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Biomedical subjects

B L Marino

Publications and source records attributed to B L Marino.

18 recordsLinked to original sources
PubMed1997

Sensitivity of patient report of care to organizational change.

Patient report of care is a popular outcome measure believed to be sensitive to nursing care and institutional changes that effect the delivery of nursing care. However, data collected over a 5-year period of organizational change in a pediatric teaching hospital showed no change in parent report of care. The authors discuss possible reasons for the absence of change and caution readers that patient report of care should not be the sole measure of the effect of restructuring on patients.

Adolescent↗
PubMed1995

Oxygen saturations during breast and bottle feedings in infants with congenital heart disease.

Bottle feeding is commonly advised for infants with congenital heart disease (CHD) based on the belief that breast feeding is too difficult for them. However, studies of preterm infants have shown that greater cardiorespiratory effort occurs during bottle feeding than during breast feeding. The purpose of this study is to determine if there is a relationship between feeding method (breast vs. bottle) and oxygen saturations (SaO2) in infants with CHD. In a correlational design, pulse oximetry measured SaO2 during one breast and one bottle feeding in each of 7 infants with CHD. SaO2 during breast feeding is significantly different from SaO2 during bottle feeding (F = 59.72, p < .0001). SaO2 during breast feeding is higher on average and less variable (M = 96.3%, SD = 2.2) than SaO2 during bottle feedings (M = 92.5%, SD = 6.9), indicating that there is less cardiorespiratory stress with breast feeding. None of the infants desaturated (SaO2 < 90%) during breast feedings, whereas four infants desaturated during bottle feedings.

Bottle Feeding↗
PubMed1991

Studying infant and toddler play.

The play of infants and toddlers is a rich and flexible research modality. Play assessment can be an outcome measure of cognition or social ability, or it can be measured in conjunction with related constructs such as language to give a broad view of early development. Play can also be an effective intervention in studies of cognition, language, motor, or social development. This article offers strategies for the researcher who is interested in infant and toddler play. Emphasis is placed on environmental variables that the researcher manipulates to optimize the child's performance. Play measures are briefly addressed.

Child, Preschool↗
PubMed1987

Management of gastroschisis.

Twenty consecutive cases of gastroschisis are presented. One patient died before surgery and 19 were managed with no surgical mortality. Both delayed closure with Silastic material and primary closure were used. The relationship of increased intra-abdominal pressure to the ease of abdominal wall closure is discussed and related to the prolonged gut dysfunction noted in this condition. The technique for both primary closure and silastic staging is presented. The technique selected for each case should be based on intragastric pressure measurements. Results suggest that either technique can be used with low mortality and that some of the morbidity and mortality reported for silastic closure is related to adaptation of a technique developed for closure of omphalocele to gastroschisis closure, without making allowances for the different pathophysiology of the two entities. Abdominal wall cellulitis seen following primary closure is discussed. The series studied suggests that the cellulitis is traumatic in origin and related to manual stretching of the abdominal wall.

Abdominal Muscles↗
PubMed1980

When nurses compete with parents.

Subtle competition flourishes between parents and nurses in neonatal intensive care settings. Because the parents have so little opportunity to contribute to the care of their infants, and because they come to the experience with a broad range of emotional preparation, they often feel displaced by the competent and occassionally overprotective staff nurses. The nurses may not recognize the subtle forms of competition but they do cope with outcomes: hostile or uncooperative parents. This article describes competitive situations, discusses the impact upon the family, and recommends alternatives to competitive nursing care.

Adult↗
PubMed1978

Usefulness of continuous positive airway pressure in differential diagnosis of cardiac from pulmonary cyanosis in newborn infants.

Differential diagnosis of cyanosis in the neonate is difficult and cardiac catheterisation may be required for a correct diagnosis. It has been suggested that the response of PaO2 to continuous positive airway pressure (CPAP) with 100% oxygen may be useful. The purpose of this study was to test further this hypothesis by studying all neonates investigated for cyanosis with a PaO2 less than or equal to 50 torr in 0-8 to 1-0 F1O2. Arterial blood samples were obtained in an F1O2 of 0-21-0-4 and 0-8-1-0, and in an F1O2 of 0-8-1-0 with 8-10 cm CPAP, and were analysed for PaO2, PaCO2, and pH, bicarbonate being calculated. The final diagnoses were congenital heart disease (CHD) 21 cases, pulmonary parenchymal disease (PD) 10 cases, and persistent fetal circulation (PFC) 3 cases. No significant difference in pH, bicarbonate, or PaCO2 was observed among the three groups or with CPAP. In the CHD and PFC infants CPAP produced no significant change in PaO2. In the PD babies PaO2 increased by an average of 33 torr (P less than 0-05). Despite thus attaining statistical significance 2 PD infants had no increase in PaO2 with CPAP. An increase of PaO2 greater than 10 torr with CPAP suggests PD, and a nonsignificant increase in PaO2 does not rule out PD. Irrespective of initial PaO2, final PaO2 in 0-8-1-0 F1O2 with CPAP greater than 50 torr suggests PD, and less than 50 torr suggests CHD. The results indicate that CPAP may be used as an adjunct in differentiating cardiac from pulmonary disease.

Cyanosis↗
PubMedDate not supplied

Prevalence of errors in a pediatric hospital medication system: implications for error proofing.

The purpose of this study was to determine the prevalence of errors in the medication system of a pediatric teaching hospital. Error was defined broadly to capture all deviations in the process from medication order through administration of the dose. The long-term goal was to provide direction to efforts to error-proof the system. The sample was 3,312 medication orders written during 669 patient-days for which a total of 11,978 doses were passed. Errors were categorized as intercepted errors (intercepted through the normal processes of the medication system) or administration errors (errors that involve the patient with or without adverse sequelae). Errors were also categorized as errors in primary activities (e.g., prescribing or preparing the medication for administration) or supporting activity (e.g., transferring the order to another record). A total of 784 errors were identified; 98% were intercepted and 2% were administration errors. More errors (71%) occurred in supporting activities than in primary activities. Medication systems are complex processes. Errors are imbedded in the medication system and are typically intercepted before patients are involved. Intercepting errors involves additional work that adds to an already cumbersome process. Error proofing will be different for errors in primary activities and for supporting activities.

Child↗
PubMedDate not supplied

Parents' report of children's hospital care: what it means for your practice.

PURPOSE: To determine the aspects of nursing practice that are predictive of parent satisfaction with their child's hospitalization. METHOD: A sample of 3,299 families whose children were hospitalized in a tertiary pediatric teaching hospital between 1995 and 1998 were surveyed. The survey covered their experiences during the child's hospitalization and their overall satisfaction with care. FINDINGS: Survey questions that were most strongly associated with overall satisfaction were questions about caring practices that are collaborations between nurses and parents. Satisfied parents reported nursing care that was tailored to their needs and preferences. CONCLUSIONS: These findings are consistent with Curley's model for nursing practice, which predicts better patient outcomes when nursing care is synergistic with patient characteristics.

Adolescent↗
PubMedDate not supplied

Temperament in infants and toddlers with cardiac disease.

Parental report of temperament in a group of 97 infants and toddlers with cardiac disease revealed differences from healthy children on several temperament dimensions. Increasing disease severity did not correspond with increasingly extreme temperament scores.

Attitude to Health↗
PubMedDate not supplied

Chloral hydrate side effects in young children: causes and management.

OBJECTIVE: To determine the factors related to undesired effects of chloral hydrate in young children undergoing echocardiogram. Undesired effects studied were reaction to chloral hydrate before to sedation (ataxia, excitement), delayed sedation, light sleep during sedation, and behavioral changes after sedation. DESIGN: Descriptive, correlational design. SETTING: Echocardiography laboratory in a pediatric teaching hospital. SUBJECTS: 140 children aged 0 to 36 months who were undergoing diagnostic echocardiography. Severity of cardiac disease ranged from benign murmur to uncorrectable lesion. Thirty children (21%) had cyanotic cardiac disease. Children were sedated with chloral hydrate per routine (mean dose 87 mg/kg) and observed from time of sedation throughout the examination. Data were collected on child's age, food ingested before sedation, transcutaneous oxygen saturation, and daytime nap schedule. OUTCOME MEASURES: Incidence of paradoxical excitement before sedation, length of time until child reached deep sedation, depth of sleep during the examination, and behavioral changes after sedation. RESULTS: Paradoxical excitement before sedation occurred in 25 children (18%). Length of time until child reached deep sedation averaged 25 minutes. Three children never fell asleep. Proximity of sedation to naptime was positively correlated to the speed of sedation. Deep sedation was achieved in 131 children (94%). Depth of sleep during the examination was related to child's age, proximity of sedation to nap time, and recent food ingestions. Older children, who were due for a nap and who had refrained from eating before the examination were most likely to remain soundly asleep throughout the examination. Children with cyanotic defects were not adversely affected by deep sedation with chloral hydrate. Most children experienced motor and affective changes after sedation. CONCLUSIONS: In this sample, chloral hydrate was an effective and safe sedative. Implications for nursing include changes in scheduling practices, limiting food ingestion before sedation, and information to provide parents about chloral hydrate sedation.

Akathisia, Drug-Induced↗
PubMedDate not supplied

A comparison of growth patterns in breast and bottle-fed infants with congenital heart disease.

PURPOSE: To describe the feeding and growth patterns of breast and bottle-fed infants with congenital heart disease. METHODOLOGY: A descriptive correlational design was used to examine relationships between incidence of breast feeding, severity of disease, and patterns of weight gain for 45 mother-infants dyads. FINDINGS: Using chi square analysis, length of hospital stay was found to be significantly related to the decision to switch from breast to bottle feeding. Bottle-fed infants fell significantly off their individual growth curves than did breast-fed infants. CONCLUSIONS: Severity of cardiac defect was not a predictor of the infant's ability to breast feed nor of the duration of breast feeding after discharge. Maternal variables may account for initial failure of breast feeding.

Bottle Feeding↗