline personality disorder (BPD) is a cluster B personality disorder. It is characterized by erratic behaviors, emotional instability and one of its hallmarks is self injurious behavior, which starts in adolescence. Patients with BPD are difficult to treat, most have a history of child sexual abuse, about a quarter present with sexual abuse from a caretaker. Although personality disorders are diagnosed only in adults, BPD manifests itself in adolescence in the form of uncontrollable anger, self mutilations, dissociation and other such behaviors. Hence, there is a growing number of scientists discussing the possibility of diagnosing BPD in adolescents. Here, we …

Sustained Attention In Children With Two Etiologies Of Early Hydrocephalus., Maegan D. Swartwout, Paul T. Cirino, Amy W. Hampson, Jack M. Fletcher, Michael E. Brandt, Maureen Dennis

Journal Articles

Several studies have shown that children with spina bifida meningomyelocele (SBM) and hydrocephalus have attention problems on parent ratings and difficulties in stimulus orienting associated with a posterior brain attention system. Less is known about response control and inhibition associated with an anterior brain attention system. Using the Gordon Vigilance Task (Gordon, 1983), we studied error rate, reaction time, and performance over time for sustained attention, a key anterior attention function, in 101 children with SBM, 17 with aqueductal stenosis (AS; another condition involving congenital hydrocephalus), and 40 typically developing controls (NC). In SBM, we investigated the relation between cognitive …

Body Mass Index And Health Related Quality Of Life In Elementary School Children: A Pilot Study, Lei Zhang, Peter J. Fos, William D. Johnson, Vafa Kamali, Reagan G. Cox, Miguel A. Zuniga, Theresa Kittle

Nursing Faculty Publications and Presentations

Background: We investigated the relationship between Body Mass Index (BMI) and health-related quality of life (HRQOL) indicated by baseline health status in elementary school children. Methods: Data were obtained via parents whose children enrolled in an elementary school, kindergarten to fourth grade, in southern Mississippi in spring 2004. Parents completed the SF-10 for Children, a brief 10-item questionnaire designed to measure children's HRQOL on a voluntary basis. Results: A total of 279 parents completed the questionnaires for their children. On average, physical and psychosocial summary scores, major indicators for HRQOL, were significantly higher among the elementary school children in our …

Characteristics Of A Spina Bifida Population Including North American Caucasian And Hispanic Individuals, Kit Sing Au, Phong X Tran, Chester C Tsai, Michelle R O'Byrne, Jone-Ing Lin, Alanna C Morrison, Amy W Hampson, Paul Cirino, Jack M Fletcher, Kathryn K Ostermaier, Gayle H Tyerman, Sabine Doebel, Hope Northrup

Journal Articles

BACKGROUND: Meningomyelocele (MM) is a common human birth defect. MM is a disorder of neural development caused by contributions from genes and environmental factors that result in the NTD and lead to a spectrum of physical and neurocognitive phenotypes.

METHODS: A multidisciplinary approach has been taken to develop a comprehensive understanding of MM through collaborative efforts from investigators specializing in genetics, development, brain imaging, and neurocognitive outcome. Patients have been recruited from five different sites: Houston and the Texas-Mexico border area; Toronto, Canada; Los Angeles, California; and Lexington, Kentucky. Genetic risk factors for MM have been assessed by genotyping and …

Medical Supervision Of Young Female Athletes Training In Complex Coordinational Sports, Irina Schevchenko, Viktor V. Abramov, Paul T Gibson, Hatim A. Omar

Pediatrics Faculty Publications

This article proposes simple medical criteria that can be used by trainers and others for effective medical supervision of young female athletes.

METHODS: The cross-sectional, age-stratified study compared girls 10-17 years of age involved in intensive training in gymnastic floor exercises, trampoline, or badminton. Each sport and/or control group was represented by 40-45 girls. Data included medical history, morphometric variables and observation of biological development.

RESULTS: Gymnasts started training earliest (approximately 5-years-old) and trained most intensely (18-20 h/wk), followed by trampolinists and then badmintonists. Height, weight, body mass index, and % body fat were reduced in athletes, with gymnasts showing …

Functional Status, Heart Rate, And Rhythm Abnormalities In 521 Fontan Patients 6 To 18 Years Of Age., Andrew D. Blaufox, Lynn A. Sleeper, David J. Bradley, Roger E. Breitbart, Allan Hordof, Ronald J. Kanter, Elizabeth A. Stephenson, Mario Stylianou, Victoria L. Vetter, J Philip Saul, Pediatric Heart Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Our objective was to determine the relationship between functional outcome and abnormalities of heart rate and rhythm after the Fontan operation.

METHODS: The National Heart, Lung, and Blood Institute Pediatric Heart Network conducted a cross-sectional analysis of patients who had undergone a Fontan procedure at the 7 network centers. Analysis was based on 521 patients with an electrocardiogram (n = 509) and/or bicycle exercise test (n = 404). The Child Health Questionnaire parent report and the oxygen consumption at the anaerobic threshold were used as markers of functional outcome.

RESULTS: Various Fontan procedures had been performed: intracardiac lateral tunnel …

Blood Utilization In Children Managed Non-Operatively For Blunt Solid Organ Injury., Scott J. Keckler, Kuojen Tsao, Susan W. Sharp, G W. Holcomb Iii, Daniel J. Ostlie, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Blood product utilization is an important issue in health care, given the frequent shortages in hospitals and the societal burden required to maintain the supply. Therefore, we retrospectively audited our blunt spleen/liver trauma experience to determine the percentage of cross-matched blood that was transfused to see whether more stringent typing criteria should be applied.

METHODS: A retrospective analysis of a recent 7-year experience with nonoperative management in patients with blunt spleen or liver injury was performed. Demographics, packed red blood cells prepared by cross-match, and transfusions were measured. Unmatched, O-type blood given in the trauma bay was excluded. Patients …

Management Of Pediatric Acute Appendicitis In The Computed Tomographic Era., Kuojen Tsao, Shawn D. St Peter, Patricia A. Valusek, Troy L. Spilde, Scott J. Keckler, Abhilash Nair, Daniel J. Ostlie, G W. Holcomb Iii

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND/PURPOSE: The treatment options for complicated appendicitis in children continue to evolve. Optimal management of complicated appendicitis relies on an accurate preoperative diagnosis. We examined the accuracy of our preoperative diagnosis including computed tomography (CT) and the influence on the management of children with perforated and nonperforated appendicitis.

METHODS: Following IRB approval, a 6-year review of all patients that underwent an appendectomy for suspected appendicitis was performed. Treatments included immediate operations and initial nonoperative management (antibiotic therapy +/- percutaneous drainage of abscess). Appendicitis was confirmed by histological examination.

RESULTS: One thousand seventy-eight patients underwent appendectomy for suspected appendicitis. Preoperative CT …

Single Daily Dosing Ceftriaxone And Metronidazole Vs Standard Triple Antibiotic Regimen For Perforated Appendicitis In Children: A Prospective Randomized Trial., Shawn D. St Peter, Kuojen Tsao, Troy L. Spilde, G W. Holcomb Iii, Susan W. Sharp, J Patrick Murphy, Charles L. Snyder, Ronald J. Sharp, Walter S. Andrews, Daniel J. Ostlie

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Appendicitis is the most common emergency condition in children. Historically, a 3-drug regimen consisting of ampicillin, gentamicin, and clindamycin (AGC) has been used postoperatively for perforated appendicitis. A retrospective review at our institution has found single day dosing of ceftriaxone and metronidazole (CM) to be a more simple and cost-effective antibiotic strategy. Therefore, we performed a prospective, randomized trial to compare efficacy and cost-effectiveness of these 2 regimens.

METHODS: After internal review board approval (IRB no. 04 12-149), children found to have perforated appendicitis at appendectomy were randomized to either once daily dosing of CM (2 total doses per …

Resource Utilization And Outcomes From Percutaneous Drainage And Interval Appendectomy For Perforated Appendicitis With Abscess., Scott J. Keckler, Kuojen Tsao, Susan W. Sharp, Daniel J. Ostlie, G W. Holcomb Iii, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Given the perceived technical demands of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess, initial percutaneous drainage has become an attractive option in this patient population. This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon. However, the medical burden on the patient and on the quality of patient outcomes has not been described in the literature. Therefore, we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospective trial.

METHODS: After institutional review board …

Chest Radiograph After Central Line Placement Under Fluoroscopy: Utility Or Futility?, Scott J. Keckler, Troy L. Spilde, Brian Ho, Kuojen Tsao, Daniel J. Ostlie, G W. Holcomb Iii, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Postoperative portable chest films are routinely performed after fluoroscopic placement of central venous catheters to evaluate positioning and to rule out significant complications (eg, pneumothorax). Emerging evidence in the literature has called this practice into question suggesting that routine postoperative chest x-ray is unnecessary. Therefore, we investigated our recent experience to examine the utility of these films, to examine the development of symptoms relative to therapeutic intervention, and to report a cost-benefit analysis.

METHODS: After obtaining institutional review board approval, all charts of patients undergoing central venous catheter placement from January 2004 to December 2005 at our institution were …

Pediatric Safety And Quality, Susan R. Lacey, Janis B. Smith, Karen Cox

Manuscripts, Articles, Book Chapters and Other Papers

Excerpt

Pediatric care is complex due to developmental and dependency issues associated with children. How these factors impact the specific processes of care is an area of science in which little is known. We are only beginning to understand the relationship between nurse staffing and adverse events in hospitalized children; effects that may be compounded by inadequate numbers of pediatric nurses. Throughout health care providing safe and high quality patient care continues to provide significant challenges. Efforts to improve the safety and quality of care are resource intensive and take continued commitment not only by those who deliver care, but …

Verb Generation In Children With Spina Bifida., Maureen Dennis, Derryn Jewell, Ross Hetherington, Christine Burton, Michael E. Brandt, Susan E. Blaser, Jack M Fletcher

Journal Articles

We investigated verb generation in children with spina bifida meningomyelocele (SBM; n = 55) and in typically developing controls (n = 32). Participants completed 6 blocks (40 trials each) of a task requiring them to produce a semantically related verb in response to a target noun and an additional 40 trials on which they were simply required to read target nouns aloud. After controlling for reading response time, groups did not differ significantly in verb generation response time or learning. Children with SBM produced more non-verb errors than controls and tended to repeat their mistakes over blocks. Verb generation performance …

Antidepressant Prescribing Practices For The Treatment Of Children And Adolescents., Supriya K. Bhatia, Amy J. Rezac-Elgohary, Benedetto Vitiello, Michael A. Sitorius, Bruce A. Buehler, Christopher J. Kratochvil

Journal Articles: Psychiatry

OBJECTIVE: This study evaluates pediatric antidepressant prescribing practices of Nebraska clinicians.

METHODS: Surveys were sent in July, 2005, to 1,521 prescribing clinicians throughout Nebraska to assess pediatric antidepressant use along with any practice changes following the U.S. Food and Drug Administration (FDA) "black box" warning issued in October, 2004.

RESULTS: Over half (n = 866) of the clinicians responded to the survey, of which 96.8% reported awareness of the FDA "black box" warning. Of the respondents, 76.9% (n = 666) were prescribing antidepressants to children and/or adolescents. Clinicians reported decreased prescribing frequency for both children (15.5%) and adolescents (36.6%), with …

Current Application Of Thoracoscopy In Children., Kuojen Tsao, Shawn D. St Peter, Susan W. Sharp, Abhilash Nair, Walter S. Andrews, Ronald J. Sharp, Charles L. Snyder, Daniel J. Ostlie, G W. Holcomb Iii

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The safety and efficacy of thoracoscopy for thoracic lesions and conditions in children is evolving. Our experience with thoracoscopy has expanded in recent years. Therefore, we reviewed our most recent 7-year experience to examine the current applications for thoracoscopy in children.

METHODS: A retrospective review of all patients undergoing a thoracoscopic operation at Children's Mercy Hospital (Kansas City, MO) between January 1, 2000, and June 18, 2007, was performed. Data points reviewed included patient demographics, type of operation, final diagnosis, complications, and recovery.

RESULTS: During the study period, 230 children underwent 231 thoracoscopic procedures. The mean age was 9.6 …

The Uses Of Rickets: Race, Technology, And The Politics Of Preventive Medicine In The Early Twentieth Century, M. Allison Arwady

Yale Medicine Thesis Digital Library

Rickets, the bone disease classically caused by Vitamin D deficiency, was one of the most common diseases of children 100 years ago. It has been recognized as a disease of urban living and linked to issues of race and culture for generations. This paper uses unpublished patient records from 1904 to 1909 and archival and published materials from multiple community-based trials, including the New Haven Rickets Study (1923-1926), to explore how the definition, diagnosis, and treatment of rickets shifted in the first decades of the twentieth century in the United States. Before 1910, as evidenced by patient records, neither the …

Psychosocial Functioning In Childhood Cancer Survivors, Measured By Parent, Teacher And Child Surveys, Tamara Porter Miller

Yale Medicine Thesis Digital Library

The purpose of the current study is to understand emotional and neurocognitive functioning in childhood cancer survivors. In this single-evaluation cross sectional study, 41 childhood cancer survivors (53.2% of those eligible) in the Health Education Research Outcomes in Survivors (HEROS) Clinic at Yale-New Haven Hospital between the ages of six and eighteen and their parents and teachers completed the Behavior Assessment System for Children, Second Edition (BASC-II), Behavior Rating Inventory of Executive Functioning (BRIEF) and Pediatric Quality of Life Inventory (PedsQL). Patients, parents and teachers scores were compared to those of normative populations for emotional, neurocognitive and quality of life …

Educational Class For Parents Of A Child Recently Diagnosed With Autism, Sarah Haugen, Marcie Sandeen

Occupational Therapy Capstones

The purpose of this scholarly project was to develop an education class for parents of children with autism. When discussing the term autism with parents it can lead to confusion, the term autism has changed greatly in the past few decades and today agreement on what the term means is still lacking. With a diagnosis of autism the parents are also going to face many challenges and added stress throughout their daily lives. These known problems helped to determine the need to create the product of this scholarly project. A review of literature and research was conducted to collect accurate …

Treating The Whole Child: Recognizing And Addressing Depression In Children With Physical Disabilities, Kathleen A. Koehn

Occupational Therapy Capstones

The purpose of this scholarly project was to develop a tool that would assist occupational therapy practitioners working with children with physical disabilities in recognizing and addressing symptoms of depression in that population. Ailey (2003) reported that symptoms of depression in children with developmental disabilities are frequently attributed incorrectly to a child's primary diagnosis, rather than depression. Because occupational therapists typically see these children more frequently than primary care physicians, they are in a prime position to assist in the screening and referral processes related to depression.

This project involved a comprehensive review of the literature, including data on the …

Bilateral Galactocele In A Male Infant, Hakan Döneray, Behzat Özkan, Fazli Erdoğan, Ahmet Bedi̇i̇ Salman

Turkish Journal of Medical Sciences

Temporary breast enlargement may be seen in normal newborn and adolescent boys. Cysts of the breast are uncommon in childhood. Galactocele, defined as an encysted collection of milk products, is an extremely rare cause of breast enlargement in infants and children. We herein report a male infant with bilateral galactocele who was otherwise healthy, and we also review the literature.

Oncolog Volume 53, Number 02, February 2008, Joe Munch, Diane Witter, Guillermo Garcia-Manero Md

OncoLog MD Anderson's Report to Physicians (All issues)

• Assessing Symptom Burden in Cancer
• DiaLog: Making Headway in Hematology, by Guillermo Garcia-Manero, MD, Associate Professor, Department of Leukemia
• Helping Kids Make Smart Food Choices
• Expanding Therapy Options for Advanced Cancer

Oncolog Volume 53, Number 09, September 2008, Maude Veech, Dawn Chalaire

OncoLog MD Anderson's Report to Physicians (All issues)

• Deciphering Metastatic Colorectal Carcinoma
• House Call: Planning Ahead with Advance Directives
• A Child-Centered Approach to Anesthesia for Proton Therapy

Continuous Source Of Care Among Young Underserved Children: Associated Characteristics And Use Of Recommended Parenting Practices., Esther K Chung, Leny Mathew, Kelly F Mccollum, Irma T Elo, Jennifer F Culhane

Department of Pediatrics Faculty Papers

OBJECTIVES: The aim of this study was to 1) assess sociodemographic and health characteristics associated with having a continuous source of care (CSOC) among young children and 2) determine the relationship between having a CSOC and use of parenting practices.

METHODS: We conducted a prospective, community-based survey of women receiving prenatal care at Philadelphia community health centers. We conducted surveys at the first prenatal visit and at a mean age +/- standard deviation of 3 +/-1, 11 +/- 1, and 24 +/- 2 months postpartum, obtaining information on sociodemographic and health characteristics, child's health care provider, and 6 parenting practices. …

Ideas For Inclusion: A Resource For Occupational Therapists, Jason Browning, Roxanne Hartje

Occupational Therapy Capstones

School-based occupational therapy practice is continually changing to meet the needs of the students and stay in alignment with federal mandates and current research. Current legislative regulations of No Child Left Behind Act of2001 (NCLB 2001; Public Law 107-110) and The Individuals with Disabilities Education Improvement Act of 2004 (IDEIA 2004, Public Law 108-446) together require that education programs be provided in the natural or least restrictive environment. After the review of literature and personal interviews it was found that many occupational therapists, teachers and school based staff were having difficulty fulfilling this requirement, often using the direct, pull-out service …

The Use Of Aquatic Therapy For Children With Neuromuscular Disorders, Chris Hydukovich, Troy Schmitz

Occupational Therapy Capstones

Purpose: The purpose of this literature was to determine the effects aquatic intervention has on children suffering from neuromuscular disorders compared to that of traditional land-based physical and occupational therapy services.

Method: A literature search was conducted using PubMed, OT search, AJOT online, CINAHL, the Mayo Clinic Triage, and various occupational therapy textbooks regarding the use of aquatic therapy in a neuromuscular population. Information was extracted from this literature to generate educational material for parents of child receiving aquatic occupational therapy.

Results: A review of literature presented cerebral palsy as the main neuromuscular disorder of study associated with aquatic therapy. …

Promoting Children's Health In The Home Environment: A Parent/Guardian Handbook, Shannon Troje, Stacie Voth

Occupational Therapy Capstones

The World Health Organization (2003) stated that "obesity is a global epidemic". The United States (U.S.) in particular has a statistically significant higher rate of obesity in children. According to the American Academy of Pediatrics (2003), 15.3% of children between the ages of 6 and 11 years old are obese as a result of unhealthy habits and routines. Because these habits and routines often begin in the home environment, health promotion activities should involve parents/guardians (Manios, Kafatos, & Mamalakis, 1998).

At this time there are few resources available for parents/guardians and their children to promote wellness in the home environment. …