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Biomedical subjects

R S Fowler

Publications and source records attributed to R S Fowler.

12 recordsLinked to original sources
PubMed1991

Congenital heart disease, parental stress, and infant-mother relationships.

The effect of congenital heart disease on early social relationships was assessed by observing 42 infants with the disease and 46 healthy infants in a standardized laboratory setting with their mothers. Significantly fewer infants with congenital heart disease, in comparison with healthy peers, were considered to have secure relationships with their mothers. The quality of the infant-mother relationship in the group with congenital heart disease was not related to parents' reports of their own stress or psychologic well-being. Severity of illness did not have a direct effect on the quality of the infant-mother relationship, but securely attached infants showed more subsequent improvement in health than insecurely attached peers showed. Attention to the infant-mother relationship in clinical care may improve the social development of babies with congenital heart disease and may have positive effects on physical health as well.

Adult↗
PubMed1990

Chronic illness in infancy and parenting stress: a comparison of three groups of parents.

Compared responses of parents of infants with cystic fibrosis, those with congenital heart disease, and those with healthy babies on the Parenting Stress Index. Diagnostic group differences were found mainly in the Child Domain with parents of ill infants reporting greater stress. Differences between mothers and fathers were found mainly in the Parent Domain. The groups did not differ in reports of stress arising from life events other than the target child's illness.

Adaptation, Psychological↗
PubMed1977

A simple method for ECG and VCG assessment of the severity of pulmonary valve stenosis.

In patients with isolated pulmonary valve stenosis, the right ventricular (RV) hypertrophy is related to the hemodynamic severity of their lesions. We estimated the peak RV pressure noninvasively in 112 patients with isolated pulmonary valve stenosis by a Frank lead vectorcardiogram (VCG), an orthogonal electrocardiogram (ECG), and a standard scalar ECG. In 78 randomly assigned patients, 10 ECG measurements and 13 VCG measurements were correlated with the peak RV pressure at cardiac catheterization; the best multiple linear regression equation used the R wave in standard lead 1 (ECG), maximal rightward voltage in the terminal part of the frontal vector loop (VCG), and the Q wave in the orthogonal Z lead, giving R = 0.66 (SEM 25). The equation was validated in the other 34 patients; correlation of estimated with actual peak RV pressure was r = 0.64. A nomogram for clinical use was devised from this regression equation.

Adolescent↗
PubMed1976

Mucocutaneous lymph node syndrome with coronary artery aneurysm.

A white North American girl with clinical features of the mucocutaneous lymph node syndrome had a myocardial infarct and angiographic evidence of a coronary artery aneurysm and mitral regurgitation. The mucocutaneous lymph node syndrome has been extensively diagnosed in Japan in recent years. It appears to be a distinct entity, although not precisely separated from polyarteritis nodosa in childhood. The condition may be more common than previously realized.

Aneurysm↗
PubMed1976

Tricuspid atresia: results of treatment in 160 children.

Experience in managing 160 patients with tricuspid atresia is reviewed. The majority of these children require operative treatment in the 1st year of life. Clinical management of this rather complex anomaly is simplified by classifying each child according to total pulmonary blood flow. An overall plan of management for patients with decreased pulmonary flow is suggested. This consists of a Potts shunt as an initial procedure, limiting its anastomotic growth so that pulmonary flow becomes inadequate at age 10 to 12 years. A Glenn anastomosis is then constructed as the second procedue. The Fontan procedure should be considered carefully as an alternative to the Glenn anastomosis in these older children. Children with increased pulmonary blood flow and transposition of the great arteries are likely to require pulmonary arterial banding in infancy. Otherwise, patients in this smaller group are managed with the same overall plan. Results of long-term palliation have been good.

Adolescent↗
PubMed1975

Sudden unexpected death in children with congenital heart disease.

Of 18,000 children with organic heart disease evaluated at The Hospital for Sick Children, Toronto between 1940 and 1971, 33 died suddenly and unexpectedly between 1 and 21 years of age. Nine had discrete obstruction of the left ventricular outflow tract and five had muscular narrowing of the left ventricular outflow tract and five had muscular narrowing of the left ventricular outflow tract. Pulmonary vascular disease caused seven sudden deaths, and arrhythmias (usually due to atrioventricular block) caused seven more. Of the five other children who died suddenly three had transposition of the great arteries, one had a complex cyanotic heart defect and one had an anomalous course of the left coronary artery, which originated from the right sinus of Valsalva. With earlier investigation of aortic stenosis, earlier closure of ventricular septal defect to avoid pulmonary vascular disease, better design of artificial pacemakers and better investigation of patients with angina, many of these deaths will be avoided in the future.

Adolescent↗
PubMed1975

Stroke: Does rehabilitation affect outcome?

A sample of 114 consecutive stroke admissions to a rehabilitation center was studied statistically to determine functional gains achieved and retained after rehabilitation. In order to provide a measure of function, a functional profile was developed that evaluates seven activities, each according to a five-point scale. It was found that significant gains were achieved which could not be attributed merely to spontaneous recovery. An estimate of the cost benefit ratio showed that the reduced cost resulting from returning patients to the family or to independent living more than paid for the cost of providing rehabilitation services to the whole sample.

Activities of Daily Living↗
PubMed1975

Stroke rehabilitation: Outcome and prediction.

Predictors of functional outcome were developed in a group of 114 stroke patients consecutively admitted to a tertiary rehabilitation center. These predictors included a pool of medical data, the age of the patient, psychological tests and the patient's educational level. None of these predictor items showed a correlation with outcome high enough to allow precise prediction of individual outcome. They did, however, provide general indicators for those patients with severe functional impairment who are more likely to gain from a rehabilitation program. The group of medical predictors indicated that a patient with a more extensive, severe lesion, with signs of congestive heart failure, generalized arteriosclerosis, gross perceptual deficit, a lower level of education, and who is older, is less likely to improve in the rehabilitation program. Since a prediction on an individual basis was not possible, it was concluded that even the most severely involved patient should be provided with a therapeutic rehabilitation trial. There was no correlation between severity of the functional impairment at admission and the gains obtained in the rehabilitation program. The same predictors were used to predict whether the patient went home or to an institution. It was found that family income and involvement in support of the patient predicted this outcome, whereas medical data did not. Since family involvement can sometimes be changed by a therapeutic team, this predictor may also present a major target for therapeutic intervention.

Age Factors↗