Biomedical subjects

Brett R Kuhn

Publications and source records attributed to Brett R Kuhn.

6 recordsLinked to original sources

PubMed2006

Pediatric prescribing practices for clonidine and other pharmacologic agents for children with sleep disturbance.

The prescription rates of clonidine have risen dramatically and the extent to which these increases can be attributed to treatment of sleep disturbance is unknown. Surveys were mailed to 800 pediatricians across four geographically diverse states to assess prescribing practices specific to sleep disturbance. Ninety-six percent of the respondents treated sleep disturbance. More than one third of the sample reported using clonidine specifically for sleep disturbance including sleep onset, sleep schedule, nighttime awakening, and early morning awakening problems and parasomnias. Clonidine ranked second only to antihistamines as the most commonly used medication for treating sleep disturbance.

Adolescent↗

PubMed2005

Comparing child outcomes of physical punishment and alternative disciplinary tactics: a meta-analysis.

This meta-analysis investigates differences between the effect sizes of physical punishment and alternative disciplinary tactics for child outcomes in 26 qualifying studies. Analyzing differences in effect sizes reduces systematic biases and emphasizes direct comparisons between the disciplinary tactics that parents have to select among. The results indicated that effect sizes significantly favored conditional spanking over 10 of 13 alternative disciplinary tactics for reducing child noncompliance or antisocial behavior. Customary physical punishment yielded effect sizes equal to alternative tactics, except for one large study favoring physical punishment. Only overly severe or predominant use of physical punishment compared unfavorably with alternative disciplinary tactics. The discussion highlights the need for better discriminations between effective and counterproductive use of disciplinary punishment in general.

Child↗

PubMed2004

The intervention selection bias: an underrecognized confound in intervention research.

Selection bias can be the most important threat to internal validity in intervention research, but is often insufficiently recognized and controlled. The bias is illustrated in research on parental interventions (punishment, homework assistance); medical interventions (hospitalization); and psychological interventions for suicide risk, sex offending, and juvenile delinquency. The intervention selection bias is most adequately controlled in randomized studies or strong quasi-experimental designs, although recent statistical innovations can enhance weaker designs. The most important points are to increase awareness of the intervention selection bias and to systematically evaluate plausible alternative explanations of data before making causal conclusions.

Child↗

PubMed2003

Treatment efficacy in behavioral pediatric sleep medicine.

Behavioral interventions have been identified as the treatment of choice for many forms of pediatric sleep disturbance. We adopt criteria established by the Task Force on Promotion and Dissemination of Psychological Procedures (1996) to evaluate the literature base describing behavioral interventions for pediatric sleep disturbance. Three well-established interventions, one promising intervention and one probably efficacious intervention, have emerged for bedtime refusal and frequent nighttime awakenings. Only one intervention for sleep terrors and sleepwalking has sufficient empirical support to be considered promising. Behavioral interventions targeting circadian rhythm disorders (e.g., delayed sleep phase), nightmares and rhythmic movement disorder (RMD) have not been researched sufficiently to be considered empirically supported.

Behavior Therapy↗

PubMedDate not supplied

Brief report: a "storybook" ending to children's bedtime problems--the use of a rewarding social story to reduce bedtime resistance and frequent night waking.

OBJECTIVE: To evaluate the efficacy and acceptability of a social story with tangible rewards to reduce children's disruptive bedtime behavior and frequent night waking. METHOD: Four children (ages 2 to 7), with clinically significant disruptive bedtime behavior, received the intervention, which consisted of a social story (The Sleep Fairy) that sets forth (a) parental expectations for appropriate bedtime behavior and (b) rewards for meeting those expectations. RESULTS: Parent sleep diaries indicated that children had a 78% average decrease in frequency of disruptive bedtime behaviors from baseline to intervention, with another 7% decrease at 3-month follow-up. Night wakings, a problem for 2 children during baseline, were not a problem during intervention and follow-up. Parents reported improved daytime behavior for 3 of the 4 children. Parents gave the intervention high acceptability ratings and maintained a high level of treatment fidelity. CONCLUSIONS: Use of a social story helped parents implement a multicomponent intervention using a familiar bedtime routine, thereby increasing the likelihood that implementation and effects occurred. The book format makes this intervention widely available to parents and professionals, with minimal costs and inconvenience.

Attention Deficit and Disruptive Behavior Disorder↗

PubMedDate not supplied

Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: results of a feasibility intervention study.

PURPOSE/OBJECTIVES: To evaluate outcomes of an intervention designed to promote sleep and modify fatigue after adjuvant breast cancer chemotherapy. DESIGN: Prospective, repeated measures, quasi-experimental, feasibility study. SETTING: Midwestern urban oncology clinics. SAMPLE: 21 female participants, ages 43-66 years (meanX = 55.3) with stage I or II breast cancer status post four cycles of doxorubicin chemotherapy. Eight had four additional cycles of paclitaxel, 10 also had radiation, and 18 took tamoxifen. METHODS: each woman continued to revise her Individualized Sleep Promotion Plan (ISPP), developed during her first cycle of chemotherapy, that included sleep hygiene, relaxation therapy, stimulus control, and sleep restriction components. The daily diary, Pittsburgh Sleep Quality Index, wrist actigraph, and Piper Fatigue Scale were used for seven days 30, 60, and 90 days after the last chemotherapy treatment and one year after the first chemotherapy treatment. MAIN RESEARCH VARIABLES: Adherence and sleep and wake, fatigue, and ISPP components. FINDINGS: Adherence to the ISPP components remained high at all times (77%-88%) except for stimulus control (36%-56%). Sleep outcome means and the actigraph revealed that (a) sleep latency remained less than 30 minutes per night, (b) the time awake after sleep onset exceeded the desired less than 30 minutes per night, (c) sleep efficiency scores ranged from 82%-92%, (d) total rest time ranged from seven to eight hours per night, (e) feelings on arising ranged from 3.7-3.8 (on a 0-5 scale), (f) nighttime awakenings ranged from 10-11 per night, and (g) daytime naps ranged from 10-15 minutes in length. Fatigue remained low, from 2.9-3.5 on a 0-10 scale. CONCLUSIONS: Adherence rates remained high for most components. Sleep and wake patterns were within normal limits except for the number and duration of night awakenings. Fatigue remained low. IMPLICATIONS FOR NURSING: Future testing using an experimental design will focus on increasing ISPP adherence and decreasing nighttime awakenings. Adopting behavioral techniques to promote sleep may result in improved sleep and lower fatigue after chemotherapy.

Adult↗