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Biomedical subjects

K L Arheart

Publications and source records attributed to K L Arheart.

10 recordsLinked to original sources
PubMed1992

The effect of cesarean section on intraventricular hemorrhage in the preterm infant.

OBJECTIVE: The null hypothesis is that active labor is a more important factor with regard to both timing and progression of periventricular-intraventricular hemorrhage than is route of delivery. Infants delivered by cesarean section after entering the active phase of labor will behave in a manner similar to that of previously studied infants delivered vaginally as to when periventricular-intraventricular hemorrhage occurs and frequency of progression. STUDY DESIGN: The 106 infants of 85 women delivered by cesarean section were the subjects of this study. Forty-six infants were in the no-labor group, 33 in the latent-phase labor group, and 27 in the active-phase labor group. Head ultrasonographic examinations were performed at delivery, at 1, 6, 12, and 24 hours, and then daily for the first 7 days of life. Continuous variables were compared by one-way analysis of variance among those infants with no hemorrhage or with periventricular-intraventricular hemorrhage. Categoric variables were compared by chi 2 analysis and Fisher's exact test when appropriate. A p value of less than 0.05 was considered significant. RESULTS: There was no difference in the frequency of early hemorrhage (less than or equal to 1 hour of age), late hemorrhage (greater than 1 hour of age), or overall periventricular-intraventricular hemorrhage in the infants not in labor, in latent-phase labor, or in active-phase labor at the time of cesarean section. However, the frequency of grade 3 or 4 hemorrhage and the progression of hemorrhage were significantly higher in the infants whose mothers had an active phase of labor compared with infants whose mothers had no labor or did not progress beyond the latent phase. Infants who had early periventricular-intraventricular hemorrhage (less than or equal to 1 hour of age) also had a higher frequency of progression of hemorrhage. CONCLUSIONS: Cesarean section before the active phase of labor does not change the overall frequency of hemorrhage but results in a lower frequency of progression to grade 3 or 4 hemorrhage. We do not feel that these data support performing more cesarean sections for preterm delivery as a method of preventing progression of periventricular-intraventricular hemorrhage in the preterm infant.

Birth Weight↗
PubMed1992

Face validity.

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Clinical Nursing Research↗
PubMed1992

Early and late intraventricular hemorrhage: the role of obstetric factors.

OBJECTIVE: To evaluate the influence of active phase labor and other obstetric factors on the development of periventricular-intraventricular hemorrhage in the neonate. METHODS: A total of 230 infants were studied. Antenatal enrollment was carried out when estimated fetal weight was 1750 g or less. Serial head ultrasound scans were performed to screen for periventricular-intraventricular hemorrhage, with the initial scan performed within minutes of birth. Scan findings and obstetric and neonatal variables collected prospectively at scheduled intervals were analyzed to determine the significant factors that predispose to intraventricular hemorrhage. RESULTS: In 47 infants (20%), intraventricular hemorrhage was detected within 1 hour of birth (early) and in another 49 (21%) at a later age (late). The overall incidence of hemorrhage was similar between vaginal and cesarean deliveries (41 and 44%, respectively). Early hemorrhage was more frequent in vaginal (28%) than cesarean deliveries (11%), whereas late hemorrhage was more frequent in cesarean deliveries. When the role of delivery mode and labor was analyzed by stepwise logistic regression, the odds ratios for development of early intraventricular hemorrhage increased in the following order: cesarean delivery with no labor, cesarean delivery with latent phase labor, vaginal delivery with forceps use, cesarean delivery with active phase labor, and vaginal delivery without forceps use. For late hemorrhage, the odds ratios increased in the following order: vaginal delivery with forceps, vaginal delivery without forceps, cesarean delivery with no labor, cesarean delivery with latent phase labor, and cesarean delivery with active phase labor. CONCLUSIONS: Active phase labor may predispose to early periventricular-intraventricular hemorrhage, but its influence may be attenuated by use of forceps or by abdominal delivery. The protective effect of forceps remains for late periventricular-intraventricular hemorrhage, but abdominal delivery does not seem to protect against late hemorrhage.

Cerebral Hemorrhage↗
PubMed1991

Similarities and differences on five inventories among mood and anxiety disorder patients.

The Eysenck Personality Questionnaire (EPQ), BAROMAS, Leisure Interests Checklist (LIC), Mental Health Inventory (MHI) and a one-page checklist of Body Problems were given to 128 outpatients with serious mood or anxiety disorders. Compared to normative data published on the first four devices, the combined patients were far 'sicker' in nearly all comparisons (P less than or equal to 0.01). However, anxiety and mood patients did not differ on the EPQ, BAROMAS, or LIC. On Body Problems, strong contrasts emerged (P less than 0.04), especially when 'fringe' cases were excluded (e.g. dysthymics from mood, and obsessives from anxiety disorder diagnoses). Small anxiety subtype groups also differed (P less than 0.05). On the MHI, both global and core groups of mood--especially unipolar (depressed)--patients differed from the anxiety disorders (P less than 0.04).

Adult↗
PubMed1991

Application of the Millon Adolescent Personality Inventory in evaluating orthodontic compliance.

Lack of adolescent patient compliance is a significant problem in orthodontics. The purpose of this study was to examine the feasibility of using a commercially available adolescent personality test to predict the behavior of adolescent patients in an orthodontic practice. Specifically, this study tested (1) the use of the Millon Adolescent Personality Inventory (MAPI) as an appropriate instrument for an adolescent orthodontic population and (2) the correlation between MAPI test results and orthodontic compliance. The MAPI was administered to 104 13- to 18-year-old orthodontic patients who were blindly evaluated for orthodontic compliance after 2 years of treatment. Twenty modified MAPI scales with high internal consistencies (coefficient alpha = 0.66 to 0.87) were developed. Factor analytic results demonstrated that the modified scales had a dimensionality that was similar to that of the original test. Seven of 20 test scales and gender were found to be significantly correlated with orthodontic compliance. These eight variables contribute to a predictive model that accounts for 24% of the variance in assessing orthodontic compliance. We conclude that the MAPI has potential as a useful instrument in assisting the management of adolescent patient behavior in an orthodontic practice.

Adolescent↗
PubMed1991

A placebo-controlled trial of nadolol in the treatment of neuroleptic-induced akathisia.

BACKGROUND: Although propranolol has been documented to be useful in treatment of neuroleptic-induced akathisia, preliminary anecdotal reports on the efficacy of nadolol in treatment of this condition are contradictory. METHOD: To evaluate the efficacy of nadolol in treatment of this condition, a double-blind, placebo-controlled trial was conducted in 20 psychiatric inpatients. Patients with akathisia of at least moderate severity were randomly assigned to receive nadolol 40 to 80 mg/day or placebo. Patients were rated daily for 4 days, then every other day for 15 days by means of the Extrapyramidal Symptom Rating Scale. RESULTS: No significant differences were found between or within groups in subjective restlessness scores. In objective akathisia scores, there were no significant differences between groups; however, beginning at Day 9, both groups showed significant improvement compared with Day 1. There was no difference between groups in number of responders. CONCLUSIONS: The authors' data do not support the efficacy of nadolol in the treatment of neuroleptic-induced akathisia and do not provide support for a peripheral site of action for beta-blockers in treatment of this condition.

Adolescent↗
PubMed1990

Frequent handling in the neonatal intensive care unit and intraventricular hemorrhage.

The association between periventricular-intraventricular hemorrhage (PV-IVH) and frequent handling resulting from various neonatal intensive care procedures and routine interventions was evaluated in a prospective clinical study. Inborn premature babies with birth weight less than or equal to 1500 gm (n = 156) who did not have PV-IVH or who had grade 1 PV-IVH at less than or equal to 1 hour were randomly assigned to the reduced manipulation protocol (n = 62) or to standard care (n = 94). A bedside microcomputer-based data acquisition system was used to monitor the duration of rest or the number of interventions per day. Infants assigned to receive reduced manipulation spent a significantly higher percentage of time each day at rest than did those who received standard manipulation (p less than 0.006). However, the incidence of grades 2 to 4 PV-IVH did not differ significantly (30% in the study vs 37% in the standard manipulation group). When we analyzed the effect of manipulation in relation to risk of PV-IVH, while taking into account other perinatal variables, standard manipulation was not associated with increased risk of grades 2 to 4 PV-IVH. However, low birth weight, maternal smoking, general anesthesia, early grade 1 PV-IVH, low hematocrit, lowest arterial oxygen pressure within the first 6 hours of life, and large base deficit at 6 hours of age all increased the relative risk of grades 2 to 4 PV-IVH.

Cerebral Hemorrhage↗
PubMed1990

Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage.

Bedside microcomputer-derived, minute-to-minute mean arterial pressure (MAP) values during the first 48 hours of life were studied in 100 preterm babies with birth weight less than or equal to 1500 gm. In those babies (n = 72) with no periventricular-intraventricular hemorrhage (PV-IVH) or with grade 1 PV-IVH, the MAP values increased during the study period, with minute-to-minute variation and interval undulation. The MAP values in those with birth weight greater than 1000 gm were higher than in those of lower birth weight. Infants in whom grades 2 to 4 PV-IVH developed (n = 28) had consistently lower MAP values during the study period. Minute-to-minute variability, expressed as the average of the coefficients of variation at 15-minute intervals, did not differ between birth weight groups, nor did they differ between the PV-IVH group and their matched control subjects. However, those with PV-IVH spent a greater percentage of time, with a coefficient of variation greater than or equal to 13% or less than 3%, than their matched control subjects spent (p less than 0.005). This study provides reference data for MAP changes in premature babies. The observed MAP changes in those with PV-IVH lend support to a significant role for MAP alterations in the pathogenesis of PV-IVH.

Blood Pressure↗
PubMed1990

Development and testing of the Stressor Scale for Pediatric Oncology Nurses.

Pediatric oncology nursing has been identified as a stressful specialty, but the exact sources of the stress have not been comprehensively specified nor put into measurable form. Effective interventions can best be developed when the stressors are known and measured. The purpose of this study was to develop and test an instrument that could accurately and sensitively measure the job-related stressors for pediatric oncology nurses. A 61-item, visual analogue instrument, the Stressor Scale for Pediatric Oncology Nurses (SSPON), was inductively developed from interviews with 30 pediatric oncology nurses. Subsequently, the SSPON was tested in three geographically separated samples of pediatric oncology nurses (n = 78). After an item analysis, 11 items were deleted from the scale. Reliability of the SSPON was estimated using both stability and internal consistency methods. The test-retest correlation coefficient was 0.88, and the total scale alpha coefficient was 0.94. Content validity was estimated using a two-stage process of developmental and judgment quantification with a panel of three specialty nurses. Construct validity was estimated through testing of theoretically derived hypotheses and a cluster analysis. Findings indicated the SSPON is content valid. Six meaningful clusters that represented sources of job-related stress were identified and defined. The revised SSPON appears to have adequate psychometric properties for a new instrument.

Evaluation Studies as Topic↗