Hoffman finds pediatrics both intense and rewarding. Interview by Jan Thornburg.
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Child↗
Biomedical subjects
J Hoffman
Publications and source records attributed to J Hoffman.
Rhythmic patterning in mother-newborn interaction.
Face-to-face, dyadic interaction in term and preterm mother-newborn pairs was examined for a rhythmic pattern at 40 weeks gestational age. Three-minute interaction episodes for each mother-infant pair were recorded on videotape and scored with a dyadic code graded along a dimension of disengagement-engagement. Spectral analysis was used to analyze the data for rhythmicity. A reliable rhythmic structure was found in all dyadic interactions. No significant difference was evident between term and preterm dyads. The findings provide quantitative evidence of rhythmic patterning in dyadic interaction from birth for term pairs and as early as 40 weeks gestation for preterm pairs, which is much earlier than previously reported in the literature. The Dyadic Interaction Code, a new tool for studying the interaction process over time, is described, and a recently reported method of analysis (spectral analysis) for interaction data is applied to mother-newborn behavioral data.
Adolescent↗
Interrupted root development--a new form of dentin dysplasia.
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Child↗
The instaform mold: a rapid method of fabricating a scoliosis brace.
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Braces↗
Comparison of the clinical efficacy of three perivascular techniques for axillary brachial plexus block.
BACKGROUND AND OBJECTIVES: This study compared the efficacy of three perivascular techniques of axillary block. METHODS: In group 1, all of the local anesthetic was injected after advancing the needle through the axillary artery (back of artery, n = 20); in group 2, after withdrawing slightly from the artery (front of artery, n = 20); and in group 3, half of the anesthetic was injected after advancing through and half after withdrawing from the axillary artery (half and half, n = 20). The local anesthetic used for the axillary block was 50 ml of 1.5% mepivacaine with epinephrine 1:200,000. RESULTS: The groups did not differ significantly in the incidence of analgesia or anesthesia expected in the median nerve distribution, where there was a significantly lower incidence of anesthesia in the back of the artery group. This group also had a slower onset of anesthesia for the median and the medial antebrachial cutaneous nerves. CONCLUSIONS: There was no significant difference in the number of patients requiring supplementation, with five patients in the back group (25%), three patients in the front group (15%), and one patient in the half and half group (5%) requiring supplementation for the surgical procedure.
Adult↗
Educational implications of nurses' brain dominance, learning styles, and attitudes toward computerization.
Nurses have been described as exhibiting computer anxiety as hospitals become automated. Suggestions have been made to provide inservice education to decrease computer anxiety before systems installation. This study examined nurses' brain dominance profiles, learning styles, and attitudes toward computers. Results indicated that 95 staff nurses had 14 different learning styles and were willing to use computers to document nursing care. As hospital inservice education programs are developed, a variety of teaching-learning methods needs to be developed to facilitate learning this new technology.
Adult↗
Dose escalation in chemoradiation for anal cancer: preliminary results of RTOG 92-08.
PURPOSE: Radiation Therapy Oncology Group experience with chemoradiation for anal cancer has shown a local failure rate of 20% to 30% with radiotherapy doses of 45 to 50 cGy. This study was undertaken to assess the effect of higher radiotherapy doses on toxicity, local control, and survival in this disease. MATERIALS AND METHODS: Forty-seven patients with anal cancers measuring > or = 2 cm were treated with a concurrent combination of two cycles of 5-fluorouracil infusion (1000 mg/m2 over 24 hrs for 4 days) and mitomycin C (10 mg/m2 bolus) plus 59.6 Gy of pelvic and perineal radiotherapy administered over 8.5 weeks, including a 2-week rest period. Patients were followed for toxicity, disease status, and colostomy-free survival. Twenty-three (49%) patients had advanced (T3-4) primary tumors; 42 (92%) patients had NO disease, and 36 (77%) patients had squamous histology. For perspective, a comparative analysis was made with 147 patients treated on the previous RTOG protocol for anal cancers (RTOG 87-04) with identical chemotherapy but radiotherapy doses of 40 to 50.4 Gy. RESULTS: Transient hematologic and skin toxicity predominated during treatment or in early follow-up. One patient developed septicemia and died of multiple gastrointestinal toxicities. Twelve (26%) patients had greater than grade 3 complications and, of these, 9 (20%) had hematologic side effects alone. A comparative analysis with 147 patients treated on RTOG protocol 87-04 showed no significant differences in pretreatment characteristics of disease extent, performance status, or histology. A mandatory 2-week split in the current chemoradiation protocol contrasted with 12% of patients having a 2-week or greater treatment break in RTOG 87-04. Patients treated on the current protocol (RTOG 92-08) had a markedly lower incidence of > or = grade 3 dermal toxicity (34% vs. 55%) but a higher colostomy rate at 1 year (23% vs. 6%) and at 2 years (30% vs. 7%) compared with RTOG 87-04. CONCLUSIONS: Numerical increases in radiotherapy dose over those used in conventional chemotherapy regimens for anal cancers do not appear to increase local control when given in split-course fashion. For higher radiotherapy doses (> 50 Gy) to increase local control, radiation may have to be given in continuous fashion, which almost certainly means that our threshold of acceptable acute toxicity, particularly dermal toxicity, may have to be raised.
Adult↗
Incidence of genitofemoral nerve block during lumbar sympathetic block: comparison of two lumbar injection sites.
BACKGROUND AND OBJECTIVES: Genitofemoral nerve (GFN) block is a known side effect of a lumbar sympathetic block (LSB), although the incidence has not been well documented. Furthermore, genitofemoral neuralgia can occur following neurolytic LSB. Because the level at which the GFN exits the psoas sheath varies, this study was designed to identify differences in the incidence of GFN block following LSB at the level of the second versus the fourth lumbar vertebrae. METHODS: Patients requiring LSB to evaluate chronic lower extremity pain were prospectively studied. Patients were injected at the second lumbar (L2 group) or fourth lumbar (L4 group) vertebral body depending on the location of the pain syndrome in the lower extremity. Lumbar sympathetic blocks were performed using 10 mL of a 0.5% bupivacaine solution with radiocontrast; spread of injectate was verified using fluoroscopy. An observer evaluating for presence of GFN block was blinded to the lumbar level of injection. RESULTS: Thirty patients were enrolled (L2 group, n = 15; L4 group, n = 15). Spread of local anesthetic/radiocontrast solution was limited to approximately one vertebral body above and one below the target level. There was no difference in the ability to achieve a LSB; success rates were 66% and 73% using L2 and L4, respectively. The incidence of GFN block was 0% (0/15) in the L2 group versus 40% (6/15) in the L4 group; this was statistically significant (P = .017, Fisher's exact test). CONCLUSIONS: The GFN is less likely to be blocked when the LSB is performed near the second lumbar vertebra as compared with the fourth lumbar vertebra.
Adult↗