The purpose of this study was to assess pediatric nurses' perceptions and knowledge base about Attention Deficit Hyperactivity Disorder (ADHD). One thousand five hundred and sixty research surveys were mailed to nurses that were active members of a national pediatric nursing organization. Surveys included a questionnaire, adapted from the ADHD Management Scale developed by Lobar & Phillips, and a demographic questionnaire (See Appendix C). Five hundred and fifty five nurses responded. T he adapted scale consisted of two parts that measure perception and knowledge of ADHD. Open-ended questions were asked about the diagnosis of ADHD, the use of Ritalin for ADHD, types of factors that may affect the course of hospitalization, and types of injuries to which ADHD children may be prone. ANOVA was applied to the data from the overall mean perception and knowledge scores to make comparisons among and between groups of pediatric nurses based on age, education, experience, and type of employment. The results of the study suggested that hospital-based nurses, nurses under the age of 40 years, and nurses with Associate and Bachelor degrees had more erroneous perceptions and minimal knowledge about ADHD, than the Masters and Doctoral degree nurses and the community and college based nurses.

Magister Scientiae Dentium - MSc(Dent) / The aim of the study was to determine the oral and debntal health status of pediatric cardiac patients, 12 years of age and younger, and compare them with non-cardiac patients. A total of 150 children, 75 with known cardiac condition (study group) and 75 no-cardiac (control group) were examined. No statistically significant differences were established in the study between the caries experience score for the cardiac and control groups. The study concludes that the cardiac group generally has a higher decay component and a lower missing component which may be an indication of the lack of dental intervention. The gingival inflammation was significantly higher in the cardiac group although the plaque scores were similar in the two groups. / South Africa

Childhood chronic illness is replete with stressors that affect children's functioning across physical, social, emotional, and psychological domains. In this project, efforts were directed toward the identification and assessment of spirituality as a potential addition to the approach-avoidance paradigm of coping response. Twenty-two children diagnosed with either cancer or sickle cell disease were interviewed, along with their mothers, regarding psychosocial adjustment and typical approaches to coping with stressors. Children completed depression, anxiety, and quality of life questionnaires. Child participants were also asked to rate how often they utilized specific spiritual and general coping strategies in the month prior to the assessment. Mothers completed measures of depression and spiritual well-being, as well as parent proxy reports on their children's quality of life and use of spiritual coping. A factor analysis of the spiritual coping measure designed for use in the study (the Spiritual Coping Module) indicated strong support for the theoretically driven factors of religious and existential coping. Children's use of coping did not significantly account for heightened quality of life, nor for the presence of depressive and anxious symptomatology. However, maternal spiritual well-being accounted for 52.5% of the variance in self-reported maternal depression. Results are discussed in the context of improving children's adjustment to chronic illness through increased understanding of the child's and family's pattern of coping responses. / Master of Science

Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this study was to determine the rate of plaque formation in children and its relationship to their periodontal and caries indices and to evaluate a television area measurement instrument. Plaque formation at 6-, 24-, 48-, and 96-hour intervals was observed in 56 children aged 8 through 12 to establish the rapidity of its reformation after a thorough dental prophylaxis. The plaque was recorded with disclosing agents and oriented Polaroid photographs and measured by newly developed television and electronic area measurement instrumentation which proved to be highly reliable. The presence of caries and periodontal disease was then correlated with the amount of plaque recorded at each observation period. A high correlation was found between the Anterior P-M-A and the Periodontal Index. No significant correlations were found between the periodontal indices and the DMFs scores or with the amount of plaque present and the DMFs scores. Seventy-seven per cent of the children displayed measurable amounts of plaque just 6 hours after a thorough dental prophylaxis. In comparing the amount of plaque formed by these children with results reported from similar studies conducted on adults, it is apparent that children in this age group form more plaque in less time than adults. A significant correlation was found between the amount of plaque present and the periodontal indices at the 48-hour examination.

Indiana University-Purdue University Indianapolis (IUPUI) / The need for a safe but effective agent to sedate dental patients who are severe behavior management problems prompted this investigation of ketamine HCl. Ketamine HCl is a general anesthetic agent with the unique property of selectively depressing the higher centers of the brain without adversely affecting respiration or cardiac output. Sixty behavior problem pedodontic patients were selected at random and placed in one of three groups to receive the following treatments: Treatment I - ketamine HCl and scopolamine; Treatment II - ketamine, scopolamine, and droperidol, and Treatment III - ketamine, scopolamine, and nitrous oxide-oxygen analgesia. Each treatment group received ketamine HCl 2 mg/lb and 0.1 - 0.3 mg scopolamine. The second two treatment groups were supplemented with droperidol .025 mg/lb or nitrous oxide-oxygen (20-50%) to maintain anesthesia. The patients were given a series of pre and post-treatment mental and physical tests and were considered completely recovered when they could equal their pre treatment test scores. Routine dental restorative procedures limited to one and one-half hours were carried out with the use of the ruber dam. Onset of anesthesia was five minutes for all three treatment groups. Treatment III showed a significantly longer working time but recovery times were not significantly different between groups. Ketamine HCl was determined to be a safe, effective agent for use in pedodontic outpatients provided prescribed techniques are followed. Complications were infrequent and minor and parental response was considered satisfactory.

Indiana University-Purdue University Indianapolis (IUPUI) / This investigation served as a follow-up of the unilateral and bilateral cleft lip and palate patients who underwent primary alveolar bone grafting at James Whitcomb Riley Hospital of the Indiana University Medical Center. The sample consisted of 18 patients, 15 males and three females, who received primary alveolar grafts between September 7, 1983 and March 5, 1985. Thirteen had complete unilateral clefts, and five had complete bilateral clefts of the lip and palate. The mean age of the group was 8 years, and none had received orthodontic treatment. The statistical analysis of the lateral cephalometric radiographs revealed significant differences in maxillofacial growth between the Riley sample population and the non-cleft, age-matched patients in the University of Michigan Growth Study. The Riley data were, overall, statistically and proportionately smaller than the normal population. These findings are due to the smaller skeletal size of the Riley group. Arch symmetry measurements indicated that at 8 years of age there were significant differences from ideal or perfect symmetry. Due to existent dental development and scarring from the palatal procedure, these findings were expected. Ideal symmetry may not be a realistic achievement for the cleft patients. Palatal surface area values were visually analyzed through graphs. The growth patterns of the Riley population were similar to those of the normal and non-grafted cleft groups in a study from the University of Miami. The data supports the theory that primary alveolar bone grafting, as performed at James Whitcomb Riley Hospital, does not result in growth attenuation.

Natural killer (NK) cells are a type of lymphocyte involved in innate and adaptive immunity. In adults, exercise can increase NK cell cytotoxicity both as a total percent of target cell lysis and an increase in the function of each NK cell. Much less is known about this response in children. Thus, the objectives of this study were to examine: 1) the effects of exercise intensity and structure on NK specific lysis and NKCA per cell in youth, and 2) differences in baseline and post-exercise specific lysis and NKCA per cell by pubertal status and sex. We also examined the NK cell and NK subset response to these exercise protocols by pubertal status and sex to help contextualize the NK functional response. We recruited healthy, recreationally active pre-pubertal (8-11 years, N=5) and late/post-pubertal (15-18 years, N=6) children from the Hamilton community. Participants completed 4 experimental cycling sessions in a randomized order including: high intensity intermittent (HI-INT) or continuous (HI-CONT), and moderate intensity intermittent (MOD-INT) or continuous (MOD-CONT) cycling. Blood was collected at baseline (PRE), immediately post-exercise (POST), and at 30- and 60-minutes recovery (REC1 and REC2, respectively). Peripheral Blood Mononuclear Cells (PBMC) were isolated from each timepoint and used in a cytotoxic assay with K562 targets. Flow cytometry was used to quantify target cell death (reported as specific lysis and NKCA per cell), and to determine NK cells and subsets as a proportion of lymphocytes. Exercise significantly increased specific lysis from PRE (25.1± 6.7%) to POST (30.6±11.0%), while NKCA per cell increased from PRE (0.69±0.76) to REC2 (1.3±1.3); p<0.05 for both. These responses were seen irrespective of exercise intensity and structure, pubertal status, and sex. The % total NK cells increased from PRE to POST (6.8±2.8% vs. 13.6±7.2%), and was greater in post-pubertal children vs. pre-pubertal children (20.9±6.2% vs. 9.1±4.3%), and after HI-INT (15.5±8.1%) and MOD-INT (16.2±9.5%) vs. HI-CONT (12.0 ± 5.0%) and MOD-CONT exercises (10.6 ± 4.5%; p<0.05 for all). Acute exercise can enhance NK cell cytotoxicity in youth regardless of exercise intensity, structure, pubertal status, or sex. NK function and mobilization responses to exercise did not always align, which suggests that unique post-exercise processes contribute to changes in NK cell proportions, specific lysis, and NKCA per cell. Our study has enhanced the understanding of exercise-induced changes NK cell cytotoxicity in the growing years. Future research will focus on explaining these effects, and exploring the clinical application of exercise programs in youth. / Thesis / Master of Science (MSc) / The purpose of this study was to determine if exercise can increase the function of Natural Killer cells (NK cells) in children. These cells are a very important part of our immune system that work to protect us from harmful infections and cancers. We also wanted to see if puberty or sex influence how NK cells respond to exercise. We asked boys and girls who were 8-11 years old or 15-18 years old to visit our lab 5 times. During their first visit, we measured their fitness level. In the next 4 visits, they completed one of four different types of exercise including: 1) 30 minutes of hard cycling, 2) 5 minutes of stop-and-start hard cycling, 3) 30 minutes of less hard cycling, and 4) 5 minutes of stop-and-start less hard cycling. We collected blood at four times during each session, including: 1) before the exercise, 2) immediately after the exercise, 3) 30-minutes after exercise, and 4) 60-minutes after exercise. We took NK cells from this blood and added them to cancer cells. We measured how many cancer cells were killed by the NK cells. We were interested in learning if exercise changed the percent of cancer cells killed by NK cells. We also wanted to know if exercise helped make each NK cell a better killer. We found that immediately after exercise, NK cells were able to kill a greater percent of cancer cells than they could before exercise. We also found that at 60-minutes after exercise, each NK cell killed a greater number of cancer cells than they were able to before exercise. There were no differences in NK cell cancer killing capacity between boys and girls, or between pre-pubertal or post-pubertal children. Our study helps us understand how we can increase important immune functions with exercise in children.

Indiana University-Purdue University Indianapolis (IUPUI) / Malpractice litigation is on the increase and a lack of informed consent is more frequently becoming primary and secondary causes of action. A study was designed to compare and analyze the viewpoints of Indiana pediatric dentists and trial attorneys concerning the doctrine of informed consent. The ultimate goal was to share the information with both groups and raise the level of awareness of the doctrine among pediatric dentists. A three-page questionnaire dealing with the doctrine of informed consent was mailed to 85 pediatric dentists and 350 trial attorneys practicing in Indiana. The response rate for pediatric dentists was 70.6 percent and the response rate for trial attorneys was 61.4 percent. Overall, most pediatric dentists and trial attorneys were moderately familiar with the doctrine of informed consent. However, trial attorneys do not feel that pediatric dentists conform to the doctrine, while pediatric dentists perceive that they do conform. Pediatric dentists and trial attorneys recommend that informed consent be obtained orally and then documented on an informed consent form. Both professional groups agree that obtaining informed consent is necessary in the practice of pediatric dentistry. Unfortunately, pediatric dentists and trial attorneys do not f eel that predoctoral dental school education or specialty training prepares the pediatric dentist to obtain an informed consent. Not surprisingly, both groups feel that pediatric dentists are more concerned with obtaining informed consent today than they were in the past. Most pediatric dentists are obtaining informed consent in less than five minutes. However, pediatric dentists feel that the time spent obtaining informed consent has either remained the same (55.9 percent) or increased (44.1 percent); trial attorneys feel that this trend has increased (81.5 percent). Overall, pediatric dentists and trial attorneys disagree on whether parental consent is required for specific patient types. Moreover, the two groups agree on the type of consent necessary. For 20 dental procedures (54 percent) and disagree on 17 dental procedures (46 percent). Finally, most trial attorneys and pediatric dentists feel that conforming to the doctrine of informed consent reduces or eliminates future malpractice litigation.

No description available.

The benefits of intraoperative transesophageal echocardiography (TEE) during cardiac surgery are well documented. Intraoperative TEE accurately confirms and in many cases refines delineation of congenital heart lesions, can be used as a means for establishing an intraoperative technical surgical score, and offers a low incidence of intraoperative complications. It seemed likely that the rate of perioperative complications in children would be congruent with the current available data in adults. After Institutional Review Board approval, a retrospective chart review of patients at Boston Children's Hospital who underwent the TEE procedure between May 2012 and December 2014 was conducted. The final study sample consisted of 129 patient charts. Adverse events related to TEE were documented and defined as follows: 1) those potentially attributable to TEE and 2) those with a high likelihood of being related to TEE; defined as dysphagia, esophageal perforation, gastrointestinal bleeding, and throat discomfort/pain. Of the 129 total cases, there was only one case reporting an intraoperative adverse event with a high likelihood of being related to TEE. This incidence rate of 0.77% is consistent with the literature existing on adult and pediatric TEE safety studies. Literature on postoperative adverse events related to intraoperative TEE use in pediatric patients was limited to the incidence of dysphagia. The sample included no incidence of dysphagia and the review enumerated six postoperative adverse events (4.65%) of which had a high likelihood of being related to TEE. Three of these events were classified as major and three were classified as minor. Major postoperative events included blood draining from nasogastric/orogastric tubes and blood tinged secretions suctioned from the endotracheal tube. Minor events were patient reported as sore throat and voice hoarseness. It was concluded that TEE use is not associated with an increased risk of adverse events in pediatric patients if performed according to institutional procedure and recommendations. Intraoperative TEE offers immediate assessment of the adequacy of surgical repair and presence of residual lesions. This information can be used to generate a surgical technical performance score. The ability to detect and correct residual lesions with information provided by intraoperative TEE allows the surgeon to improve technical performance thereby reducing postoperative morbidity.