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Biomedical subjects

J Harr

Publications and source records attributed to J Harr.

8 recordsLinked to original sources
PubMed2001

Variation in therapy and outcome for pediatric head trauma patients.

OBJECTIVE: This study was undertaken to examine variation in therapies and outcome for pediatric head trauma patients by patient characteristics and by pediatric intensive care unit. Specifically, the study was designed to examine severity of illness on admission to the pediatric intensive care unit, the therapies used during the pediatric intensive care unit stay, and patient outcomes. DATA SOURCES AND SETTING: Consecutive admissions from three pediatric intensive care units were recorded prospectively (n = 5,749). For this study, all patients with an admitting diagnosis of head trauma were included (n = 477). Data collection occurred during an 18-month period beginning in June 1996. All of the pediatric intensive care units were located in children's hospitals, had residency and fellowship training programs, and were headed by a pediatric intensivist. METHODS: Admission severity was measured as the worst recorded physiological derangement during the period 1 yr old (16.1% vs. 6.1%; p = .002). Comparisons by insurance status indicated that observed mortality rates were highest for self-paying patients. However, patient characteristics were not associated with use of therapies or standardized mortality rates after adjustment for patient severity. There was significant variation in the use of paralytic agents, seizure medications, induced hypothermia, and intracranial pressure monitoring on admission across the three pediatric intensive care units. In multivariate models, only the use of seizure medications was associated significantly with reduced mortality risk (odds ratio = 0.17; 95% confidence interval = 0.04-0.70; p = .014). CONCLUSIONS: Therapies and outcomes vary across pediatric intensive care units that care for children with head injuries. Increased use of seizure medications may be warranted based on data from this observational study. Large randomized controlled trials of seizure prophylaxis in children with head injury have not been conducted and are needed to confirm the findings presented here.

Child, Preschool↗
PubMed2001

Evidence-based pediatric nursing: does it have to hurt?

Pediatric nursing is deeply rooted in tradition and ritual. Although many practices remain relevant, others do not stand up to the challenge of an evidence-based nursing practice. Though intuition and tradition are important aspects of professional nursing practice, their incorporation into clinical practice can vary among practitioners. Although ample evidence to guide the practice of pain assessment and pain management in children exists, children remain undermedicated when compared to adults. This article explores the influence of practice traditions, personal bias, and the persistence of myths regarding pain in children on the practice of pain relief.

Attitude of Health Personnel↗
PubMed1999

Prescription and administration of around the clock analgesics in postoperative pediatric cardiovascular surgery patients.

Despite an increased awareness of postoperative pain management in infants and children, they are still often undermedicated. The importance of providing maximum comfort to children following cardiac surgery is accentuated with shortened hospital stays that require early ambulation to achieve early discharge. The purposes of this study were to evaluate the administration of prescribed around the clock (ATC) pain medication and documentation of pain assessment when administering pro re nata (prn) analgesics. A descriptive design was used to study 114 consecutive patients who underwent surgery for congenital heart disease. Administration of ordered ATC medications was best in the sternotomyl > 24 months of age group and poorest in the thoracotomyl < 24 months of age group. The use of the Wong-Baker FACES Pain Rating Scale in patients who were > 36 months of age (n = 71) was 38% for predose evaluation and only 15% for postdose evaluation. Findings suggest that the postoperative pain of infants and young children demands better attention. The administration of prescribed ATC medications is imperative in providing maximal postoperative pain relief in the pediatric cardiovascular surgery patient.

Adolescent↗
PubMed1996

Double-u double-u double-u dot APIC dot org: a review of the APIC World Wide Web site.

The widespread use of the Internet and the development of the World Wide Web have led to a revolution in electronic communication and information access. The Association for Professional in Infection Control and Epidemiology (APIC) has developed a site on the World Wide Web to provide mechanisms for international on-line information access and exchange on issues related to the practice of infection control and the application of epidemiology. From the home page of the APIC Web site, users can access information on professional resources, publications, educational offering, governmental affairs, the APIC organization, and the infection control profession. Among the chief features of the site is a discussion forum for posing questions and sharing information about infection control and epidemiology. The site also contains a searchable database of practice-related abstracts and descriptions and order forms for APIC publications. Users will find continuing education course descriptions and registration forms, legislative and regulatory action alerts and a congressional mailer, chapter and committee information, and infection control information of interest to the general public. APIC is considering several potential future enhancements to their Web site and will continue to review the site's content and features to provide current and useful information to infection control professionals.

Computer Communication Networks↗
PubMedDate not supplied

Characteristics of families enrolled in an isolated, mountain Head Start program: managing social capital.

The purpose of this exploratory, descriptive study was to identify the characteristics of families who chose to enroll their children in a Head Start program. Twenty families were asked questions about their level of education, financial assistance, driving distances to healthcare, and characteristics of their neighborhood. Families were asked about the educational aspirations they have for their children and the quality of their schools. How they felt about certain characteristics of their neighborhood, (respect for authority and unemployment) were not associated with families' willingness to be involved in Head Start activities or influence how they felt about their schools (p < .05). They were not involved in religious, political, or other community based organizations. For the parents who wanted their children to complete college, 80% had a high school education or less.

Adult↗