PubMed Health⌕ Search

Biomedical subjects

D R DeMaso

Publications and source records attributed to D R DeMaso.

At least 19 recordsLinked to original sources
PubMed2001

Illness-related concerns of mothers of children with congenital heart disease.

OBJECTIVE: This study examined concerns expressed by mothers of children with congenital heart disease (CHD). The relationships among mothers' concerns, medical severity, and mother's emotional state were examined at two points in time. METHOD: Thirty-eight mothers of children with CHD aged 3 to 16 completed semistructured interviews and rating scales during hospitalization and 2 to 4 weeks after discharge. Mothers rated their distress about illness-related concerns, as well as their own depressed mood and anxiety. Mothers and two cardiologists rated the medical severity of each child's disease. RESULTS: Mothers' concerns were reliably grouped into five categories: medical prognosis, quality of life, psychosocial functioning, effects on family, and financial issues. During hospitalization, mothers were most concerned about medical prognosis. Distress about most concerns decreased postdischarge, as did mother's anxiety and depressed mood. Mothers' perceptions of medical severity were associated with distress about psychosocial issues postdischarge. Mother's anxiety was not associated with number of concerns reported, or with distress about those concerns. Maternal depressed mood was associated with fewer illness-related concerns, but greater distress about those concerns. CONCLUSIONS: Illness-related concerns can be meaningfully categorized and are not necessarily a function of disease severity or mother's emotional state. An awareness of common concerns will improve clinical care by enabling practitioners to anticipate and address concerns in a proactive way. The results may inform the development of supportive mental health interventions for families of children with CHD.

Adaptation, Psychological↗
PubMed2001

The prenatal visit.

In their role as advocates for children and families, pediatricians are in an excellent position to support and guide parents during the prenatal period. Prenatal visits allow the pediatrician to gather basic information from parents, provide information and advice to them, and identify high-risk situations in which parents may need to be referred to appropriate resources for help. In addition, prenatal visits are the first step in establishing a relationship between the pediatrician and parents and help parents develop parenting skills. The prenatal visit may take several possible forms depending on the experience and preferences of the parents, competence and availability of the pediatrician, and provisions of the health care plan.

Adult↗
PubMed2001

Zora: a pilot virtual community in the pediatric dialysis unit.

We describe a five-month pilot project conducted in the dialysis unit at Boston's Children's Hospital. Pediatric patients with renal disease used the Zora therapeutic community program while undergoing hemodialysis. Zora is a 3D multi-user computer environment designed at the MIT Media Laboratory to help young people explore issues of identity, while engaging in a virtual community. Users build "virtual rooms" and populate them with objects and characters, program them with storytelling behaviors, and converse with other young people in real-time through a virtual character representing themselves. It was specifically designed to help young people explore issues of identity, while engaging in a participatory virtual community. This paper presents the experience and evaluates the feasibility and safety of using Zora in a hospital setting. It describes how Zora facilitated explorations of identity and mutual patient support and interaction. Finally it also presents design recommendations for future interventions of this kind. More generally, this paper explores the potential of technology specifically designed with therapeutic purposes to help patients cope with their illness.

Attitude of Health Personnel↗
PubMed2000

Postoperative recovery in children after minimum versus full-length sternotomy.

BACKGROUND: Minimal access incisions for pediatric cardiac surgery have been reported to hasten postoperative recovery. This prospective study compared recovery after a minimum versus full-length sternotomy for repair of atrial septal defects in children. METHODS: We studied 35 children undergoing atrial septal defect repair using a full-length sternotomy (n = 18) or ministernotomy (n = 17) according to the surgeon's preference. All children were managed according to an established clinical practice guideline. Intraoperative comparisons included patient demographics, bypass and cross-clamp times, and, as a measure of stress response, epinephrine, norepinephrine, and lactate levels at six time intervals throughout the surgical procedure. Postoperative comparisons included pain scores at 6, 12, and 24 hours, frequency of emesis, analgesic requirements, respiratory rate and gas exchange, and length of intensive care unit and total hospital stay. Nurse and parent assessment scores of overall recovery were constructed using visual analog and Likert scales. RESULTS: No significant differences between mini- versus full-length sternotomy were detected for the measured outcome variables. No adverse outcomes were detected. CONCLUSIONS: In this prospective study, a ministernotomy did not enhance postoperative recovery, and the primary advantage appears to be an improved cosmetic result.

Adolescent↗
PubMed2000

Implementation of an electronic medical record system in a pediatric psychopharmacology program.

The design, implementation, and utilization of an electronic medical record system (EMRS) in a pediatric psychopharmacology clinic is described. The EMRS is a relational database with information entered directly by the clinician during a patient visit. It has been used during more than 2590 patient visits with 805 patients. Complete clinical documentation and simultaneous data entry as well as computer generated prescriptions for the patient were accomplished 75% of the time within a 20-min medication management session. One hundred consecutive parents of patients were asked to fill out a five-question survey to begin to assess the impact of the application. Of the 87 parents who responded, all (100%) noted that the doctor paid attention to their concerns. Between 88 and 90% of the parents reported that the use of the computer is a 'good' thing, made it easier to work with the doctor, and that they understood why the computer was being used. The findings support that the development and implementation of an EMRS with direct clinician information entry within pediatric psychopharmacology clinic, is feasible.

Attitude to Computers↗
PubMed2000

The experience journal: a computer-based intervention for families facing congenital heart disease.

OBJECTIVE: To test the feasibility and safety of a computer-based application designed to facilitate the healthy coping of children and their families who must contend with significant congenital heart disease (CHD). The application, called the Experience Journal (EJ), is a psychoeducational intervention based on a narrative model involving the sharing of personal stories about an illness. METHOD: Testing was conducted in 2 phases. In phase 1, 9 parents of children with CHD and 1 adult with CHD were asked to use the EJ. After utilization, semistructured interviews assessed EJ usability and safety. In phase 2, 40 mothers of children with CHD used the EJ during a hospitalization. Assessment of feasibility and safety was measured through the use of semistructured interviews prior to EJ utilization and 2 to 4 weeks after hospital discharge. RESULTS: Results revealed that the EJ was safe and useful for decreasing social isolation, increasing understanding of familial feelings about cardiac illness, and fostering positive reactions in mothers. CONCLUSIONS: Computer-based interventions that present psychoeducational and medical information closely connected to "one's own story" may open up new possibilities for families facing pediatric illnesses.

Adaptation, Psychological↗
PubMed1998

Experience journals: using computers to share personal stories about illness and medical intervention.

Medical advances make it increasingly possible for children with previously fatal illness to live and thrive. However, a significant number still experience repeated operations, hospitalization, and invasive procedures, or need special care at home. Many do so with little or no intervention to help them and their families cope with the emotional stresses involved. One significant source of emotional and cognitive support is the community of patients and families who have experienced similar medical procedures. However, in spite of a general willingness to share experiences, communication among patients and families is usually limited. To facilitate this process, we are investigating the use of computer technology to record, organize, and display stories about the experiences of families with children who have been treated for cardiac and neurological illness at Children's Hospital, Boston. We are asking children and their families to record text and multimedia vignettes describing some aspect of their illness, coping strategies, or care that might be useful to others. These contributions will be available for browsing at a secure World-Wide-Web site. However, economic realities preclude reliance on a professional site administrator to organize and monitor what we hope to be a rapidly growing Web site with a large, distributed authorship. The need to make the Web site fully accessible to users who have varying familiarity with computers and Web browsing imposes further constraints. We are therefore developing software to automate the process of managing and organizing an easily accessed Web site that contains an "Experience Journal." We describe this software, the rationale for its development, and our plans for its use in the coming year.

Adolescent↗
PubMed1997

Sertraline treatment of transition-associated anxiety and agitation in children with autistic disorder.

The intolerance of children with autistic disorder to changes in their routine or environment is well known, typically presenting with acute symptoms of anxiety, panic, irritability, or agitation. In a clinical sample of children (6-12 years old) with autistic disorder and transition-induced behavioral deterioration, 8 of 9 patients showed a clinically significant improvement in response to sertraline treatment. Only one child was taking concurrent psychotropic medication. Therapeutic doses were surprisingly low in all cases (25-50 mg daily), with a clinical response appearing generally in 2-8 weeks. Adverse effects were minimal (one child developed stomachaches), except for apparent sertraline-induced behavioral worsening in 2 children when their doses were raised to 75 mg daily. In 3 children, an initial satisfactory clinical response appeared to diminish after 3-7 months of treatment, despite steady or increased doses. In 6 patients, the beneficial effects persisted throughout the several-month follow-up period. Only four of the children's families were identified as having mood and/or anxiety disorders. This open-label study suggests that short-term sertraline treatment may reduce the behavioral reactions seen in association with situational transitions or environmental changes in children with autistic disorder, though the beneficial effect may be only temporary in some children. Our experience suggests that small doses of sertraline may be effective and that some children may require divided doses of sertraline during the day. Controlled studies are needed to determine the efficacy, safety, and pharmacokinetics of sertraline in treating this "need for sameness," both in short-term and long-term studies of children with autistic disorder.

1-Naphthylamine↗
PubMed1997

Case study: seizure disorder presenting as panic disorder with agoraphobia.

Seizure disorders can produce anxiety that is almost indistinguishable from psychiatric disorders. There are few reports of adolescents with seizure disorders that produce fear. The first case of an adolescent female who presented with panic disorder and agoraphobia which was a consequence of seizure activity is reported. Careful diagnostic evaluation and correlation with video electroencephalography were important in distinguishing seizure activity from panic disorder.

Adolescent↗
PubMed1996

Use of risperidone in psychotic disorder following ischemic brain damage.

Risperidone, a novel atypical neuroleptic agent, was used to treat a psychotic disorder secondary to ischemic brain damage in a 19-year-old adolescent, who had been treatment-refractory to two conventional antipsychotic agents and valproate. Clinically significant reductions in behavioral agitation and psychotic thinking initially appeared within the first 4 days of treatment with risperidone 3 mg twice daily. Risperidone was well tolerated despite this adolescent's severe cardiac and pulmonary illnesses. There was no evidence of increased neurotoxic symptoms in the presence of the ischemic brain damage. With its favorable side effect profile, risperidone may hold promise in the treatment of patients with psychotic disorders due to general medical conditions.

Adult↗
PubMed1995

The role of maternal factors in the adaptation of children with craniofacial disfigurement.

This study hypothesized that maternal adjustment, perceptions, and social support would better predict child adaptation to craniofacial disfigurement than medical severity. Mothers of 77 children (ages 6-12) completed the Child Behavior Checklist, Beck Depression Inventory, Spielberger Trait Anxiety Scale, Social Support Questionnaire Revised, and Parenting Stress Index. Medical severity was assessed by the number of operations (craniofacial and other), comorbid medical conditions, and the Hay Attractiveness Scale. The children and mothers in our sample resembled a normal population in terms of their psychological functioning and quality of the mother-child relationships. Maternal adjustment and maternal perceptions of the mother-child relationship were more potent predictors of children's emotional adjustment than either medical severity or maternal social support.

Adaptation, Psychological↗
PubMed1994

Depressive disorders and suicidal intent in adolescent suicide attempters.

This study describes the relationships between the presence of a depressive disorder, suicidal intent, and the medical seriousness of a suicide attempt in an adolescent sample. Consecutive adolescents who attempted suicide were evaluated for the presence or absence of current DSM-III-R depressive disorders (DD). Adolescent suicide attempters with DD were compared with those without DD regarding the level of their suicide intent and the medical seriousness of their suicide attempt. Adolescent suicide attempters with a diagnosis of DD were found to have a higher level of suicidal intent than were those without depressive illness. There was no relationship between the medical seriousness of the suicide attempt and the presence of DD. Clinicians should specifically assess for DSM-III-R DD as a means of determining suicidal intent in adolescent suicide attempters.

Adolescent↗
PubMed1993

Developmental differences in detection and disclosure of sexual abuse.

OBJECTIVE: This study examined the role of developmental differences in the detection and disclosure of child sexual abuse. METHOD: A random medical record review was conducted of 72 children and adolescents seen over a consecutive 3-year period for suspected sexual abuse in the emergency room of a pediatric hospital. The following data were gathered: (1) demographic information, (2) presenting symptomatology that initiated caregiver decision to seek evaluation, (3) type of disclosure (purposeful or accidental), and (4) precipitants to disclosure. RESULTS: Preschool age children were significantly more likely than school age children and adolescents to exhibit behavioral or physical symptoms that prompted caregivers' suspicion of sexual abuse. Preschool age children made disclosures accidentally and typically with an immediate precipitating event unrelated to the abuse itself. In contrast, sexual abuse disclosures from school age children were purposeful and not associated with a precipitating event. CONCLUSIONS: Practitioners need to be aware of the developmental differences in the detection of sexual abuse, including the forces that inhibit disclosure in older children.

Adolescent↗
PubMed1993

Psychopathology in the families of children and adolescents with borderline personality disorder.

OBJECTIVE: The purpose of this study was to determine whether rates of psychopathology differed between the families of a group of children and adolescents with borderline personality disorder and the families of a psychiatric comparison group. METHOD: The rates of psychiatric disorders in the families of 44 child and adolescent outpatients with borderline personality disorder were compared with the rates in the families of a psychiatric comparison group of 100 children and adolescents, none of whom had a diagnosis of borderline personality disorder. Psychopathology in family members was ascertained by the family history method with the use of information from semistructured interviews with the subjects in the two study groups and with their parents or guardians. The adults were systematically interviewed regarding specific DSM-III-R disorders in their families. RESULTS: The families of the patients with borderline personality disorder had significantly greater rates of psychopathology, particularly in the areas of depressive, substance abuse, and antisocial disorders. CONCLUSIONS: The finding of higher rates of psychopathology among the family members of the group with borderline personality disorder supports the hypothesis that a history of significant family psychopathology is associated with the disorder.

Adolescent↗
PubMed1992

An integrated medical and psychiatric approach to conversion symptoms in a four-year-old.

Conversion disorder is a challenging diagnosis in children and adolescents. Medical and psychiatric diagnoses need to be evaluated both separately and in relation to each other. This case highlights both the diagnostic criteria for a conversion disorder in a young child and the need for an integrated medical and psychiatric approach by physicians.

Child of Impaired Parents↗
PubMed1992

Recruitment and training of child and adolescent psychiatry residents from pediatrics.

This article describes a 21-year experience of recruiting and training child and adolescent psychiatry residents with pediatric backgrounds. Three grounds of physicians are compared: those with previous training in general psychiatry alone, those with previous training in both general psychiatry and pediatrics, and those with previous training in pediatrics alone. Residents with pediatric backgrounds compared favorably with those with general psychiatry training. Those with only pediatric training were not only able to successfully complete the residency, but also the majority entered the field of child psychiatry. The findings support accepting residents directly from pediatrics as a viable pathway into child psychiatry.

Adolescent↗