Medicine and Health Sciences Commons^™

Parent- Versus Child-Reported Functional Health Status After The Fontan Procedure., Linda M. Lambert, L Luann Minich, Jane W. Newburger, Minmin Lu, Victoria L. Pemberton, Ellen A. Mcgrath, Andrew M. Atz, Mingfen Xu, Elizabeth Radojewski, Darlene Servedio, Brian W. Mccrindle, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: We sought to compare perceptions of functional health status between children who had undergone a Fontan procedure and their parents.

METHODS: Fontan procedure survivors 10 to 18 years of age were included in the study if the child completed the Child Health Questionnaire (CHQ) and the parent completed the parent form to assess the child's functional health status. Comparisons were made between raw domain scores for the parent- and child-completed CHQs.

RESULTS: Between March 2003 and April 2004, 1078 Fontan survivors were screened. Of the 546 eligible and consented patients, 354 were 10-18 years of age and 328 parent/child …

Treatment Response In Depressed Adolescents With And Without Co-Morbid Attention-Deficit/Hyperactivity Disorder In The Treatment For Adolescents With Depression Study., Christopher J. Kratochvil, Diane E. May, Susan G. Silva, Vishal Madaan, Susan E. Puumala, John F. Curry, John Walkup, Hayden Kepley, Benedetto Vitiello, John S. March

Journal Articles: Psychiatry

OBJECTIVE: In the Treatment for Adolescents with Depression Study (TADS), fluoxetine (FLX) and the combination of fluoxetine with cognitive-behavioral therapy (COMB) had superior improvement trajectories compared to pill placebo (PBO), whereas cognitive-behavioral therapy (CBT) was not significantly different from PBO. Because attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD) frequently co-exist, we examined whether ADHD moderated these outcomes in TADS.

METHOD: A total of 439 adolescents with MDD, 12-17 years old, were randomized to FLX, CBT, COMB, or PBO. Random coefficients regression models examined depression improvement in 377 depressed youths without ADHD and 62 with ADHD, including 20 who were …

Sexuality And Persons With Down Syndrome. A Study From Brazil, Bruna Marques Bononi, Maria José Carvalho Sant'anna, André Chao Vasconcellos De Oliveira, Tadeu Silveira Renattini, Carla Franchi Pinto, Maria Lúcia Passarelli, Verônica Coates, Hatim A. Omar

Pediatrics Faculty Publications

In recent years, important gains and changes have been observed in the life of teenagers with Down syndrome (DS) with increased inclusion into society. This review will discuss adolescence and sexuality in teenagers with DS from a descriptive study of 50 patients with DS between the ages of 10 and 20 years. The mean age was 13.5 years, 50% females; 86% went to school with 62.2% in school for over six years. Of the patients that attended school, 60% went to special education school and only 10% read and wrote correctly. In an evaluation of autonomy, 66% took showers, 78% …

Modern Approaches To Pediatric Brain Injury Therapy, Peter A Walker, Matthew T Harting, James E Baumgartner, Stephen Fletcher, Nathan Strobel, Charles S Cox

Faculty, Staff and Student Publications

Each year, pediatric traumatic brain injury (TBI) accounts for 435,000 emergency department visits, 37,000 hospital admissions, and approximately 2,500 deaths in the United States. TBI results in immediate injury from direct mechanical force and shear. Secondary injury results from the release of biochemical or inflammatory factors that alter the loco-regional milieu in the acute, subacute, and delayed intervals after a mechanical insult. Preliminary preclinical and clinical research is underway to evaluate the benefit from progenitor cell therapeutics, hypertonic saline infusion, and controlled hypothermia. However, all phase III clinical trials investigating pharmacologic monotherapy for TBI have shown no benefit. A recent …

Functional State Following The Fontan Procedure., Ismee A. Williams, Lynn A. Sleeper, Steven D. Colan, Minmin Lu, Elizabeth A. Stephenson, Jane W. Newburger, Welton M. Gersony, Meryl S. Cohen, James F. Cnota, Andrew M. Atz, Richard V. Williams, Renee Margossian, Andrew J. Powell, Mario P. Stylianou, Daphne T. Hsu, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Despite improvements in outcomes after completion of the Fontan circulation, long-term functional state varies. We sought to identify pre- and postoperative characteristics associated with overall function.

METHODS AND RESULTS: We analyzed data from 476 survivors with the Fontan circulation enrolled in the Pediatric Heart Network Fontan Cross-sectional Study. Mean age at creation of the Fontan circulation was 3.4 plus or minus 2.1 years, with a range from 0.7 to 17.5 years, and time since completion was 8.7 plus or minus 3.4 years, the range being from 1.1 to 17.3 years. We calculated a functional score for the survivors by …

Comparison Of Echocardiographic And Cardiac Magnetic Resonance Imaging Measurements Of Functional Single Ventricular Volumes, Mass, And Ejection Fraction (From The Pediatric Heart Network Fontan Cross-Sectional Study)., Renee Margossian, Marcy L. Schwartz, Ashwin Prakash, Lisa Wruck, Steven D. Colan, Andrew M. Atz, Timothy J. Bradley, Mark A. Fogel, Lynne M. Hurwitz, Edward Marcus, Andrew J. Powell, Beth F. Printz, Michael D. Puchalski, Jack Rychik, Girish S. Shirali, Richard Williams, Shi-Joon Yoo, Tal Geva, Pediatric Heart Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

Assessment of the size and function of a functional single ventricle (FSV) is a key element in the management of patients after the Fontan procedure. Measurement variability of ventricular mass, volume, and ejection fraction (EF) among observers by echocardiography and cardiac magnetic resonance imaging (CMR) and their reproducibility among readers in these patients have not been described. From the 546 patients enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study (mean age 11.9 +/- 3.4 years), 100 echocardiograms and 50 CMR studies were assessed for measurement reproducibility; 124 subjects with paired studies were selected for comparison between modalities. Interobserver agreement …

Gestational Diabetes Mellitus--A Forerunner Of Chronic Disorders In Mother And Child, Romaina Iqbal, Sobia Jawaid, Abdul Jabbar, Rahat Qureshi

Community Health Sciences

Gestational Diabetes Mellitus (GDM) can have serious immediate as well as long term consequences, both for the mother as well as the off-spring. It seems that women of south Asian origin are not only more likely to have GDM but also suffer more from the adverse consequences of the disorder. These consequences include the development of type 2 DM in women with a history of GDM and a higher risk of obesity and metabolic syndrome in the off-spring. Pakistani physicians should consider GDM seriously because the WHO states that rise in the prevalence of type 2 DM will mainly occur …

Epidemiology And Outcomes Of Candidemia In 2019 Patients: Data From The Prospective Antifungal Therapy Alliance Registry., David L Horn, Dionissios Neofytos, Elias J Anaissie, Jay A Fishman, William J Steinbach, Ali J Olyaei, Kieren A Marr, Michael A Pfaller, Chi-Hsing Chang, Karen M Webster

Jefferson Hospital Staff Papers and Presentations

BACKGROUND: Candidemia remains a major cause of morbidity and mortality in the health care setting, and the epidemiology of Candida infection is changing.

METHODS: Clinical data from patients with candidemia were extracted from the Prospective Antifungal Therapy (PATH) Alliance database, a comprehensive registry that collects information regarding invasive fungal infections. A total of 2019 patients, enrolled from 1 July 2004 through 5 March 2008, were identified. Data regarding the candidemia episode were analyzed, including the specific fungal species and patient survival at 12 weeks after diagnosis.

RESULTS: The incidence of candidemia caused by non-Candida albicans Candida species (54.4%) was higher …

History Of Maltreatment And Psychiatric Impairment In Children In Outpatient Psychiatric Treatment, Kerry Gagnon

Honors Scholar Theses

There is increasing evidence that childhood victimization and attachment disruptions impact a child’s development. In this study, children and adolescents from an outpatient psychiatric clinic were assessed, measuring history of trauma, history of out-of-home placement, initial diagnoses, and CBCL internalizing and externalizing problem scores. Multiple regression analyses showed that both violent abuse trauma (physical/sexual abuse) and victim trauma (physical abuse/sexual abuse/witnessing domestic violence/witnessing community violence) are prevalent among patients with externalizing severity problems; concluding that diagnosis alone may not account for a history of victimization, but externalizing problem severity does. Overall, the study is consistent with past literature that it …

Adult And Child Semantic Neighbors Of The Kroll And Potter (1984) Nonobjects, Holly L. Storkel, Suzanne M. Adlof

Faculty Publications

Purpose - The purpose was to determine the number of semantic neighbors, namely semantic set size, for 88 nonobjects (J. F. Kroll & M. C. Potter, 1984) and determine how semantic set size related to other measures and age.

Method - Data were collected from 82 adults and 92 preschool children in a discrete association task. The nonobjects were presented via computer, and participants reported the first word that came to mind that was meaningfully related to the nonobject. Words reported by two or more participants were considered semantic neighbors. The strength of each neighbor was computed as the …

Laparoscopic Treatment Of Pancreatic Pseudocysts In Children., Suzanne M. Yoder, Steven Rothenberg, Kuojen Tsao, Mark L. Wulkan, Todd A. Ponsky, Shawn D. St Peter, Daniel J. Ostlie, Timothy D. Kane

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Pancreatic pseudocysts are problematic sequelae of pancreatitis or pancreatic trauma causing persistent abdominal pain, nausea, and gastric outlet obstruction. Due to the low volume of disease in children, there is scant information in the literature on the operative management of pseudocysts with minimally invasive techniques. We conducted a multi-institutional review to illustrate several technical variations utilized in achieving laparoscopic cystgastrostomy in the pediatric population.

METHODS: A retrospective review was conducted of all patients who underwent laparoscopic cystgastrostomy in five institutions. Patient data, operative techniques, and postoperative course were analyzed.

RESULTS: There were 13 patients with a mean age of …

Thoracoscopy In Children: Is A Chest Tube Necessary?, Todd A. Ponsky, Steven S. Rothenberg, Kuojen Tsao, Daniel J. Ostlie, Shawn D. St Peter, G W. Holcomb Iii

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: Historically, a chest tube or drain has been left following a thoracic operation to allow drainage of air or fluid in the postoperative period. However, in patients undergoing thoracoscopy, the tube is often the greatest source of postoperative pain. We began excluding chest tubes several years ago and therefore are reviewing our experience to evaluate the safety and efficacy of this approach.

METHODS: A retrospective review of the medical record was performed on patients undergoing thoracoscopy at two centers from 1993 to 2007. Patients who left the operating room without a chest tube were included in this series. Patient …

Coronary Steal Syndrome After Coronary Artery Bypass For Anomalous Aortic Origin Of A Coronary Artery., Benjamin A. Youdelman, Glenn J. Pelletier, C Igor Mesia, Marshall L. Jacobs

Department of Surgery Faculty Papers

Anomalous aortic origin of a coronary artery found in a symptomatic 9-year-old boy was initially treated with coronary artery bypass grafting using a left internal mammary artery anastomoses to the left anterior descending coronary artery, but resulted in coronary ischemia, likely from a steal phenomenon. Subsequent transection of the proximal left internal mammary artery with anastomosis to the ascending aorta, and coronary ostial enlargement, resulted in a durable treatment. We recommend caution in choosing coronary artery bypass grafting using a left internal mammary artery pedicle graft for the treatment of anomalous aortic origin of a coronary artery.

Does Cardiac Morphology Predict Plasma Brain Natriuretic Peptide Levels In Adolescent Athletes?, Kurt J. Nilsson, Michael S. Womack, Ronald Pfeiffer, Chad Harris, Mark Debeliso

Kinesiology Faculty Publications and Presentations

Objective: The purpose of this study was to establish the relationship of plasma levels of brain natriuretic peptide (BNP) to physiological parameters and cardiac morphological characteristics in a population of young athletes. Our hypothesis is that physiological and cardiac morphological characteristics do not predict BNP levels in adolescent athletes.

Design: Observational study

Setting: Outpatient hospital Patients: 30 healthy male adolescent high school football players (16.0 +/- 1.1 yrs)

Interventions: Physical exam, electrocardiography, plasma BNP measurement by rapid fluorescent immunoassay, and limited echocardiography

Main Outcome Measure Null hypothesis: physiologic parameters and cardiac morphology do not predict plasma BNP levels in healthy …

Oncolog Volume 54, Number 03, March 2009, Joe Munch

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

• Rare Tumors: Finding Common Ground
• Neuroendocrine Tumors
• House Call: How You Can Help a Seriously Ill Friend

Trends In Mental Health Of An Adolescent Medicine Clinic Patient Population, Abdel Salous, Linah Al-Alem, Hatim A. Omar

Pediatrics Faculty Publications

The correlation between exposure to forms of violence and development of mental disorders in victims is well established. The purpose of this paper was to identify mental health problems in an adolescent medicine clinic population in Lexington, KY and to investigate potential correlation of mental disorders with psychosocial factors. Data were gathered from the charts of 169 adolescent clinic patients (age 10-22) seen in the clinic for mental health care and analyzed using Excel. Of the patient population, 68% were urban, whereas 32% were rural. In terms of gender, 40% of the patients were male and 60% were female, 80% …

Atorvastatin May Have No Effect On Acute Phase Reaction In Children After Intravenous Bisphosphonate Infusion., Tarak Srivastava, Connie J. Haney, Uri S. Alon

Manuscripts, Articles, Book Chapters and Other Papers

Intravenous bisphosphonate therapy is associated with acute phase reaction characterized by fever and musculoskeletal pain. Bisphosphonates have been shown in vitro to activate gammadeltaT-cells to proliferate and produce cytokines, suggesting a role in acute phase reaction, which can be effectively blocked by statins. We conducted a double-blind randomized crossover placebo controlled study in 12 children (12.1 +/- 4.2 yr; 10 girls and 2 boys) receiving intravenous bisphosphonates to evaluate whether statins can be used to prevent acute phase reaction associated with therapy. Children received two cycles given 3-4 mo apart of intravenous bisphosphonate given on 2 consecutive days in each …

Practice-Based Care Coordination: The Outcomes Of Care Coordination Activities In An Inner-City Pediatric Clinic, Giorelly Jacqueline Prado

UCHC Graduate School Masters Theses 2003 - 2010

No abstract provided.

The Rate And Time Course Of Complications In Catheter-Dependent Hemodialysis Patients, Shreya Sood

Yale Medicine Thesis Digital Library

Many patients with end-stage renal disease come to rely on catheters as their only means of hemodialysis when other options are no longer viable. These patients have a very poor quality of life due to their chronic illness as well as many long-term complications related to the use of tunneled catheters. Many prior attempts have been made to understand these catheter-related problems. Yet, they continue to be a major cause of morbidity and mortality in chronic catheter-reliant patients. We hope to examine the rate as well as long term time course of these complications such that in future, we may …

At Options With Children With Autism, Melissa Stevens, Megan Neppl

Occupational Therapy Capstones

According to information from the Center for Disease Control Prevention (2007) it is estimated that autism affects 1 in 150 births. The Autism Society of America (2007) reports that the prevalence of autism is expected to increase by 10-17 % per year. It has been shown through research that assistive technology can benefit or increase performance in children with autism spectrum disorder. It also can address performance areas limited in children with autism, such as communication, cognition, self-care, leisure, social/play, productivity, and sensorimotor (Reed, 2002). Assistive technology can aid these children in various contexts such as school, home, and play. …

A Cognitive Behavioral Approach To Occupational Therapy Hippothearpy [I.E.., Hippotherapy] For Children And Adolescents With Mood Disorders, Abby Heaton, Krista Tangen

Occupational Therapy Capstones

Children and adolescents are increasingly being identified with mood disorders. A growing concern is that children and adolescents are not afforded a wide range of interventions to address the symptoms of mental illness. Cognitive behavioral therapy (CBT) has been identified as a useful treatment method for mood disorders. Hippotherapy has also been utilized in the treatment of mental illness. A literature review was conducted to explore the therapeutic benefits of cognitive behavioral therapy and hippotherapy for children and adolescents diagnosed with mood disorders. Although CBT has been recognized as useful, CBT methods applied to hippotherapy in occupational therapy does not …

Viral Etiology And Symptoms Of Acute Upper Respiratory Tract Infections In Children, Emi̇n Ünüvar, İsmai̇l Yildiz, Ayşe Kiliç, Seyhan Selvi̇ Aslan, Bülent Çakal, Sadik Toprak, Seli̇m Badur, Fatma Oğuz, Müjgan Sidal

Turkish Journal of Medical Sciences

Aims: To determine viral causes of acute upper respiratory tract infections and clinical findings in children living in Istanbul, Turkey. Materials and Methods: This prospective study was carried out in 234 outpatient children (age range: 1-180 months) with acute upper respiratory tract infections, seen in the outpatient clinic at Istanbul Medical School Children´s Hospital. After clinical findings were recorded, nasal swab specimens were taken. In 201 specimens collected, influenza-A and -B, adenovirus, respiratory syncytial virus, and parainfluenza viruses were studied using direct fluorescence antibody, polymerase chain reaction (PCR), and cell culture techniques. Results: Rate of virus isolation was 29.8% (60/201). …

Evaluation And Follow-Up Of Cases Diagnosed As Child Abuse And Neglect At A Tertiary Hospital In Turkey, Ülkü Tiraş, Di̇lek Di̇lli̇, Yildiz Dallar, Resmi̇ye Oral

Turkish Journal of Medical Sciences

Aim: Data on child maltreatment in Turkey would appear to be scarce. This manuscript aims to address the prevalence and severity of child maltreatment in Turkey. Materials and methods: We report on 215 cases at the Ministry of Health’s Ankara Training and Research Hospital that were followed-up by the multidisciplinary Child Protection Team (CPT) between 1 January 2001 and 31 December 2005. The data collected on subjects included characteristics of the victims and the perpetrators, family demographics, maltreatment types, medical findings, mortality rate, and outcomes for the victim and the perpetrator. Results: Age and gender distribution of the victims were …

A Clinical Guide To The Psychosocial Issues Related To Pediatric Traumatic Brain Injuries, Mandy Christen, Becky Hansmeier

Occupational Therapy Capstones

Children and adolescents who sustain a traumatic brain injury (TBI) demonstrate changes in personality, such as mood swings, irritability, impulsivity, argumentative behaviors, decreased frustration tolerance, and difficulty cooperating (Prigatano & Gray, 2007; Prigatano & Gray, 2008; Souza, Braga, Filho, & Dellatolas, 2007). These clients also have an increased susceptibility to psychiatric disorders, including mood and anxiety disorders, later in the lifespan as physical and cognitive demands increase (Koponen et al., 2002; Luis & Mittenberg, 2002; Viguier, Dellatolas, Gasquet, Martin, & Choquet, 2001). Despite these substantial risk factors, a significant number of children and adolescents continue to have unrecognized or unmet …

A Team Approach To Cortical Visual Impairment (Cvi) In Schools, Donna Shaman

Occupational Therapy Capstones

Cortical visual impairment (CVI) is presently the fastest growing cause of visual impairment in children. The influx of children with CVI entering school districts requires Individualized Education Program (IEP) teams to gain expertise about CVI and learn best practices to work with these children. CVI experts agree that a collaborative transdisciplinary team can best serve the complex needs of the children. Written by an occupational therapist, this project designs a CVI manual, A Team Approach to CVI in Schools, which reviews current literature and provides support for client centered, occupational based education for children with CVI. The literature review points …

Acute Physical Therapy Management Of Pediatric Patient With Traumatic Brain Injury, Michelle Holt

Physical Therapy Scholarly Projects

Background and Purpose: Traumatic brain injury can cause many deficits including decreased balance and coordination. The purpose of this case report is to describe the interventions used and subsequent outcomes for a pediatric patient following traumatic brain injury in the acute care setting. Also, this case report serves to describe the methods and tools used in a hospital that is not equipped with pediatric-specific equipment or utilities.

Case Description: This paper describes the four-day inpatient physical therapy management of a six-year-old female who fell from a horse and sustained a left open depressed frontal skull fracture with an underlying subdural …

Comparative Efficacy Of 2 Topical Anesthetics For The Placement Of Orthodontic Temporary Anchorage Devices, Derek S Reznik, Arthur H Jeske, Jung-Wei Chen, Jeryl English

Faculty, Staff and Student Publications

This study compared the effectiveness of topical benzocaine 20% versus a combination of lidocaine, tetracaine, and phenylephrine in providing sufficient analgesia for the placement of orthodontic temporary anchorage devices (TADs). The 2 topical anesthetics were tested against each other bilaterally using a randomized, double-blind, crossover design. The agents were left in place for the amount of time prescribed by the manufacturer. The TAD was then placed, and each subject rated the degree of pain on a Heft-Parker visual analogue scale. A pulse oximeter was used to record the preoperative and postoperative pulse rates. Statistically significant differences in perceived pain (P …

Intra-Individual Variation In Children's Physical Activity Patterns: Implications For Measurement, Kate Ridley, Tim Olds, Beth P. Hands, Dawne Larkin, Helen Parker

Health Sciences Papers and Journal Articles

Children's physical activity (PA) patterns change form day to day. This intra-individual variability affects precision when measuring key physical activity and sedentary behavior variables. This paper discusses strategies to reduce the random error associated with intra-individual variability and demonstrates the implications for assessing PA when varying number of days are sampled. Self-reported data collected on two hundred and ninety eight 13- to 14-year-olds were used to compare estimates of PA and sedentary behaviour derived from between 1 and 7 days of recall data. Large intra-individual coefficients of variation were calculated for physical activity level (14.5%), moderate-to-vigorous physical activity (83.4%), screen …

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

Faculty, Staff and Student Publications

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 …