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Biomedical subjects

D Herndon

Publications and source records attributed to D Herndon.

28 records · Page 2Linked to original sources
PubMedDate not supplied

Parental well-being and behavioral adjustment of pediatric survivors of burns.

Parents of pediatric patients with burns often perceive their children as troubled and having an increased number of problem behaviors. This study examines the relationship between these problem behaviors and the parent's own emotional well-being. Mothers of 38 burned children completed three standardized questionnaires: Child Behavior Checklist, Parental Stress Index, and the Eight State Questionnaire. The population was further divided into troubled and untroubled by a Child Behavior Checklist total problem T score of 60. Parents were not significantly different from reference populations on most of the scales. However, the Parental Stress Index results revealed that parents who report their children as troubled are themselves stressed, not only by their children's behaviors but in areas unrelated to their children. In addition, these mothers report often feeling depressed and guilty on the Eight State Questionnaire. This study emphasizes the need for psychological assessment of both parents and children.

Adaptation, Psychological↗
PubMedDate not supplied

Efficacy of school reentry programs.

Evaluation of school reentry programs are rarely reported, and statements of the value of reentry programs are usually based on anecdotal information. No known reports of empiric data support claims of positive benefit for burned children. This article reports a multifaceted effort to evaluate the effectiveness of one reentry program involving three approaches: (1) questionnaire answered by the school contact person after reentry program, (2) interviews with a random sample of patients (n = 58) and parents (n = 44) 1 to 5 years after burn, and (3) assessment of patients' behavior problems by teachers on a standardized behavior checklist comparing 10 patients who had a school reentry program involving videos to introduce them to their classmates with 10 patients who were matched for age, sex, and total body surface area burned and had no reentry program beyond phone contact. Results indicate that school reentry programs are popular with teachers and parents. This pilot effort involving empiric data failed to demonstrate a positive effect on the adjustment of the child.

Adaptation, Psychological↗
PubMedDate not supplied

Clinical evaluation of an acellular allograft dermal matrix in full-thickness burns.

A multicenter clinical study assessed the ability of an acellular allograft dermal matrix to function as a permanent dermal transplant in full-thickness and deep partial-thickness burns. The study consisted of a pilot phase (24 patients) to identify the optimum protocol and a study phase (43 patients) to evaluate graft performance. Each patient had both a test and a mirror-image or contiguous control site. At the test site, the dermal matrix was grafted to the excised wound base and a split-thickness autograft was simultaneously applied over it. The control site was grafted with a split-thickness autograft alone. Fourteen-day take rates of the dermal matrix were statistically equivalent to the control autografts. Histology of the dermal matrix showed fibroblast infiltration, neovascularization, and neoepithelialization without evidence of rejection. Wound assessment over time showed that thin split-thickness autografts plus allograft dermal matrix were equivalent to thicker split-thickness autografts.

Adolescent↗
PubMedDate not supplied

Competence and physical impairment of pediatric survivors of burns of more than 80% total body surface area.

Children who survive massive burn injuries are challenged by the physical sequelae of their injuries as they return to normal daily routines. The purpose of this study was to assess the impact of physical impairment on the competence of such children as they pursued their lives. It was hypothesized that children who survive burn injuries of more than 80% total body surface area would be less competent than their unburned peers, and that competence would decrease with increased physical impairment. Competence for the 19 patients was assessed by parental report using the Child Behavior Checklist and by the patient's self-report on the Youth Self-Report. Physical impairment scores were calculated from range of motion measurements of upper and lower extremities according to AMA guidelines. Competence scores for the sample were within normal ranges. Physical impairment was significantly related to competence only in the area of activity on both the Child Behavior Checklist and the Youth Self-Report.

Activities of Daily Living↗
PubMedDate not supplied

Lung compliance, airway resistance, and work of breathing in children after inhalation injury.

Pathophysiologic changes associated with inhalation injury make mechanical ventilation in children a challenge. Decreased lung compliance and increased airway resistance after inhalation injury may lead to elevated airway pressures and barotrauma. Previous studies have shown significant decreases in the incidence of pneumonia and death in adult patients with inhalation injury treated with high-frequency percussive ventilation (HFPV) as compared with conventional mechanical ventilation (CMV). No studies to date have compared lung compliance, airway resistance, or work of breathing in children being treated with HFPV versus CMV. The purpose of this study was to evaluate lung compliance, airway resistance, and work of breathing in pediatric patients with inhalation injury who required mechanical ventilation. Ten children with bronchoscopically identified inhalation injury requiring mechanical ventilation were studied. Five children received CMV and five children received HFPV. All patients were treated according to our standard inhalation injury protocol. Based on our data and patient population, children receiving ventilation with the HFPV have a significant decrease in the work of breathing as compared with CMV.

Adult↗
PubMedDate not supplied

High frequency percussive ventilation in pediatric patients with inhalation injury.

The objective of this study was to present data that showed high frequency percussive ventilation (HFPV) was superior to traditional mechanical ventilation for the treatment of children with inhalation injuries. Inhalation injuries continue to be the number one cause of death of patients with thermal injuries in the United States. Therapy for this condition has consisted of conservative pulmonary toilet and mechanical ventilation. Despite improvements in the management of burn injury, patients with inhalation injury develop pneumonia and pneumothorax, leading to adult respiratory distress syndrome. Unfortunately, inhalation injury that is complicated by pneumonia has been shown to increase mortality by 60% in these patients. Cioffi has shown that prophylactic use of HFPV in adult patients with inhalation injury has been a successful method of reducing the incidence of pneumonia and mortality. The effects of HFPV on the incidence of pneumonia, peak inspiratory pressures, and arterial partial pressure of oxygen/fraction of inspired concentration of oxygen (P/F) ratios were retrospectively studied in 13 children with inhalation injuries and compared with historic controls treated with conventional mechanical ventilation. All patients were treated with our standard inhalation injury protocol and extubated when they met standard extubation criteria. Patients ranged in age from 6 to 9 years, and most had burns covering greater than 50% of their total body surface areas. No deaths occurred in either group, but the patients who were treated with HFPV had no cases of pneumonia (P < .05), better P/F ratios (P < .05), lower peak inspiratory pressures, and less work of breathing (P < .05) as compared with our control group. On the basis of our clinical experience and data, the use of HFPV seems to be an effective treatment for the reduction of pulmonary morbidity in pediatric patients with inhalation injuries.

Case-Control Studies↗
PubMedDate not supplied

An approach to the timely treatment of acute stress disorder.

A convergent postburn psychopharmacologic treatment for children for acute stress disorder (ASD) symptoms has not been established. Both the application of what has been learned through treatment of similar symptoms experienced by adults with posttraumatic stress disorder and the examination of safe treatment options for children led to the clinical decision to use imipramine for 25 pediatric patients with acute burns. The treatment histories of these patients were retrospectively reviewed to see if further exploration into the efficacy of imipramine was warranted. Eighty percent of the children experienced remission of hyperarousal symptoms (eg, trouble staying asleep, trouble falling asleep) and intrusive reexperiencing symptoms (eg, nightmares). Twelve percent of the children experienced a decrease in the frequency or intensity of ASD symptoms. Eight percent had no relief of ASD symptoms. Initial findings suggest that imipramine assists children who have postburn ASD symptoms by decreasing the hyperarousal and intrusive reexperiencing symptoms of ASD.

Adult↗
PubMedDate not supplied

Physical and psychologic rehabilitation outcomes for pediatric patients who suffer 80% or more TBSA, 70% or more third degree burns.

Advances in medical management have dramatically decreased the mortality of children with massive burn injuries, which raises many questions about the expected quality of life for these young survivors. In this article, we address this issue by examining the functional and psychological adaptation of 41 young survivors with 88% mean total body surface area (TBSA) burns and 85% mean third degree TBSA burns. Patient scores were compared with normative data on standardized psychological measures of adjustment and on performance of age appropriate activities of daily living (ADL) skills. Thirty-three of the 41 patients (80%) were independent in basic ADL skills. Eighty-six percent of the patients who were aged 10 years and older were independent in advanced ADL skills. Patients with amputated fingers were significantly more dependent in ADL skills than those without amputations (P < .05). Mean psychosocial adjustment scores were within normal limits and were not significantly related to functional independence in ADL skills.

Activities of Daily Living↗
PubMedDate not supplied

Positive self-regard as a coping mechanism for pediatric burn survivors.

Pediatric burn survivors are reported to present optimistic pictures of themselves; it has been suggested that their reports of high self-esteem may reflects a coping mechanism. The purpose of this study was to compare burned children's self-perceptions of competence and adequacy to normative population with the use of two standardized instruments. A random sample of 32 pediatric burn survivors was administered two standardized instruments: the Piers-Harris and the Harter Self-Perception Profiles for children and adolescents. Paired t tests revealed significantly higher self-concepts by the burned children than the nonclinical reference groups on five of the six Piers-Harris clusters and on two of the nine Harter Self-Perception Profiles domains. Also, the relationship between the children's perceived self-worth in each domain, and the importance they attributed to that domain, indicate that the burned children are satisfied with themselves in those areas they perceive as important. Results from both tests suggest that the burn survivors' report of positive self-esteem may reflect a necessary defense mechanism in the adjustment process, which should be supported by the burn team.

Adaptation, Psychological↗