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Results.
Kinds of Results. Selected AbstractsPrevalence of Sedentary Lifestyle in Individuals With High Blood PressureINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2010Nirla Gomes Guedes RN OBJECTIVE., To identify the prevalence of a sedentary lifestyle in individuals with high blood pressure. METHODS., This cross-sectional study was conducted among 310 individuals with high blood pressure. RESULTS., The prevalence of the diagnosis of sedentary lifestyle was 60%. The more common defining characteristics were "lack of physical conditioning" and "lack of practice for physical exercises." The nursing diagnosis was associated with age and presence of diabetes. Individuals who presented with a sedentary lifestyle related to lack of motivation were significantly younger. CONCLUSIONS., This study showed a high prevalence of "sedentary lifestyle" and its associations with age and the presence of diabetes. IMPLICATIONS TO NURSING PRACTICE., The acknowledgement of "sedentary lifestyle" contributes to the choice for nursing interventions that promote physical activity centered on the subject and the surroundings. [source] Psychosocial Experiences of Parents of a Child With Imperforate AnusJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2009Margret Nisell PURPOSE., This study aims to examine the psychosocial experiences of parents of children with imperforate anus (IA) and to describe their potential positive experiences. DESIGN AND METHODS., Parents of IA children and a comparison group answered a questionnaire, which was analyzed quantitatively and with manifest content analysis. RESULTS., Social relationships and respect for the child's will were more affected among IA mothers. Positive experiences were revealed in relation to the child, the parent, and the family. PRACTICE IMPLICATIONS., Support to parents in caring for a child with IA should be individualized and occasionally undertaken through collaboration with experts from child and adolescent psychiatry. [source] The Association Between Internet Use and Depressive Symptoms Among South Korean AdolescentsJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2009Sunhee ParkArticle first published online: 28 APR 200 PURPOSE., This study explores the cross-sectional relationship between Internet use and depressive symptoms in South Korean adolescents. DESIGN AND METHODS., Existing data, the three-wave Korean Youth Panel Survey, were analyzed. The sample was a cohort representing the population of second-year students at Korean middle schools in 2003 (N = 3,449). Multivariate logistic regression was used. RESULTS., A one-unit increase in Internet use was positively associated with a 20.7% increase in risk for depressive symptoms. PRACTICE IMPLICATIONS., It may be worthwhile for nursing professionals to inquire about Internet use as part of a measure of screening for depressive symptoms in teens. [source] Parenting Stress in Mothers of Children With Autism Spectrum DisordersJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2009Supapak Phetrasuwan PURPOSE., The purpose of this paper is to describe the sources of parenting stress in mothers of children with Autism Spectrum Disorders (ASD) and examine the relationship between parenting stress and maternal psychological status (depression and well-being). DESIGN AND METHODS., A descriptive correlational design was used. Data were collected via mailed questionnaires. RESULTS., Behavioral symptoms were the primary source of parenting stress for mothers. There was no relationship between child characteristics and parenting stress. Mothers reporting more parenting stress had more depressive symptoms and lower levels of well-being. PRACTICE IMPLICATIONS., Our findings have implications for interventions with mothers to help them manage their children's behavior and focus on stress reduction and well-being. [source] Development of a Clinical Practice Guideline for Testing Nasogastric Tube PlacementJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2009Sue Peter PURPOSE.,A Perth metropolitan hospital group standardized changes to nasogastric tube placement, including removal of the "whoosh test" and litmus paper, and introduction of pH testing. DESIGN AND METHODS.,,Two audits were conducted: bedside data collection at a pediatric hospital and a point-prevalence audit across seven hospitals. RESULTS.,,Aspirate was obtained for 97% of all tests and pH was , 5.5 for 84%, validating the practice changes. However, patients on continuous feeds and/or receiving acid-inhibiting medications had multiple pH testing fails. PRACTICE IMPLICATIONS.,Nasogastric tube placement continues to present a challenge for those high-risk patients on continuous feeds and/or receiving acid-inhibiting medications. [source] Exploring Youth Development With Diverse Children: Correlates of Risk, Health, and Thriving BehaviorsJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2009Laureen H. Smith PURPOSE.,This study explored the relationships between internal and external assets, risk behaviors, health behaviors, and thriving behaviors in diverse children. DESIGN AND METHODS.,The strength of relationships existing between measures, differences between group means based on gender, grades earned, and school, and confidence interval (p , .05) were tested in a sample of 61 urban sixth graders. RESULTS.,Few assets were related to substance use. Assets were related to delinquency acts, health behaviors, and thriving indicators. Group differences between schools and gender and the total number of assets were noted. PRACTICE IMPLICATIONS.,Supporting assets are important to consider when nurses perform assessments and design interventions to support youths in their maturation processes. [source] The Effect of Childhood Sexual Abuse on Adolescent Pregnancy: An Integrative Research ReviewJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2008Melissa A. Francisco PURPOSE.,This study aims to describe the current research literature on the relationship of childhood sexual abuse and adolescent pregnancy and highlight the potential cross-cutting risk factors. DESIGN AND METHODS.,Thirteen articles were identified as the basis of this review using Cooper's methodology (1998) for synthesizing research. Articles were categorized according to the levels of evidence proposed by Melnyk and Fineout-Overholt (2005). RESULTS.,The majority of the studies identified a relationship between childhood sexual abuse and adolescent pregnancy (n = 9). Cross-cutting risk factors included female gender, younger age, substance use/abuse, family constellation, parent,child conflict, and mother disengagement. PRACTICE IMPLICATIONS.,Strategies for nurses to identify pregnant and parenting adolescents who have been sexually victimized are important for early intervention. Resiliency factors of young people who report positive outcomes are highlighted. [source] Family-Based Weight Management With Latino Mothers and ChildrenJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2008Kathy Shadle James PURPOSE.,This paper aims to design a culturally appropriate weight management intervention for high-risk Latino families and to examine the feasibility of recruiting program participants. DESIGN AND METHODS.,A descriptive design using qualitative and quantitative data collected during preliminary phases of an ongoing intervention study. RESULTS.,From the preliminary works, a curriculum was revised for Latino families who have overweight children. The curriculum was modified to include suggestions from the focus groups, including helping mothers set limits with their children and make the transition to lighter foods and a more active family life. PRACTICE IMPLICATIONS.,The information will aid professionals in the process of program design for Latino families who have weight concerns. [source] Evaluation of a Pilot Hospital-Based Community Program Implementing Fitness and Nutrition Education for Overweight ChildrenJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2008Karen Gabel Speroni PhD PURPOSE.,Evaluate the effect of the Kids Living FitÔ hospital-based intervention on body mass index (BMI) percentile, adjusted for age (months) and gender in children ages 8,12 years with BMI percentiles , 85. DESIGN AND METHODS.,Twelve weekly exercise sessions and three nutrition presentations were held. Nurses recorded BMI and waist circumference at baseline, week 12, and week 24. Participants completed food and activity diaries. RESULTS.,Of the 32 participants enrolled, 16 completed all outcome measures and experienced a decrease in average BMI, BMI percentile, and waist circumference between baseline and weeks 12 and 24. PRACTICE IMPLICATIONS.,Hospitals can offer exercise and nutrition programs to decrease childhood obesity in their communities. [source] Ecological Differences in Weight, Length, and Weight for Length of Mexican American Children in the WIC ProgramJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2008Elizabeth Reifsnider PhD, WHNP PURPOSE.,Examine factors common in the environments of children who obtain services from a WIC program to determine if differences in ecological/environmental factors can be found in the children who differ in weight, length, and weight for length. DESIGN AND METHODS.,Cross-sectional study of 300 children, 100 each who were stunted, normal weight for length, or overweight. Instruments used were NCATS, ARSMA II, 24-hr diet recall, and Baecke Activity Questionnaire. RESULTS.,Significant differences were present in children's diet, parents' BMI, parents' generation in United States, parents' activity levels, and maternal,child relationship. PRACTICE IMPLICATIONS.,Encourage parents to adopt family approaches to encourage normal body size in children. [source] Effectiveness and Appropriateness of Therapeutic Play Intervention in Preparing Children for Surgery: A Randomized Controlled Trial StudyJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2008Ho Cheung William Li PURPOSE.,This paper aims to examine the effectiveness and appropriateness of using therapeutic play in preparing children for surgery. DESIGN/METHOD.,A randomized controlled trial was employed. Children (7,12 years of age; n = 203) admitted for surgery during a 13-month period were recruited. RESULTS.,The results support the effectiveness and appropriateness of using therapeutic play in preparing children for surgery. PRACTICE IMPLICATIONS.,The study results promote awareness in nurses and parents that play is a very important part of children's lives, and heighten the importance of integrating therapeutic play as an essential component of holistic and quality nursing care to prepare children for surgery. [source] Collaborative Childcare Health Consultation: A Conceptual ModelJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2008Angela A. Crowley PhD PURPOSE.,This study explored the nature of consultation between childcare providers and nurse childcare health consultants and identified factors that promote a collaborative relationship. DESIGN AND METHODS.,A qualitative study using semistructured, individual interviews of five collaborative and five conflicted pairs of nurse childcare health consultants and childcare center directors. Data were analyzed following principles of grounded theory and applying the constant comparative method of analysis. RESULTS.,Establishing a collaborative relationship was influenced by previous experiences and four themes in the relationship: open and active communication, commitment, respect, and congruent philosophies. PRACTICE IMPLICATIONS.,Preparation in developing collaborative relationships should be incorporated into the education of nurse consultants and childcare directors and providers. [source] Parents' Concerns About Issues Related to Their Children's Genetic ConditionsJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2008Agatha M. Gallo PURPOSE.,The purpose of this analysis was to examine parents' (N = 142) concerns about issues (i.e., privacy of information, insurance, healthcare costs, employment, school) related to their children's genetic conditions. DESIGN AND METHODS.,Using a series of matrices, thematic analysis was conducted focusing on parents' concerns. RESULTS.,Parents were less concerned with privacy and more concerned with insurance, healthcare costs, employment, and school issues. PRACTICE IMPLICATIONS.,Nurses and other healthcare professionals need to give parents the opportunity to discuss their concerns and to assist parents with strategies and resources to meet the needs of their children and families. [source] Adolescents' Pain Experiences Following Acute Blunt Traumatic Injury: Struggle for Internal ControlJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2007Margie Crandall ISSUES AND PURPOSE.,Although blunt trauma injury is a common cause for adolescent pain, little is known about the experience of pain as perceived by adolescents. DESIGN AND METHOD.,Semistructured interviews were conducted with 13 adolescents following blunt trauma injury. Two age-appropriate valid measures (i.e., Adolescent Pediatric Pain Tool and Temporal Dot Matrix) were incorporated into the interviews to elaborate their pain experiences. Grounded theory method was used to analyze data and build substantive theory. RESULTS.,Adolescents' behavioral and cognitive actions (i.e., "internal control") to manage and endure pain were influenced by their pain perceptions, physical losses, and clinicians' actions. PRACTICE IMPLICATIONS.,Nurses, family members, and peers have a crucial role in alleviating adolescents' distress and pain. [source] Children's Expectations of Pain, Perceptions of Analgesic Efficacy, and Experiences With Nonpharmacologic Pain Management Strategies at Home Following TonsillectomyJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2007Kimberly A. Sutters PURPOSE.,To document children's (ages 6,15 years) descriptions of their pain management at home following tonsillectomy. DESIGN AND METHODS.,Audio-taped interviews of 80 children were transcribed and coded. Data for each response category were tabulated. RESULTS.,Children reported they had more pain after surgery than expected, the pain medicine helped to take their pain away, taking the pain medicine was associated with a negative response by some children, and cold liquids/food by mouth provided pain relief. PRACTICE IMPLICATIONS.,Findings provide insight into children's perspective of pain management at home following tonsillectomy and methods for relieving their pain. [source] Pain-Sensitive Temperament and Postoperative PainJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2007Charmaine Kleiber PURPOSE.,To describe the relationship between pain-sensitive temperament and self-report of pain intensity following surgery. DESIGN AND METHODS.,Fifty-nine adolescents and young adults (average age 14 years) undergoing spinal fusion for adolescent idiopathic scoliosis completed the Sensitivity Temperament Inventory for Pain,Child version (STIP-C). The Pearson correlation between STIP-C scores and the highest pain intensity for each of the first three postoperative days was investigated. RESULTS.,There was a small but significant correlation between the Perceptual Sensitivity and Symptom Reporting subscales of the STIP-C and pain intensity measured on the third postoperative day. PRACTICE IMPLICATIONS.,Aspects of the pain-sensitive temperament may be important in understanding the variability in postoperative pain. This is the first investigation of the relationship between pain-sensitive temperament and surgical pain. More research is needed in this area. [source] Psychosocial Care Needs of Children With Recent-Onset AsthmaJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2007Angela M. McNelis PURPOSE.,To examine psychosocial care needs of children with recent-onset asthma. DESIGN/METHODS.,Data were collected over 2 years from 63 children ages 8,14 years. RESULTS.,Children's need for attention to specific aspects of their asthma care remained high over the 2 years, as did their perceived needs for information and support and their concerns and fears. PRACTICE IMPLICATIONS.,Children have many needs, and healthcare professionals may not be providing care that addresses these needs. The Child Report of Psychosocial Care can be used as a quick tool to assess and guide interventions related to specific areas of need. [source] Stimulant Medications: A Trade-off?JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2006The Lived Experience of Adolescents With ADHD PURPOSE.,The purpose of this study was to gain information and insight about prescription stimulant medication use among children and adolescents with attention deficit,hyperactivity disorder (ADHD) across developmental stages. DESIGN AND METHODS.,Investigators conducted semistructured qualitative interviews with 15 college students with ADHD. Follow-up interviews confirmed and validated information obtained during initial interviews. RESULTS.,Qualitative data analysis resulted in three global categories related to the use of prescription stimulant medication from childhood to late adolescence: (a) the early years, (b) "the trade-off," and (c) stimulant medications in college. PRACTICE IMPLICATIONS.,Increased education about prescription stimulant medications and closer management is needed to reduce side effects and minimize the risks of misuse. [source] Methods of Continuing Professional Education Preferred by Irish Pediatric NursesJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2006Carmel Doyle PURPOSE.,To explore the continuing professional education (CPE) of pediatric nurses in Ireland and establish if and in what ways pediatric nurses are taking part in CPE as well as factors that might assist or hinder pediatric nurses in undertaking CPE. DESIGN AND METHODS., A stratified random sample of 205 registered children's nurses (RCNs) completed a questionnaire. RESULTS.,RCNs in Ireland use a variety of methods of CPE, the most popular being journal reading, while the least popular method is the use of computerized journal databases and the internet. Many RCNs appear to lack the computer skills necessary to utilize these methods of CPE. PRACTICE IMPLICATIONS.,The favored methods of CPE by RCNs need to be utilized and promoted in the practice setting in order to ensure RCNs are up to date in the provision of quality care to pediatric patients. [source] The Effect of Creating a Mental Set on Cognitive Learning and Affective Behaviors of Nursing StudentsNURSING FORUM, Issue 4 2009Loucine M. D. Huckabay RN BACKGROUND., A mental set predisposes a person to view and approach a problem in a predetermined manner. Affective behaviors determine whether students value what they learn. PURPOSE., This study investigated the effect of mental set in the form of negative impressions and anxieties about a nursing course (pathophysiology) on cognitive learning and affective behaviors. RESULTS., Results showed that, irrespective of type of mental set, all students learned significantly. Students who entered the course with a negative set scored significantly lower in affective behaviors than students who entered with a positive or neutral mental set. Predispositions stayed stable; significant changes occurred within each group, but not enough to change a negative set into a positive set or vice versa. IMPLICATIONS., Implications for nursing education and creation of affective behaviors conducive for life-long learning are presented. [source] Early and Midterm Results of an Alternative Procedure to Homografts in Primary Repair of Truncus Arteriosus CommunisCONGENITAL HEART DISEASE, Issue 3 2010Pedro Curi-Curi MD ABSTRACT Background., Repair of truncus arteriosus communis (TAC) in the neonatal and early infant period has become a standard practice. We report our experience on primary repair of TAC with a bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early and midterm results. Methods., From January 2001 to December 2007, 15 patients with mean age 1.5 years (range 3 months to 8 years), underwent primary repair of simple TAC. Cases with cardiogenic shock, complex-associated cardiac lesions, or adverse anatomy of the truncal valve were excluded. The Collett and Edwards anatomical type classification of TAC was as follows: type I, 13 (87%); and type II, 2 (13%). Right ventricular outflow tract was reconstructed in all the cases with a bovine pericardial-valved woven Dacron conduit. Results., Overall mortality was 6.6% (1 death due to severe pulmonary hypertension). At a mean follow-up of 31 months (range 6,51), there were no deaths (5-year actuarial survival 93.4%). Out of the 14 midterm survivors, three developed stenosis of the pericardial-valved woven Dacron conduit, but only one underwent interventional procedure including percutaneous balloon dilation with stenting for associated left pulmonary artery hypoplasia. The rate of patients with no surgical or percutaneous reinterventions performed because of obstruction of the right ventricular outflow tract reconstruction in the midterm (5 years) was 86%. Conclusions., Truncus arteriosus communis repair with a bovine pericardial-valved woven Dacron conduit can be performed with a very low perioperative mortality and satisfactory midterm morbidity, favorably compared with that reported for the use of homografts. Interventional cardiac catheterization may delay the time of reoperation for inevitable conduit replacement due to stenosis. [source] Right Ventricular Function in Congenital Heart Defects Assessed by Regional Wall MotionCONGENITAL HEART DISEASE, Issue 3 2010FSCAI, Michael R. Nihill MB ABSTRACT Objectives., To develop a simple method to assess right ventricular function by angiography. Background., Conventional methods of evaluating right ventricular function are inaccurate, cumbersome, and expensive. Methods., We analyzed biplane right ventricular angiograms taken in the posterior,anterior and lateral projections using software to measure right ventricular volumes and regional wall motion in 78 patients with normal hearts (n = 29), atrial septal defects (ASD n = 13), pulmonary valve stenosis (PVS n = 21), and postoperative atrial switch patients (n = 15). We also measured the shortening fraction (SF) from the midtricuspid annulus to the septum and correlated various angiographic measurements with the right ventricular (RV) ejection fraction. Results., The volume-overloaded patients (ASD) had larger end diastolic volumes and increased SF compared with normal patients, while the pressure-loaded patients (PVS) had normal volumes and SF. The postoperative atrial switch patients had decreased systolic function and increased end diastolic volume. The SF for all of the patients correlated with the ejection fraction (r= 0.785, P, .0001). Conclusions., A simple measurement of the end diastolic and end systolic distance from the midtricuspid annulus to the septum (SF) provides a good index of RV function by angiography and correlates well with RV ejection fraction. [source] Neurodevelopmental Outcomes in Infants after Surgery for Congenital Heart Disease: A Comparison of Single-Ventricle vs.CONGENITAL HEART DISEASE, Issue 2 2010Two-Ventricle Physiology ABSTRACT Introduction., The neurodevelopmental outcome of children with repaired congenital heart defect has risen in importance with improved survival. This study compares neurodevelopmental outcomes of children who had CHD with single ventricle physiology with those who had CHD with two-ventricle physiology. Patients and Methods., Participants included 112 infants discharged from the NICU between February 1999 to August 2006. The 12 infants who had a known genetic defect were excluded. Of the 100 infants 26 had single ventricle physiology and 74 had CHD with two-ventricle physiology. The children were seen in a follow-up clinic and growth parameters and standardized instruments were used to evaluate development. The referral rate to early intervention services was also compared. Results., The number of functional ventricles did not significantly differentiate growth parameters at 6,8 months of age. Early cognitive outcomes were relatively unimpaired in both the groups (single ventricle vs. two ventricle physiology). Early motor outcomes were worse in (p < 0.05) CHD with single ventricle physiology. The rate of referral for early intervention services was high in both groups compared to the average rate of referral in the state, but there was not a significant difference between the CHD groups. Conclusion., Significant differences noted on motor outcomes at the 6,8 month visit were no longer apparent in later visits. Referral to early intervention services is high in both the groups. These findings are important to those caring for infants with CHD because many of these patients may need referral for early intervention. [source] Pediatric Interventional Cardiology in the United States is Dependent on the Off-label Use of Medical DevicesCONGENITAL HEART DISEASE, Issue 1 2010Jamie S. Sutherell MD ABSTRACT Objective., A substantial unmet medical device need exists in pediatric care. As a result, the off-label use of approved devices is routine in pediatric interventional cardiology, but the extent and nature of this practice has not been previously described. The purpose of this study, therefore, is to evaluate the prevalence and nature of off-label cardiac device use in an active pediatric interventional program in the United States. Study Design., This study is a retrospective review of all interventional cardiac procedures performed at our institution from July 1, 2005 to June 30, 2008. Diagnostic (noninterventional) catheterizations, myocardial biopsies, invasive electrophysiology studies, and studies involving investigational devices were excluded. Interventions performed were compared with the manufacturer's labeled indications for each device. Results., During this 3-year period, 473 patients (median age 4.1 years) underwent 595 transcatheter interventions. An approved device was utilized for an off-label application in 63% of patients, and in 50% of all interventions performed. The most frequent off-label procedures were stent implantations (99% off-label), balloon dilations (78% off-label), and coil embolizations (29% off-label). In contrast, the off-label use of septal and ductal occluders was relatively uncommon. Conclusions., In our routine (noninvestigational) practice of pediatric interventional cardiology, 63% of patients underwent procedures utilizing medical devices for off-label indications. These data underscore the need to enhance cardiac device review and approval processes in the United States to include pediatric applications. [source] Late Presenters with Dextro-transposition of Great Arteries and Intact Ventricular Septum: To Train or Not to Train the Left Ventricle for Arterial Switch Operation?CONGENITAL HEART DISEASE, Issue 6 2009Noor Mohamed Parker MBChB ABSTRACT Objective., We report our experience in managing late presenters (older than 4 weeks) with dextro-transposition of great arteries and intact ventricular septum (d-TGA/IVS) in an effort to achieve successful arterial switch operation (ASO) in a third world setting. Design., We retrospectively reviewed the charts of all late presenters with d-TGA/IVS. Patients were divided into two groups: left ventricular training (LVT) group and non-left ventricular training (non-LVT) group. LVT group underwent pulmonary artery banding and Blalock-Taussig Shunt prior to ASO. Results., Twenty-one late presenters were included in the study. In LVT group, 11 patients with median age of 6 months (range, 1,72 months) underwent LVT. Later, 8 patients with median age of 9.25 months (range, 1.33,84 months) underwent ASO. Prior to ASO, left ventricle (LV) collapse resolved in all and left ventricle to systemic pressure (LV/SP) ratio was 0.81 (range, 0.76,0.95) in 4 patients. Two patients who had LVT for ,14 days required postoperative extracorporeal membrane oxygenation (ECMO) support due to LV dysfunction. Seven patients survived to discharge. In non-LVT group, 10 patients with median age of 2.5 months (range, 1,98 months) underwent ASO. Five patients had LV collapse, and median LV/SP ratio was 0.67 (range, 0.56,1.19) in 5 patients. Seven patients needed ECMO support. Seven patients survived to discharge. Conclusion., Late presenters with d-TGA/IVS, who have LV collapse on echocardiography and/or a LV/SP ratio <0.67 on cardiac catheterization, should be subjected to LVT preferably for duration of longer than 14 days in order to avoid potential ECMO use. [source] Serum and 24-hour Urine Analysis in Adult Cyanotic and Noncyanotic Congenital Heart Disease PatientsCONGENITAL HEART DISEASE, Issue 3 2009Efrén Martínez-Quintana MD ABSTRACT Introduction., Glomerulopathy is a complication of congenital heart disease patients. The risk of developing renal impairment is particularly high in cyanotic patients. Objective., The aim of this study was to determine the prevalence of renal dysfunction and microalbumiuria in adult cyanotic and non cyanotic congenital heart disease patients. Methods., Fourteen cyanotic and 22 noncyanotic congenital heart disease patients were studied in the Adult Congenital Heart Disease Unit at the Complejo Hospitalario Universitario Insular-Materno Infantil. Demographic characteristics, complete blood count, and 24-hour urianalysis were obtained, including abdominal ultrasound in those with cyanosis. Results., No differences were seen between age (years) (27.4 ± 8.2; 26.4 ± 8.3; P = .71), sex, size, weight, or glomerular filtration rate (mL/min/1.73 m2) (81.1 ± 22.9 vs. 84.9 ± 9.2, P = .482) between cyanotic and noncyanotic patients. However, Eisenmenger patients had significantly impaired renal function when compared with noncyanotic patients (73.0 ± 17.3 vs. 84.9 ± 9.2 mL/min/1.73 m2, P = .023). Significant differences were obtained in oxygen saturation (%) (83.8 ± 5.8 vs. 97.8 ± 0.8; P = .000), hematocrit (%) (59.3 ± 8.1 vs. 40.9 ± 8.5; P = .000), platelets (103/µL) (161.5 ± 70.5 vs. 277.9 ± 57.6; P = .000), serum uric acid (mg/dL) (7.5 ± 2.3 vs. 5.6 ± 1.5; P = .008) and microalbuminuria (mg/24 hours) (12.8 [0, 700.2] vs. 2.4 [0, 18.9]; P = .000) between cyanotic and noncyanotic patients. Five cyanotic patients (35.7%) had microalbuminuria (>30 mg/24 hours) and three of them (21.4%) proteinuria (>1 g/24 hours). No significant differences were seen between serum and urine parameters between cyanotic patients who had microalbuminuria (>30 mg/24 hours) and those cyanotic patients who did not have it (<30 mg/24 hours). Conclusions., Renal impairment is frequently seen in congenital heart disease patients, being associated occasionally with proteinuria and microalbuminuria in cyanotic ones. [source] Acute Adaptation to Volume Unloading of the Functional Single Ventricle in Children Undergoing Bidirectional Glenn AnastomosisCONGENITAL HEART DISEASE, Issue 2 2009Catherine Ikemba MD ABSTRACT Objective., Volume unloading of the functional single ventricle after a bidirectional Glenn anastomosis (BDG) prior to 1 year of age leads to improved global ventricular function as measured by the myocardial performance index (MPI), a Doppler-derived measurement of combined systolic and diastolic ventricular function. Systolic function remains unchanged after BDG according to previous studies; however, acute changes in global and diastolic function have not been previously investigated in this cohort. Our objective was to assess the short-term effects of the BDG on global ventricular function in patients with a functional single ventricle. Design., Echocardiograms to obtain MPI, isovolumic contraction time, and isovolumic relaxation time were performed at four time periods: in the operating room, in the operating room prior to BDG, shortly after separation from cardiopulmonary bypass, less than 24 hours postoperatively, and either prior to hospital discharge or at the first clinic follow-up visit. Results., Twenty-six patients were enrolled. There was significant ventricular dysfunction noted shortly after separation from cardiopulmonary bypass, median MPI 0.63 (0.39,0.81), that persisted in the short term postoperatively median MPI 0.50 (0.40,0.63). Isovolumic contraction time did not change, however, isovolumic relaxation time was significantly prolonged following BDG. Conclusion., In the postoperative patient after BDG, systolic function is preserved; however, there is evidence of diastolic and global ventricular dysfunction, at least in the short term. [source] Selective Application of the Pediatric Ross Procedure Minimizes Autograft FailureCONGENITAL HEART DISEASE, Issue 6 2008David L.S. Morales MD ABSTRACT Objective., Pulmonary autograft aortic root replacement (Ross' operation) is now associated with low operative risk. Recent series suggest that patients with primary aortic insufficiency have diminished autograft durability and that patients with large discrepancies between pulmonary and aortic valve sizes have a low but consistent rate of mortality. Therefore, Ross' operation in these patients has been avoided when possible at Texas Children's Hospital. Our objective was to report outcomes of Ross' operation when selectively employed in pediatric patients with aortic valve disease. Methods., Between July 1996 and February 2006, 55 patients (mean age 6.8 ± 5.5 years) underwent Ross' procedure. Forty-seven patients (85%) had a primary diagnosis of aortic stenosis, three (5%) patients had congenital aortic insufficiency, and five (9%) patients had endocarditis. Forty-two (76%) patients had undergone prior aortic valve intervention (23 [55%] percutaneous balloon aortic valvotomies, 12 [29%] surgical aortic valvotomies, 12 [29%] aortic valve replacements, 2 [5%] aortic valve repairs). Fourteen (25%) patients had ,2 prior aortic valve interventions. Thirty-two patients (58%) had bicuspid aortic valves. Follow-up was 100% at a mean of 3 ± 2.5 years. Results., Hospital and 5-year survival were 100% and 98%, respectively. Morbidity included one reoperation (2%) for bleeding. Median length of hospital stay was 6 days (3 days,3 months). Six (11%) patients needed a right ventricular to pulmonary artery conduit exchange at a median time of 2.3 years. Freedom from moderate or severe neoaortic insufficiency at 6 years is 97%. Autograft reoperation rate secondary to aortic insufficiency or root dilation was 0%. Conclusions., By selectively employing Ross' procedure, outcomes of the Ross procedure in the pediatric population are associated with minimal autograft failure and mortality at mid-term follow-up. [source] A Risk Adjusted Method for Comparing Adverse Outcomes among Practitioners in Pediatric and Congenital Cardiac CatheterizationCONGENITAL HEART DISEASE, Issue 4 2008Lisa Bergersen MD ABSTRACT Objective., We sought to develop a method to adjust for case mix diversity and allow comparison of adverse outcome rates among practitioners in pediatric and congenital cardiac catheterization. Patients and Methods., A single institutional database that captured demographic and procedural data was used to identify patient and procedural characteristics associated with adverse events (AE) and any high severity event classified as preventable or possibly preventable (P/PP). Diagnostic and procedural risk groups were created and indicators of hemodynamic vulnerability were defined. Expected event rates by the practitioners adjusting for case mix were calculated. Standardized adverse event ratios (SAER), defined as the observed rate divided by the expected rate for each practitioner were calculated with 95% confidence intervals. Results., The database included 1727 hemodynamic (30%) and interventional (70%) cases performed by seven practitioners in 18 months. During 147 cases, at least one P/PP AE occurred; among the seven practitioners observed, event rates ranged from 3.2 to 14.2%. In multivariable analysis, risk factors for all P/PP events included highest procedure risk group (odds ratio [OR] 2.1 for group 2, and 2.8 for group 3, relative to group 1, P = .001 and P < .001, respectively) and weight less than 4 kg (OR 2.8, P < .001). High severity P/PP events occurred in 67 cases with rates ranging from 2.0 to 6.6% by the practitioners. For these events, risk factors included: highest procedure risk group (OR 4.5 for group 2, and 4.9 for group 3, both P < .001) and an indicator of hemodynamic vulnerability (OR 1.8, P = .026). For the seven practitioners, the SAER ranged from 0.41 to 1.32 for any P/PP AE and from 0.69 to 1.44 for P/PP high severity events. In this cohort, we did not identify any statistically significant performance differences. Conclusion., Despite wide variations in case mix complexity in pediatric and congenital cardiac catheterization, this study demonstrates a method for risk adjustment which allows equitable comparisons among practitioners at a single institution. [source] Early Surgical Morbidity and Mortality in Adults with Congenital Heart Disease: The University of Michigan ExperienceCONGENITAL HEART DISEASE, Issue 2 2008Ginnie L. Abarbanell MD ABSTRACT Objectives., To review early surgical outcomes in a contemporary series of adults with congenital heart disease (CHD) undergoing cardiac operations at the University of Michigan, and to investigate possible preoperative and intraoperative risk factors for morbidity and mortality. Methods., A retrospective medical record review was performed for all patients ,18 years of age who underwent open heart operations by a pediatric cardiothoracic surgeon at the University of Michigan Congenital Heart Center between January 1, 1998 and December 31, 2004. Records from a cohort of pediatric patients ages 1,17 years were matched to a subset of the adult patients by surgical procedure and date of operation. Results., In total, 243 cardiac surgical operations were performed in 234 adult patients with CHD. Overall mortality was 4.7% (11/234). The incidence of major postoperative complications was 10% (23/234) with a 19% (45/23) minor complication rate. The most common postoperative complication was atrial arrhythmias in 10.8% (25/234). The presence of preoperative lung or liver disease, prolonged cardiopulmonary bypass and aortic cross clamp times, and postoperative elevated inotropic score and serum lactates were significant predictors of mortality in adults. There was no difference between the adult and pediatric cohorts in terms of mortality and morbidity. Conclusions., The postoperative course in adults following surgery for CHD is generally uncomplicated and early survival should be expected. Certain risk factors for increased mortality in this patient population may include preoperative presence of chronic lung or liver dysfunction, prolonged cardiopulmonary bypass and aortic cross-clamp times, and postoperative elevated inotropic score and serum lactate levels. [source] | |||||||||||||||||||||||||||||||||||||