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PubMed1987

A professional recognition system using peer review.

The concept of a Professional Recognition System or a Clinical Ladder is not new. In fact, many models appear in the literature and have been implemented in hospitals across the country. However, few models contain the element of peer review. This article describes the development process, structure, and function of a Clinical Ladder program at a pediatric tertiary level hospital. The program grew out of a desire and recognized need on the part of the professional nursing staff to reward outstanding nursing care. Based on the concept of peer review, it underwent many revisions and revealed many lessons that can be put to use by other persons attempting to implement such a program.

California↗
PubMed1992

Five- to fifteen-year follow-up after Fontan operation.

BACKGROUND: The purpose of this study was to estimate survival and quality of outcome and assess factors associated with outcome for patients out 5 to 15 years from their Fontan operation. METHODS AND RESULTS: We studied 352 patients who had the Fontan operation prior to 1985. The overall 1-, 5-, and 10-year survival was 77%, 70%, and 60%, respectively. The following factors were significantly associated with lower survival: univentricular heart or complex congenital anomalies other than tricuspid atresia, early calendar year of operation, heterotaxia syndromes, early age at operation, increased pulmonary artery pressure, atrioventricular valve dysfunction, and higher (worse) New York Heart Association class. Reoperations were necessary for 103 of the 352 patients. At least 20% of the survivors have or have had cardiac arrhythmias requiring antiarrhythmic medication or mechanical pacemaker insertion. Between 7% and 10% of the patients have had or had protein-losing enteropathy/hypoproteinemia. At 5 years postoperatively, 122 patients (34.7%) were alive with a better New York Heart Association functional classification than preoperatively. Fifty-eight patients (16.5%) were alive and in the same functional classification, but 126 (35.8%) died within the first 5 years or were in a worse functional classification. Thirty-nine patients were doing excellently and 29 patients poorly 5 years after the operation. Of the surviving patients, 43% can do as much exercise as their peers, whereas 3% are incapable of exercise. CONCLUSIONS: To assure good functional long-term outcome in addition to survival, clinicians must exclude from selection for Fontan operation patients known to be at high risk for death or poor outcome.

Adolescent↗
PubMed1980

Effects of the labels "mentally retarded" and "retard" on the social acceptability of mentally retarded children.

Effects of the labels "mentally retarded" and "retard" on fifth- and sixth-grade children's attitudes toward peers were studied. Results indicated that children's attitudes (feelings and behavioral intentions) were more positive toward the target child labeled "mentally retarded" than labeled "retard." The data also showed that children's reactions to the two labels were, in part, a function of the physical appearance and academic competence of the peer being rated. Children had the most negative attitudes toward a child labeled "retard" who appeared to be "normal." In contrast, children reacted favorably to the target child labeled "mentally retarded," even when he or she was academically incompetent. Finally, boys were more negative than were girls toward the target child, especially when the child was labeled "retard." Implications for the movement to abandon the use of labels were discussed.

Attitude↗
PubMed1990

LD status and achievement: confounding variables in the study of children's social status, self-esteem, and behavioral functioning.

The purpose of the present study was to examine the role of achievement in explaining the poor social and behavioral functioning associated with LD status, and to evaluate potential gender differences in patterns of interpersonal functioning among youth with learning disabilities (LD) and nondisabled (NLD) youth. Thirty-two students with learning disabilities (21 boys, 11 girls) were matched with same-sex, same-race classmates whose reading achievement was low (LA) or average (AA), and these groups were compared on peer ratings of liking and disliking, perceptions of self-worth and social acceptance, and teacher ratings of conduct problems, anxiety-withdrawal, and attention problems. Students with learning disabilities were less accepted and less well-liked than children in the LA or AA groups and also perceived their self-worth and social acceptance to be lower than LA or AA students. Group by Sex interactions were apparent for several of the peer rating and behavioral variables, indicating that different patterns of social and behavioral functioning distinguished LD boys and LD girls from their NLD peers. The findings highlight the potential role of low achievement in peers' dislike of LD girls and suggest the importance of investigating well-defined subgroups of youth with LD in future research.

Achievement↗
PubMed1990

Training social initiations to a high-functioning autistic child: assessment of collateral behavior change and generalization in a case study.

The present case study used a multiple treatment design to assess the effects of two interventions--peer social initiations and target child initiations--on the social and disruptive behavior of a high-functioning autistic child. Intervention included initiation training and videotaped feedback highlighting successful and unsuccessful initiations. During Interventions 1 and 2, nonhandicapped peers were trained to initiate social interaction with the autistic child, resulting in an increase in social interaction which dramatically decreased in a reversal phase. Social interaction quickly increased again in Intervention 3 when the autistic child was trained to initiate interaction using the same procedures. During Interventions 1 and 2 no decrease in the autistic child's disruptive behaviors was observed; however during Intervention 3 these behaviors decreased to a low rate. Social validation, generalization, and maintenance of these behavior changes are discussed.

Attention↗
PubMed1983

Learning through observation: the effects of peer modeling on acquisition and generalization in autistic children.

The purpose of this study was to systematically determine whether low-functioning autistic children [MA of approximately half of their CA or less] could learn through observation by the use of a peer modeling procedure. Since modeling is less structured than traditional one-on-one procedures, it was also thought that modeling might facilitate subsequent generalization of tasks learned through observation. Four autistic children were taught two receptive labeling tasks. One task was taught by a traditional trial-and-error procedure, while the other task was taught by a modeling procedure wherein the models were other autistic children. Results indicated that all four children learned through observation of their peer model. Additionally, generalization and maintenance of correct responding were superior when the children learned through observation rather than by trial and error. These results are discussed in terms of the modeling literature, generalization issues, and implications for designing teaching settings for autistic children.

Adolescent↗
PubMed1994

Effects of early manual instruction on the oral-language development of two deaf children.

The speech and language training provided to deaf children at our clinic is done by the Kanazawa Method, which consists of reception and expression training in sign communication and auditory/oral language, as well as written-language training. In our investigation, we analyzed the acquisition of passive and active vocabulary in sign and oral language. The subjects were two children congenitally deaf at the 105 dB level or greater. Recorded-language samples through the age of 54 months were analyzed. Acquisition of sign occurred more quickly than oral-language acquisition. The children's production of active nouns, function words, and "wh-" question words in sign was equivalent to that of hearing peers, and later this proficiency transferred to oral language. These results suggest that early presentation of sign is effective in the acquisition of function words and interrogative sentences, both of which are especially challenging for the Deaf.

Child Development↗
PubMed1990

Analysis of a double-layered support system.

This analysis focuses on the support functions of a social network consisting of the families, educational staff, and peers of 33 adolescent females. These women were lower-class school dropouts who joined the Israeli Army and--toward the end of their service--participated in a six-month intensive program of educational upgrading. The program was administered by the Israeli Army and operated by female soldiers close in age, but not in social background and education, to the program's participants. Data were collected by a semi-structured interview and analyzed in terms of the emotional, cognitive, and behavioral support functions of the social network. Analysis shows that (1) whereas the educational staff and the peers provide the young women with all three types of support, their parents' is limited to some aspects of emotional support, and is conditional (to success); (2) the educational staff also induced the peers to act as supporters; and (3) as a result, the participants had access to a "double layer" of emotional, cognitive, and behavioral support, and benefited from being both recipients and providers of support, in the coping-enhancing conditions of sociocultural and situational similarity.

Adolescent↗
PubMed1986

Personality functioning and clinical presentation in early adolescence. II.

This study describes the presentation of early adolescents on clinical examination and its relation to personality function competence. As part of a longitudinal study 63 non-clinical subjects at age 13 underwent a semi-structured psychiatric interview. On the basis of their responses their phenomenology, attitudes, defence mechanisms and degree of relatedness to significant others were assessed independently and blindly by two psychiatrists. Our findings show that a significant minority of early adolescents have a definite personality function disturbance and that these adolescents differ from their more competent peers on a number of characteristics identifiable in a clinical interview. Such a relationship was observed in boys as well as girls, with girls presenting no greater amount of turmoil than boys. These results indicate that adolescents cannot be adequately described as a homogeneous group. Differences in individual personality functioning result in differences in the presentation and internal experience of the early adolescent.

Adolescent↗
PubMed1985

Delayed female sexual maturation. How to approach differential diagnosis.

Delayed sexual development is present when an adolescent girl fails to experience, at an age that is beyond the average for her peers, those pubertal events that are indexes of gonadal function. Adolescent girls whose sexual development is delayed can be divided into three groups: (1) those who have not menstruated but have well-developed secondary sexual characteristics, indicating that they have a functioning hypothalamic-pituitary-ovarian mechanism, (2) those with poorly developed secondary sexual characteristics whose hypothalamus and pituitary are functional but who have ovarian failure, as indicated by high levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) (hypergonadotropic hypogonadism), and (3) those with poorly developed secondary sexual characteristics whose normal ovaries are not functioning because of a hypothalamic or pituitary disorder, as indicated by low or low normal serum FSH/LH levels (hypogonadotropic hypogonadism). There are, in addition, individuals with a female habitus and external female genitalia who were reared as females but have an XY karyotype and come to the physician with a complaint of delayed female sexual maturation.

Adolescent↗
PubMed1990

Goal structure effects on social interaction: nondisabled and disabled elementary students.

This study compared social interaction behavior between nondisabled and disabled students, as a function of the way tasks were structured during a peer integration program. Of the eight pairs of students, four pairs were assigned to an individualistic goal-structured condition; the other four pairs, to a cooperative condition. For nondisabled students, the cooperative condition was associated with more social interaction during activity and free play sessions. For disabled students, the cooperative condition was associated with more social interaction during activity sessions, but not during free play sessions.

Adolescent↗
PubMed1989

Aerobic and resistive exercise modify risk factors for coronary heart disease.

An awareness of the health-related benefits of regular physical activity, prudent diet, and cessation of cigarette smoking are some of the mechanisms by which risk factors for coronary heart disease (CHD) and the incidence of complications of atherosclerosis have declined in the American population. Exercise training is associated with improvements in lipid and glucose metabolism that are manifested by enhanced insulin sensitivity, improved glucose tolerance, increased high density lipoprotein cholesterol levels, reduced triglyceride and low density lipoprotein cholesterol levels, and reductions in blood pressure. In addition to reduced risk factors for atherosclerosis, physically conditioned individuals have better cardiovascular function at rest and during exercise than their inactive peers. Thus, exercising training reduces morbidity and mortality from atherosclerotic complications through both direct (cardiovascular) and indirect (risk factor modification) mechanisms. Many studies demonstrate a strong association between regular physical activity and reduced risk for CHD. This article provides a review of risk factors for CHD and the potential health benefits of aerobic and resistive exercise. The time seems apt for the institution of multifactorial cardiovascular risk prevention programs in which aerobic and resistive exercise are combined with prudent diet therapy and smoking cessation to reduce risk factors for CHD.

Coronary Disease↗
PubMed1991

The maternal representation. A comparison of caregiver- and mother-reared toddlers.

Two groups of toddlers and their caregivers were observed at the Margaret S. Mahler Observational Research Nursery on different days. In one group (the caregiver group) the children of full-time employed mothers were cared for at home by paid caregivers. In the other group (the mother group) the children were cared for full-time by their actual mothers. These two groups are compared in terms of the children's expression of affect, interest in peers, identifications, separation protests, signals of communication, and symbolic functioning. Contributions from infant research are used to illustrate how recent conceptualizations about the construction of the maternal representation further understanding about the child's experience of multiple caregivers.

Adult↗
PubMedDate not supplied

[The nurse's role in a child psychiatric unit of St. Sophia Children's Hospital, Athens, Greece].

The role of the nurse in a child psychiatric unit is defined by the systems: a. Nurse-child b. Nurse-child-family c. Nurses-children d. Nurses-disciplinary team (a). In these systems the nurse: assesses the child, identifies the problems, sets the goals, provides care, educates the child. (b). Reinforces the parents' role, intervenes to help the relationships in the family. (c). Facilitates the team interactions and also the healthy behaviour in the peer group team, provides secure relationships. The nurse also functions as a reinforcement which leads to maturity. (d). The nurse is an equal member in the therapeutic team, is the link for communication and the main source for information. He participates in the organization and management of the team. Many nurses are specialized in psychiatric and child psychiatric nursing. All nurses believe in the continuing education and they attend various seminars. Through the activities in the unit the nurses have an update information on the subject of their work. Supervisions with educational character have been established for the nursing team. The nurse works on the base of the "special nurse-child" relationship and has the full responsibility of the child. The special nurse fulfills the nursing history. Systematic observation and evaluation are performed by the special nurse: he identifies the problems, sets the goals, formulates a programme, writes down and evaluates the results which means that he works with the implementation of the nursing process.

Child↗
PubMed1980

Child competence and psychiatric risk. III. Comparisons based on diagnosis of hospitalized parent.

The school competence of children whose parents were previously hospitalized for psychiatric disorder was studied. These children, at risk themselves for behavioral disorder, were compared to classmates as well as to each other based upon the diagnosis of the hospitalized parent. Four diagnostic groups were employed: narrowly defined schizophrenic, broadly defined schizophrenic, affective psychotic, and hospitalized nonpsychotic patients. Significant differences between the risk sample and classmates are reported along with differences among the diagnostic groups. Sons of nonpsychotic hospitalized patients were functioning most poorly and were in marked defiance of peer and adult norms. Parental and child IQ were found to have had little impact upon the data and were not considered major interactive variables. Issues concerning systems of diagnoses and the developmental implications of the findings are presented.

Achievement↗
PubMed1984

Lateral specialization and social-verbal development in preschool children.

Forty-two 2 1/2- to 5 1/2-year-old children's social and verbal behaviors were observed during free play in a preschool. A test measuring lateral specialization of verbal function and a standardized psychometric test of verbal ability were also administered. Analysis of variance indicated that the right ear (left hemisphere) is predominant in processing verbal stimuli in children as young as 2 1/2. Multiple regression analyses revealed significant relations between the right ear accuracy score for dichotically presented verbal stimuli and both psychometrically measured verbal ability and a social-verbal factor score derived from play behavior. After the increase related to age was statistically partialled out from both verbal ability and social-verbal scores, verbal expression, length of verbal utterances, time spent in conversation, and peer social interactions increased and parallel play decreased as a function of right ear (left hemisphere) accuracy for verbal stimuli. The relationship between left ear (right hemisphere) accuracy scores for verbal stimuli and social-verbal behavior, however, was not linear. Very high and very low levels of left ear recall predicted an increase in the frequency of parallel play and low social-verbal behavior while moderate levels of left ear accuracy scores predicted the reverse.

Auditory Perception↗
PubMed1984

Infants in play groups: time related changes in behavior toward mothers, peers, and toys.

Twenty-one 13-month-old infants, nine male and 12 female, were assigned to one of seven playgroups convening for 15 consecutive weekdays . Present at each 20-minute play session were three same-sexed peers with their mothers and an assortment of toys. There were systematic fluctuations in infants' attention to mother, peers, and toys. There findings suggest that a mother may serve different functions at different points in time: (a) as a secure base in initial sessions, (b) as a refueling stop when the infant grew tired, and (c) as an attractive alternative when the infant became bored with toys and peers. Within-day analyses revealed that activity level and toy exploration linearly decreased over time, while intentional contact with mother significantly increased. Social interaction with peers correlated negatively with interaction with mother over the course of the study. Sex differences over time were found to be significant: boys on day one were more interactive with both peers and toys but this level declined thereafter, while girls on day one spent more time in close proximity to mother and later, on subsequent days, increased their peer and toy play.

Child Development↗