Biomedical subjects

M K Lears

Publications and source records attributed to M K Lears.

6 recordsLinked to original sources

PubMed2001

Effectiveness of a home intervention for perceived child behavioral problems and parenting stress in children with in utero drug exposure.

OBJECTIVE: To determine if a home-based nurse intervention (INT), focusing on parenting education/skills and caregiver emotional support, reduces child behavioral problems and parenting stress in caregivers of in utero drug-exposed children. DESIGN: Randomized clinical trial of a home-based INT. SETTINGS: Two urban hospital newborn nurseries; homes of infants (the term infant is used interchangeably in this study with the term child to denote those from birth to the age of 36 months); and a research clinic in Baltimore, Md. PARTICIPANTS: In utero drug-exposed children and their caregivers (N = 100) were examined when the child was between the ages of 2 and 3 years. Two groups were studied: standard care (SC) (n = 51) and INT (n = 49). INTERVENTION: A home nurse INT consisting of 16 home visits from birth to the age of 18 months to provide caregivers with emotional support and parenting education and to provide health monitoring for the infant. MAIN OUTCOME MEASURES: Scores on the Child Behavior Checklist and the Parenting Stress Index. RESULTS: Significantly more drug-exposed children in the SC group earned t scores indicative of significant emotional or behavioral problems than did children in the INT group on the Child Behavior Checklist Total (16 [31%] vs 7 [14%]; P =.04), Externalizing (19 [37%] vs 8 [16%]; P =.02), and Internalizing (14 [27%] vs. 6 [12%]; P =.05) scales and on the anxiety-depression subscale (16 [31%] vs. 5 [10%]; P =.009). There was a trend (P =.06) in more caregivers of children in the SC group reporting higher parenting distress than caregivers of children in the INT group. CONCLUSIONS: In utero drug-exposed children receiving a home-based nurse INT had significantly fewer behavioral problems than did in utero drug-exposed children receiving SC (P =.04). Furthermore, those caregivers receiving the home-based INT reported a trend toward lower total parenting distress compared with caregivers of children who received SC with no home visits.

Affective Symptoms↗

PubMed1999

Sequential neuromotor examination in children with intrauterine cocaine/polydrug exposure.

Data are presented on 157 newborn infants followed sequentially in a randomized home-based nursing-intervention trial for drug-exposed infants with follow up at 3 (N=118), 6 (N=124), and 12 months (N=77). The objectives of this study were to describe the longitudinal neurodevelopmental status of a cohort of children with intrauterine exposure to illicit drugs during their gestation, characterize the evolution of early tone abnormalities in a polydrug-exposed cohort, and determine whether neuromotor outcome is associated with drug-exposure patterns. For analysis, infants were grouped based on maternal drug-use pattern and the presence of drug metabolites in the neonatal drug screen. The sequential neuromotor examination was used at each age to define the neuromotor status of six domains and define categorical classifications as either normal, suspect, or abnormal. Multiple patterns of neuromotor abnormalities were observed during the neonatal period; most resolved over time. Axial hypotonia was a prominent finding in the neonatal period; however, it was infrequent in abnormal examinations at 12 months. Increased lower-extremity tone was a less frequent finding during the neonatal period. Infants whose neonatal urine drug screen was positive for both cocaine and opiates, were more likely than infants with negative urine drug screens, cocaine only, or opiate only drug screen results to have abnormal neuromotor examinations; while positive maternal drug screens for concurrent cocaine and opiate use were associated with peripheral hypertonia. Persistence of increased leg-extensor tone was found in 67% of the abnormal examinations at 12 months. Acquisition of rolling and walking was delayed in the drug-exposed cohort.

Age Factors↗

PubMed1998

Home intervention for in utero drug-exposed infants.

Each year in the United States, around 5.5% (or 230,000) infants are born to mothers who used illicit drugs during pregnancy. The untoward effects of in utero drug exposure (IUDE) include significant decreases in birthweight and length and head circumference, prematurity, and developmental problems. Intensive early intervention, including home-based interventions, is recognized as an effective method to improve cognitive development and reduce health problems in these high risk infants and children. Examination of home visit records of 20 IUDE infants during their first year of life revealed frequent health and social problems. Infectious disease symptoms were the most frequent problem encountered in the home during the physical assessment of the infants. Of note was the mothers' lack of basic parenting information (understanding signs of illness, basic nutrition, and infant development) which was then provided by the nurse during each home visit. Of concern was the lack of drug treatment sought by these mothers. Findings support the view that home visiting should be incorporated into the discharge planning of any IUDE infant in order to maintain these infants in the health care system and monitor their safety.

Adult↗

PubMedDate not supplied

A centralized, computerized, and relational data base for student clinical placements.

Quality clinical experiences are a critical component of advanced practice nursing (APN) curricula. Historically, nursing instructors coordinated both the didactic and clinical components of a course. Increasingly, course coordinators organize the didactic component, and external preceptors working in the clinical setting function as practicum teachers. Both scenarios involve labor-intensive processes, and neither facilitate the scheduling of clinical experiences that build on progressive learning across the student's curriculum. A centralized, computerized, relational data base for efficient management of APN preceptors and students across the curriculum was designed. One master's-prepared clinical coordinator maintains the data base and performs all related functions. This system offers numerous benefits to students, preceptors, ] faculty, and nursing school, including balanced and progressively complex clinical learning experiences for students from competent preceptors: consistent interface with students and preceptors; faculty relief from time-consuming tasks; rapid generation of a variety of tables, rosters, and reports; consistent tracking of preceptor evaluations; timely acknowledgment of preceptor assistance; and efficient communication among students, preceptors, faculty, and school administration.

Baltimore↗

PubMedDate not supplied

International adoption: a primer for pediatric nurses.

Immigrant visas issued to orphans entering the United States (a proxy measure for international adoptions) totaled 13,620 in 1997, more than double the amount in 1992. As international adoption numbers rise, pediatric nurses encounter more adopted children and adoptive families. Among the many adoption-related issues confronting pediatric health care providers, the one most frequently voiced is: "Should we do or look for anything differently in adopted children? And, if so, what?" To address this issue, a three-fold approach is suggested: (a) recognize the physical conditions and medical problems prevalent in the international countries with high adoption rates; (b) identify the unique adoption-related tasks encountered by children according to their current developmental stage; and (c) determine recommendations for providers, parents, and children to successfully address or cope with these adoption-related tasks and conditions.

Adolescent↗

PubMedDate not supplied

The natural history, current status, and future trends of HIV infection.

Nearly 50 million people worldwide have been infected with human immunodeficiency virus (HIV), and an estimated 12 to 13 million children have been orphaned by the acquired immune deficiency syndrome (AIDS) epidemic. The natural history of HIV infection continues to evolve as researchers and clinicians unearth new facts about the virus and develop new treatment regimens for patients. The status of anti-HIV treatments is never static but constantly changing. Patients and providers struggle with adherence issues. Vaccine development, viewed as an essential step in controlling the epidemic, is complicated by the genetic diversity of the virus and the inability of the body to clear the virus. Tremendous strides have occurred in the HIV/AIDS arena, yet daunting challenges remain. This overview article presents the natural history, the current status, and future trends of HIV infection.

AIDS Vaccines↗