Melatonin treatment in individuals with intellectual disability and chronic insomnia: a randomized placebo-controlled study
Saliva; Middle Aged; Treatment Outcome; Humans; Adolescent; Child Preschool; Double-Blind Method; Time Factors; Central Nervous System Depressants/adverse effects/therapeutic use; Melatonin/adverse effects/therapeutic use; Mental Retardation/epidemiology/psychology; Sleep Initiation and Maintenance Disorders/drug therapy/epidemiology/psychology; Q3 Literature Search; chronic disease; child; female; male; adult; comorbidity; aged; sleep disturbance/disorders; chromosome 18q deletion; MPS III; pharmacologic intervention; melatonin
BACKGROUND: While several small-number or open-label studies suggest that melatonin improves sleep in individuals with intellectual disabilities (ID) with chronic sleep disturbance, a larger randomized control trial is necessary to validate these promising results. METHODS: The effectiveness of melatonin for the treatment of chronic sleep disturbance was assessed in a randomized double-blind placebo-controlled trial with 51 individuals with ID. All of these individuals presented with chronic ideopatic sleep disturbance for more than 1 year. The study consisted of a 1-week baseline, followed by 4 weeks of treatment. Parents or other caregivers recorded lights off time, sleep onset time, night waking, wake up time and epileptic seizures. Endogenous melatonin cycle was measured in saliva before and after treatment. RESULTS: Compared with placebo, melatonin significantly advanced mean sleep onset time by 34 min, decreased mean sleep latency by 29 min, increased mean total sleep time by 48 min, reduced the mean number of times the person awoke during the night by 0.4, decreased the mean duration of these night waking periods by 17 min and advanced endogenous melatonin onset at night by an average of 2.01 h. Lights off time, sleep offset time and the number of nights per week with night waking did not change. Only few minor or temporary adverse reactions and no changes in seizure frequency were reported. CONCLUSIONS: Melatonin treatment improves some aspects of chronic sleep disturbance in individuals with ID.
Braam W; Didden R; Smits M; Curfs L
Journal of Intellectual Disability Research
2008
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1365-2788.2007.01016.x" target="_blank" rel="noreferrer noopener">10.1111/j.1365-2788.2007.01016.x</a>
Sleep problems in children with Sanfilippo syndrome.
Humans; Longitudinal Studies; Sleep Disorders/etiology; Questionnaires; Time Factors; Sleep Disorders/therapy; Child Preschool; Mucopolysaccharidosis III/classification; Mucopolysaccharidosis III/complications; child; female; male; sleep disturbance/disorders; MPS III; psychological intervention
Sanfilippo syndrome is a rare degenerative disorder which has severe intellectual and behavioural sequelae, commonly including sleep problems. A parental questionnaire was used to gather information on the sleep patterns of 80 children with Sanfilippo syndrome (mean age 10 years 2 months). The majority were found to have sleep problems (78%). Many also exhibited other distressing and unusual night time behaviours (staying up all night, chewing the bedclothes or crying out suddenly), and a few laughed or sang. Such problems may have been more severe in those with Sanfilippo syndrome type B. In four of the families offered individually tailored behaviour-management advice there was immediate improvement, which was maintained at followup in two cases. These results demonstrate the usefulness of even such a minimal intervention, even in a very difficult population such as this.
Colville G A; Watters J P; Yule W; Bax M
Developmental Medicine and Child Neurology
1996
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1469-8749.1996.tb12114.x" target="_blank" rel="noreferrer noopener">10.1111/j.1469-8749.1996.tb12114.x</a>
Assessment of sleep in children with mucopolysaccharidosis type III
Actigraphy; Adolescent; Case-Control Studies; Child; Preschool; Female; Humans; Male; Melatonin/me [Metabolism]; Mucopolysaccharidosis III/pp [Physiopathology]; Sleep/ph [Physiology]; Time Factors; JL5DK93RCL (Melatonin); sleep disturbance/disorders; MPSIIIA; MPSIIIB; trajectory; characteristics
Sleep disturbances are prevalent in mucopolysaccharidosis Type III (MPS III), yet there is a lack of objective, ecologically valid evidence detailing sleep quantity, quality or circadian system. Eight children with MPS III and eight age-matched typically developing children wore an actigraph for 7-10 days/nights. Saliva samples were collected at three time-points on two separate days, to permit analysis of endogenous melatonin levels. Parents completed a sleep questionnaire and a daily sleep diary. Actigraphic data revealed that children with MPS III had significantly longer sleep onset latencies and greater daytime sleep compared to controls, but night-time sleep duration did not differ between groups. In the MPS III group, sleep efficiency declined, and sleep onset latency increased, with age. Questionnaire responses showed that MPS III patients had significantly more sleep difficulties in all domains compared to controls. Melatonin concentrations showed an alteration in the circadian system in MPS III, which suggests that treatment for sleep problems should attempt to synchronise the sleep-wake cycle to a more regular pattern. Actigraphy was tolerated by children and this monitoring device can be recommended as a measure of treatment success in research and clinical practice.
Mahon L V; Lomax M; Grant S; Cross E; Hare D J; Wraith J E; Jones S; Bigger B; Langford-Smith K; Canal M
PLoS ONE
2014
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<a href="http://doi.org/10.1371/journal.pone.0084128" target="_blank" rel="noreferrer noopener">10.1371/journal.pone.0084128</a>
The long-term effects of later life spousal and parental bereavement on personal functioning
Female; Humans; Male; Adult; Aged; Age Factors; Sex Factors; Life Change Events; Time Factors; Sampling Studies; Regression Analysis; quality of life; Adaptation; Psychological; bereavement; Family/psychology; Bereavement Leave Policy Paper; Widowhood/psychology
Using data from Americans' Changing Lives: Wave 1, 1986, this study examined the long-term effects on the personal functioning of older women and men following the death of an adult child or a spouse. Guided by Weiss's (1993) theoretical framework, 41 bereaved parents and 143 bereaved spouses were compared to 407 nonbereaved adults on measures of perceived health, self-efficacy, depression, life satisfaction, and future orientation. Analyses revealed bereavement and gender effects and a consistent influence of the sociodemographic characteristics of education, income, and duration of bereavement on functioning.
1995
Arbuckle NW; de Vries B
The Gerontologist
1995
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Journal Article
<a href="http://doi.org/10.1093/geront/35.5.637" target="_blank" rel="noreferrer">10.1093/geront/35.5.637</a>
Increase of plasmatic beta-endorphin immunoreactive material in children in the perioperative period: the influence of the site of surgery
Child; Female; Humans; Male; Time Factors; Linear Models; Analysis of Variance; adolescent; Preschool; Adaptation; Stress/immunology; Ambulatory Surgical Procedures/adverse effects/statistics & numerical data; beta-Endorphin/blood/immunology; Perioperative Care/statistics & numerical data; Physiological/immunology
BACKGROUND: The primary aim of the study was to confirm the increase of plasmatic IR beta-endorphin material during the perioperative period in children. The second was to search for the factors responsible for this increment. METHODS: Seventy-two consecutive children undergoing a surgical procedure were recruited. Pre-anaesthesia and anaesthesia were standardised. Plasmatic IR beta-endorphin material was measured at three timepoints: at baseline (t (0)), before induction (t (1)), and at the end of anaesthesia (t (2)). Two general linear models were set up to analyse the influence of demographics and clinics on the IR beta-endorphin variation between t (0) and t (1). A third model was established to process the possible surgical factors contributing to the IR beta-endorphin variation between t (1) and t (2). RESULTS: ANOVA showed that IR beta-endorphin concentrations increased significantly across the three timepoints (p < 0.0001). Wilcoxon test proved that the difference was significant both for t (0) vs. t (1) and for t (1) vs. t (2). None of the factors taken into account in the pre-operative period influenced the increase in IR beta-endorphin between t (0) and t (1). Of the factors taken into account in the surgical period, only the type of procedure was significant (p = 0.005). The t-test showed that IR beta-endorphin significantly increased during spermatic and epigastric anastomosis (p = 0.000), orchidopexy (p = 0.02), Van der Meulen urethroplasty (p = 0.004), and Duckett urethroplasty (p = 0.003). CONCLUSION: Plasmatic beta-endorphin increases during the perioperative period in children. The site of surgery is responsible for this increment during intervention.
2008
Bachiocco V; Mastrolia A; Gentili A; Pipitone E; Lima M
European Journal Of Pediatric Surgery
2008
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Journal Article
<a href="http://doi.org/10.1055/s-2007-989274" target="_blank" rel="noreferrer">10.1055/s-2007-989274</a>
Understanding Death With Limited Experience In Life: Dying Children's And Adolescents' Understanding Of Their Own Terminal Illness And Death
Adolescent; Attitude To Death; Child; Communication; Fear; Humans; Palliative Care/organization & Administration; Palliative Care/psychology; Professional-family Relations; Prognosis; Terminal Care/organization & Administration; Terminal Care/psychology; Terminally Ill/legislation & Jurisprudence; Terminally Ill/psychology; Time Factors
PURPOSE OF REVIEW: An up-to-date summary of the literature on children's and adolescents' understanding of their own terminal illness and death. RECENT FINDINGS: Clinicians still find it difficult to speak with pediatric patients about death even though guidelines for facilitating communication on the topic exist. As a result, pediatric patients are less likely to develop a clear understanding of their illness and there is a disconnect between clinicians and parents about prognosis, even when clinicians have concluded there is no longer possibility for cure. Insufficient communication and poor understanding may increase the risk of patients feeling isolated, mistrustful and anxious, and deprive them of a role model who can communicate about painful issues or share difficult feelings. Despite these complexities, young people often show remarkable resiliency in the face of death and want to get the most out of the remaining time they have. SUMMARY: In addition to these most recent findings, this review examines the challenges in researching this topic, obstacles to patients receiving information about prognosis, and how physical symptoms affect patients' ability to develop an understanding. It also reviews sources of insight into pediatric patients' understanding including the development of concepts of death, fears about their own death, legal interpretations of what patients understand, and how terminally ill young people continue to treasure life. It concludes by addressing ways clinicians can use the knowledge we have to communicate well with dying children and adolescents and their families.
Bates Alan T; Kearney Julia A
Current Opinion In Supportive And Palliative Care
2015
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10.1097/SPC.0000000000000118
Pediatric sedation with analgesia
Child; Intensive Care Units; Analgesics; Drug Therapy; Time Factors; Clinical Protocols; Anesthetics; Pediatric; Preschool; infant; Comparative Study; retrospective studies; Human; Opioid/therapeutic use; Adolescence; Fentanyl/therapeutic use; Combination; Propofol/therapeutic use; Analgesia/adverse effects/methods; Conscious Sedation/adverse effects/methods; Intravenous/therapeutic use
Sedation with analgesia is frequently required to perform painful or invasive procedures in children. The best medication combination for pediatric sedation with analgesia is yet to be identified. Sixty-four of 243 total sedation with analgesia procedures from January 1994 through August 1995 were randomly chosen for descriptive retrospective review and analysis. Four minor complications from the procedures were identified, and recovery was complete in all cases. One medication combination (fentanyl 1 microg/kg with propofol 1.5 to 2 mg/kg, followed by an infusion of 150 microg/kg/min) provided the shortest mean time to dismissal (17.8 minutes v 38 minutes) when compared with other combinations used. No episodes of respiratory depression, hypotension, or nausea and vomiting occurred in the fentanyl/propofol group. These results show that fentanyl/propofol was superior to other medications used during this study period for pediatric sedation with analgesia. Prospective comparison of this medication combination with other short-acting agents in patients undergoing both elective and emergency procedures is necessary.
1999
Bauman L; Kish I; Baumann RC; Politis GD
American Journal of Emergency Medicine
1999
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Journal Article
Was there a plan? End-of-life care for children with life-limiting conditions: a review of multi-service healthcare records
Child; Female; Humans; Male; Advance Directives; Physician-Patient Relations; Pediatrics; Practice Guidelines as Topic; Communication; Resuscitation Orders; Time Factors; quality of life; end of life; adolescent; Preschool; decision making; infant; retrospective studies; DNAR; Parents; documentation; Parents/px [Psychology]; Terminal Care; Patient Care Planning/og [Organization & Administration]; Terminal Care/og [Organization & Administration]; review; Medical Records; Neoplasms; advance planning; child and family wishes; Neoplasms/mo [Mortality]; Patient Care Planning/st [Standards]; Terminal Care/px [Psychology]
BACKGROUND: Planning for care at the end of life (EoL) is an essential component of support and care for families of children with life-limiting conditions. The purpose of this review was to compare documented EoL planning with published children's palliative care standards, across a range of children's healthcare services and to assess the impact on practice of written guidelines to support EoL care planning. METHOD: A manual retrospective review of healthcare records using a purpose-built form. Inclusion criteria were the records of children with a diagnosed life-limiting or life-threatening condition, who had died before the age of 18 years, between October 2008 and March 2010, within a defined geographical area served by one or more of the participating services. The sample was 114 sets of notes relating to a cohort of 48 children: 24 girls and 24 boys, the majority of whose deaths were cancer related. RESULTS: Examples of good practice were found in the records of individual services. Services had each developed their own systems and documents to support EoL care planning rather than using a unified documentation system. Where documented practice fell short, this was related to a lack of evidence that choice in location of death had been offered, delays in sharing of information between services, and information being buried in the narrative of the notes, making it difficult to find. CONCLUSIONS: Current documented EoL planning varies between services. Those who are infrequently involved in the provision of EoL care may benefit from support by those for whom this is part of their daily working life. These professionals can help prepare staff to engage families in these difficult but important conversations - and encourage them to document them in a way that can be easily and readily accessed and shared.
2014-03
Beringer AJ; Heckford EJ
Child: Care, Health And Development
2014
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Journal Article
<a href="http://doi.org/10.1111/cch.12020" target="_blank" rel="noreferrer">10.1111/cch.12020</a>
Esophageal coin removal by emergency physicians: a continuous quality improvement project incorporating rapid sequence intubation
Child; Female; Humans; Male; Time Factors; Preschool; infant; retrospective studies; Emergency Medicine/methods; Quality improvement; Esophagus/injuries; Foreign Bodies/surgery; Intubation/methods; Numismatics
OBJECTIVE: The objective of this study was to describe our experience removing esophageal coins from children in a tertiary care pediatric emergency department over a 4-year period. METHODS: We retrospectively reviewed a continuous quality improvement data set spanning October 1, 2004, through September 30, 2008. RESULTS: In 96 of 101 cases (95%), emergency physicians successfully retrieved the coin. The median age of the children was 19 months (interquartile range [IQR] 13-43 months; range 4 months-12.8 years). The median time to removal of coin from initiation of intubation was 8 minutes (IQR 4-14 minutes; range 1-60 minutes). Coins were extracted using forceps only in 56 cases, whereas forceps and a Foley catheter were used in the remainder. Succinylcholine and etomidate were used in almost all cases for rapid sequence intubation prior to coin removal. Complications were identified in 46 cases: minor bleeding (13), lip laceration (7), multiple attempts (5), hypoxia (3), accidental extubation (3), dental injuries (3), bradycardia (2), coin advanced (1), right main-stem bronchus intubation (1), and other (8). CONCLUSIONS: Emergency physicians successfully removed esophageal coins following rapid sequence intubation in most cases. Our approach may be considered for the management of pediatric esophageal coins, particularly in an academic pediatric emergency department.
Bhargava R; Brown L
Canadian Journal Of Emergency Medical Care
2011
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Journal Article
<a href="http://doi.org/10.2310/8000.2011.100298" target="_blank" rel="noreferrer">10.2310/8000.2011.100298</a>
Health status of bereaved parents
Child; Female; Humans; Male; Adult; Questionnaires; Death; Health Status; Longitudinal Studies; Time Factors; Case-Control Studies; adolescent; Preschool; bereavement; infant; Parents/psychology; Parent caregivers; Neoplasms/psychology
Forty-seven mothers and 33 fathers, representing 48 families, participated in a propective longitudinal study of the effects on family members of a child's dying. The purpose of this article is to describe parents' health during the terminal illness of their child and during the first year following their child's death from cancer. The Duke-UNC Health Profile was used to examine parents' health prior to and at three points in thime after the child's death. The bereavedparents' general health was compared to the health of normative sample of adults. The findings indicate that parents' health is not adversely affected by a child's death from cancer.
1996
Birenbaum LK; Stewart BJ; Phillips DS
Nursing Research
1996
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Journal Article
<a href="http://doi.org/10.1097/00005721-199705000-00019" target="_blank" rel="noreferrer">10.1097/00005721-199705000-00019</a>
Melatonin treatment in individuals with intellectual disability and chronic insomnia: a randomized placebo-controlled study
Child; Female; Humans; Male; Adult; Aged; Middle Aged; Treatment Outcome; Comorbidity; Time Factors; Double-Blind Method; adolescent; Preschool; Q3 Literature Search; Chronic disease; Saliva; Central Nervous System Depressants/adverse effects/therapeutic use; Melatonin/adverse effects/therapeutic use; Mental Retardation/epidemiology/psychology; Sleep Initiation and Maintenance Disorders/drug therapy/epidemiology/psychology
BACKGROUND: While several small-number or open-label studies suggest that melatonin improves sleep in individuals with intellectual disabilities (ID) with chronic sleep disturbance, a larger randomized control trial is necessary to validate these promising results. METHODS: The effectiveness of melatonin for the treatment of chronic sleep disturbance was assessed in a randomized double-blind placebo-controlled trial with 51 individuals with ID. All of these individuals presented with chronic ideopatic sleep disturbance for more than 1 year. The study consisted of a 1-week baseline, followed by 4 weeks of treatment. Parents or other caregivers recorded lights off time, sleep onset time, night waking, wake up time and epileptic seizures. Endogenous melatonin cycle was measured in saliva before and after treatment. RESULTS: Compared with placebo, melatonin significantly advanced mean sleep onset time by 34 min, decreased mean sleep latency by 29 min, increased mean total sleep time by 48 min, reduced the mean number of times the person awoke during the night by 0.4, decreased the mean duration of these night waking periods by 17 min and advanced endogenous melatonin onset at night by an average of 2.01 h. Lights off time, sleep offset time and the number of nights per week with night waking did not change. Only few minor or temporary adverse reactions and no changes in seizure frequency were reported. CONCLUSIONS: Melatonin treatment improves some aspects of chronic sleep disturbance in individuals with ID.
2008
Braam W; Didden R; Smits M; Curfs L
Journal Of Intellectual Disability Research
2008
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Journal Article
<a href="http://doi.org/10.1111/j.1365-2788.2007.01016.x" target="_blank" rel="noreferrer">10.1111/j.1365-2788.2007.01016.x</a>
Plasma morphine levels produced by continuous infusion in children
Child; Humans; Pain; Time Factors; adolescent; Preschool; infant; Infusions; Parenteral; Postoperative/drug therapy; Morphine/administration & dosage/blood/therapeutic use
Blood samples were taken from six children aged between 10 months and 15 years, at intervals over a period of 40 hours while they were receiving continuous morphine infusions. The plasma morphine values obtained showed similar and consistent levels 15-30 minutes after starting the infusions.
1986
Bray RJ; Beeton C; Hinton W; Seviour JA
Anaesthesia
1986
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Journal Article
<a href="http://doi.org/10.1111/j.1365-2044.1986.tb12847.x" target="_blank" rel="noreferrer">10.1111/j.1365-2044.1986.tb12847.x</a>
Immune cell-derived beta-endorphin. Production, release, and control of inflammatory pain in rats
Humans; Male; Time Factors; Analysis of Variance; Animals; Regression Analysis; Rats; Biomarkers of Pain; RNA; Genetic; Biomarkers Reference List; Inflammation/physiopathology; Freund's Adjuvant; Hindlimb; Pain/immunology/physiopathology; Corticotropin-Releasing Hormone/pharmacology; Wistar; Messenger/biosynthesis; beta-Endorphin/biosynthesis; Interleukin-1/pharmacology; Lymph Nodes/metabolism; Pro-Opiomelanocortin/biosynthesis; T-Lymphocytes/drug effects/immunology/metabolism; Transcription
Localized inflammation of a rat's hindpaw elicits an accumulation of beta-endorphin-(END) containing immune cells. We investigated the production, release, and antinociceptive effects of lymphocyte-derived END in relation to cell trafficking. In normal animals, END and proopiomelanocortin mRNA were less abundant in circulating lymphocytes than in those residing in lymph nodes (LN), suggesting that a finite cell population produces END and homes to LN. Inflammation increased proopiomelanocortin mRNA in cells from noninflamed and inflamed LN. However, END content was increased only in inflamed paw tissue and noninflamed LN-immune cells. Accordingly, corticotropin-releasing factor and IL-1beta released significantly more END from noninflamed than from inflamed LN-immune cells. This secretion was receptor specific, calcium dependent, and mimicked by potassium, consistent with vesicular release. Finally, both agents, injected into the inflamed paw, induced analgesia which was blocked by the co-administration of antiserum against END. Together, these findings suggest that END-producing lymphocytes home to inflamed tissue where they secrete END to reduce pain. Afterwards they migrate to the regional LN, depleted of the peptide. Consistent with this notion, immunofluorescence studies of cell suspensions revealed that END is contained predominantly within memory-type T cells. Thus, the immune system is important for the control of inflammatory pain. This has implications for the understanding of pain in immunosuppressed conditions like cancer or AIDS.
1997
Cabot PJ; Carter L; Gaiddon C; Zhang Q; Schafer M; Loeffler JP; Stein C
The Journal Of Clinical Investigation
1997
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Journal Article
<a href="http://doi.org/10.1172/jci119506" target="_blank" rel="noreferrer">10.1172/jci119506</a>
Starvation in man
Time Factors; Adaptation; Body Weight; Human; Homeostasis; Fasting; Gluconeogenesis; Physiological; Fatty Acids; Starvation/me [Metabolism]; Triglycerides/me [Metabolism]; Adrenal Cortex Hormones/ph [Physiology]; Alanine/me [Metabolism]; Brain/me [Metabolism]; Glucagon/me [Metabolism]; Glucose/metabolism; Glucose/pd [Pharmacology]; Insulin/me [Metabolism]; Insulin/ph [Physiology]; Kidney/me [Metabolism]; Liver/me [Metabolism]; Nitrogen/me [Metabolism]; Nonesterified/me [Metabolism]; Proteins/me [Metabolism]
1970
Cahill GF
New England Journal Of Medicine
1970
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Journal Article
<a href="http://doi.org/10.1016/s0300-595x(76)80028-x" target="_blank" rel="noreferrer">10.1016/s0300-595x(76)80028-x</a>
Hormonal response to surgical stress in schoolchildren
Child; Humans; Prospective Studies; Time Factors; adolescent; beta-Endorphin/blood; Biomarkers of Pain; Biomarkers Reference List; Adrenocorticotropic Hormone/blood; Hydrocortisone/blood; Stress/blood
PURPOSE: To determine hormone concentrations (ACTH, cortisol, beta-endorphin) in children before and after surgery, to assess the correlation between any hormonal changes and to study the influence exercised on them by the severity of surgical stress and the elective/emergency nature of the surgery. PATIENTS AND METHODS: Prospective cohort of 78 children (age= 10+/-2.6 years, range 6-13 years) undergoing elective or emergency surgery. Preoperative and postoperative (1 and 24 hours postoperation) plasma concentrations of ACTH, cortisol and beta-endorphin were determined in all children. The severity of surgical stress was evaluated as low ( 6) according to the Oxford scale. Student's t-test was used to analyse hormonal changes and the influence of degree of surgical stress and elective/emergency character of the surgery, and Pearson's coefficient for correlations between hormonal values. p < 0.05 was regarded as significant. RESULTS: We observed a significant increase in hormonal concentrations one hour after surgery. ACTH and cortisol values normalised 24 hours after surgery, but beta-endorphin concentrations remained increased. There was a correlation between ACTH and beta-endorphin values both before surgery and one hour after. Operations with high surgical stress significantly increased cortisol concentrations one hour after surgery and beta-endorphin concentrations 24 hours after surgery. Patients selected for emergency surgery showed significantly higher concentrations of cortisol and ACTH both before and after surgery. CONCLUSIONS: Postoperative hormonal response among children of school age is characterised by increases in ACTH, cortisol and beta-endorphin one hour after surgery, and by high concentrations of beta-endorphin 24 hours after surgery. Cortisol is an index of surgical stress. Emergency surgery is associated with significant increases in ACTH and cortisol.
2001
Castejon-Casado J; Moreno-Prieto M; Valladares-Mendias JC; Alaminos-Mingorance M; Lopez-Candel E; Ramirez-Navarro A
European Journal Of Pediatric Surgery
2001
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Journal Article
<a href="http://doi.org/10.1055/s-2001-12195" target="_blank" rel="noreferrer">10.1055/s-2001-12195</a>
Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey
Female; Humans; Male; Prevalence; Questionnaires; Aged; Middle Aged; Euthanasia; Age Factors; Sex Factors; Time Factors; Suicide; 80 and over; cause of death; Active; Neoplasms/therapy; Terminal Care/statistics & numerical data; Assisted/legislation & jurisprudence/statistics & numerical data; Home Care Services/statistics & numerical data; Belgium/epidemiology; Euthanasia/legislation & jurisprudence/statistics & numerical data; Voluntary/statistics & numerical data
BACKGROUND: Legalization of euthanasia and physician-assisted suicide has been heavily debated in many countries. To help inform this debate, we describe the practices of euthanasia and assisted suicide, and the use of life-ending drugs without an explicit request from the patient, in Flanders, Belgium, where euthanasia is legal. METHODS: We mailed a questionnaire regarding the use of life-ending drugs with or without explicit patient request to physicians who certified a representative sample (n = 6927) of death certificates of patients who died in Flanders between June and November 2007. RESULTS: The response rate was 58.4%. Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient's explicit request, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids. INTERPRETATION: Physician-assisted deaths with an explicit patient request (euthanasia and assisted suicide) and without an explicit request occurred in different patient groups and under different circumstances. Cases without an explicit request often involved patients whose diseases had unpredictable end-of-life trajectories. Although opioids were used in most of these cases, misconceptions seem to persist about their actual life-shortening effects.
2010
Chambaere K; Bilsen J; Cohen J; Onwuteaka-Philipsen BD; Mortier F; Deliens L
Canadian Medical Association Journal
2010
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Journal Article
<a href="http://doi.org/10.1503/cmaj.091876" target="_blank" rel="noreferrer">10.1503/cmaj.091876</a>
Emotionally focused interventions for couples with chronically ill children: a 2-year follow-up
Child; Female; Humans; Male; Follow-Up Studies; Treatment Outcome; Ontario; Time Factors; Cost of Illness; Analysis of Variance; Family Characteristics; Stress; Preschool; Adaptation; Psychological; Parents/psychology; Intervention; Interventions; Chronic Disease/psychology; Spouses/psychology; Marriage/psychology; Psychological/etiology; Marital Therapy/methods
Couples with chronically ill children are particularly at risk for experiencing marital distress. The study presented here is a 2-year follow-up of a randomized control trial that assessed the efficacy of Emotionally Focused Therapy (EFT) in decreasing marital distress in a sample of couples with a chronically ill child. Thirteen couples with chronically ill children who received treatment were assessed to determine if the significant improvement in relationship distress observed at posttreatment and 5-month follow-up would be maintained at 2-year follow-up. Results demonstrated that improvements in marital functioning were not only maintained but, in some cases, enhanced at the 2-year follow-up. This uncontrolled follow-up study provides initial evidence of the longer-term benefits of EFT.
2002
Cloutier PF; Manion IG; Walker JG; Johnson SM
Journal Of Marital And Family Therapy
2002
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Journal Article
<a href="http://doi.org/10.1111/j.1752-0606.2002.tb00364.x" target="_blank" rel="noreferrer">10.1111/j.1752-0606.2002.tb00364.x</a>
Sleep problems in children with Sanfilippo syndrome.
Child; Female; Humans; Male; Questionnaires; Longitudinal Studies; Time Factors; Preschool; Sleep Disorders/etiology; Sleep Disorders/therapy; Mucopolysaccharidosis III/classification; Mucopolysaccharidosis III/complications
Sanfilippo syndrome is a rare degenerative disorder which has severe intellectual and behavioural sequelae, commonly including sleep problems. A parental questionnaire was used to gather information on the sleep patterns of 80 children with Sanfilippo syndrome (mean age 10 years 2 months). The majority were found to have sleep problems (78%). Many also exhibited other distressing and unusual night time behaviours (staying up all night, chewing the bedclothes or crying out suddenly), and a few laughed or sang. Such problems may have been more severe in those with Sanfilippo syndrome type B. In four of the families offered individually tailored behaviour-management advice there was immediate improvement, which was maintained at followup in two cases. These results demonstrate the usefulness of even such a minimal intervention, even in a very difficult population such as this.
1996
Colville GA; Watters JP; Yule W; Bax M
Developmental Medicine And Child Neurology
1996
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1111/j.1469-8749.1996.tb12114.x" target="_blank" rel="noreferrer">10.1111/j.1469-8749.1996.tb12114.x</a>
Hospital charges for a community inpatient palliative care program
Female; Humans; Male; Adult; Aged; Middle Aged; Time Factors; Hospitals; Chi-Square Distribution; Tennessee; 80 and over; Comparative Study; referral and consultation; Palliative Care/economics/organization & administration/utilization; Cost Control; Hospital Costs/statistics & numerical data; Community/economics/utilization; Hospital Charges/statistics & numerical data; Length of Stay/economics/statistics & numerical data; Patient Admission/economics; Patient Discharge/economics
Defining financial parameters of palliative care (PC) is important for providing sustainable programming. In our study, we evaluated hospital length of stay (LOS) and charges for the first 164 inpatient PC consultations performed by the Advanced Illness Assistance (AIA) team at Blount Memorial Hospital (BMH). These AIA patients had a median LOS of 11 days (range, 3-114 days), mean total charges per patient of 65,795 dollars, and mean daily charges of 3,809 dollars. Higher mean daily charges (p = 2.74 E-08, chi-square) were associated with patients who received consultation because of nonphysical symptom reasons. Patients were followed in PC consultation (AIA follow-up days) for a median of five days (range, 1-48), and had mean daily charges of 3,117 dollars. These mean daily charges were 414 dollars less than the charges for the five days prior to PC consultation (pre-AIA days) (p = 0.04, t-test). There was a significant decrease in laboratory and imaging charges during AIA follow-up (p = 0.04, t-test). The study included a reference group of patients whose information was obtained retrospectively from the BMH Atlas (MediQual, Marlborough, MA) database. These reference group patients were hospitalized at BMH during the same time, but they were not seen by the AIA team. The reference group was matched by Diagnosis Related Group (DRG), Admission Severity Grade (ASG), and disposition to the AIA patients. The Atlas patients had a shorter median LOS of six days (range, 1-105 days), and significantly greater mean daily charges of 4,105 dollars (p = 0.006, t-test) compared with AIA patients. Mean daily charges decreased for Atlas patients, as their day of discharge approached (p < 0.001). Estimates of potential charge savings were calculated in two ways: 1) by evaluating the effect of decreasing the LOS of Atlas patients with long LOS (more than seven days) to the level of AIA patients with long LOS, and 2) by comparing the actual mean patient charges during AIA follow-up with using the pre-AIA mean daily charges during the AIA follow-up period and correcting for the effect of decreasing charges that occurred as discharge approached. The estimated savings achieved by decreasing long LOS were more than 100,000 dollars per year, and estimated savings achieved using AIA follow-up charges were more than 1,801,930 dollars per year.
2004
Cowan JD
The American Journal Of Hospice & Palliative Care
2004
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Journal Article
<a href="http://doi.org/10.1177/104990910402100306" target="_blank" rel="noreferrer">10.1177/104990910402100306</a>
Moving on from paediatric to adult health care: an initial evaluation of a transition program for young people with cystic fibrosis
Cross-Sectional Studies; Female; Humans; Male; Adult; Questionnaires; Middle Aged; Age Factors; Program Development; Program Evaluation; Patient Satisfaction; Time Factors; Adolescent Health Services; Sickness Impact Profile; quality of life; adolescent; Adolescent Transitions; Chronic disease; Continuity of Patient Care/organization & administration; Cystic Fibrosis/psychology/therapy
BACKGROUND AND OBJECTIVE: Although there are general guidelines for adolescents with chronic illnesses making the transition from paediatric to adult health care, there are few studies which evaluate transition programs. This cross-sectional study was a preliminary evaluation of a transition program for young people with cystic fibrosis. Study group and methods: A self-administered questionnaire was completed by a group of 'pre-transition' adolescents and their parents who had not moved on to adult health care and a 'post-transition' group who had moved on from the Children's Hospital at Westmead over a six year period. The questionnaire examined patient and parent concerns about adult health care, participation in steps of the transition process, satisfaction with transition and health related quality of life. Measures of disease severity (lung function tests and body mass index) were also included. RESULTS: 137 out of 220 (62%) eligible participants completed the questionnaire. In the pre-transition group, parents had more concerns compared to young people. There was no evidence of a significant difference between pre-transition and post-transition young people regarding degree of concern. Most people were satisfied with the transition program and posttransition patients and parents who completed more steps in the transition program described the overall transition process more positively. There was no evidence of a relationship between amount of participation in transition and measures of disease severity or quality of life.
2007
Craig SL; Towns S; Bibby H
International Journal Of Adolescent Medicine And Health
2007
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Journal Article
<a href="http://doi.org/10.1515/ijamh.2007.19.3.333" target="_blank" rel="noreferrer">10.1515/ijamh.2007.19.3.333</a>
A Time to Live and a Time to Die: Heterotopian Spatialities and Temporalities in a Pediatric Palliative Care Team
Anthropology; Attitude to Death; child; communication; death; humans; palliative care; Parents/psychology; patient care team; pediatric hospitals; pediatrics; spatial analysis; time factors; uncertainty
The death of a child creates especially poignant feelings and extreme stress, distress, and devastation for family members and healthcare providers. In addition, serious or long-term illness forces a reconstruction of our experiences with time and space. In this paper, we report on a long-term ethnographic study of a Pediatric Palliative Care Team (PPCT). Using the concepts of spatiality and temporality; Deleuze's concepts of smooth and striated spaces; Innis's concepts of space and time biases; Foucault's concept of heterotopian space-places with multiple layers of meaning; and a related concept of heterokairoi-moments in time with multiple possibilities-we consider how the PPCT constructs and reconstructs meaning in the midst of chaos, ethical dilemmas, and heartbreaking choices.
Davis C S; Snider M J; King L; Shukraft A; Sonda J D; Hicks L; Irvin L
Health Communication
2019
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<a href="http://doi.org/10.1080/10410236.2018.1443262" target="_blank" rel="noreferrer noopener">10.1080/10410236.2018.1443262</a>
Long-term outcome and clinical spectrum of 73 pediatric patients with mitochondrial diseases
Child; Female; Humans; infant; Male; Cohort Studies; Follow-Up Studies; Severity of Illness Index; Survival Analysis; Longitudinal Studies; Probability; Time Factors; Proportional Hazards Models; Preschool; infant; Q3 Literature Search; Newborn; AIM; IM; retrospective studies; cause of death; DNA; Mitochondrial Diseases/ge [Genetics]; Mitochondrial/ge [Genetics]; MELAS Syndrome/di [Diagnosis]; Mitochondrial Encephalomyopathies/di [Diagnosis]; DNA Fragmentation; HEREDITARY; Leber/di [Diagnosis]; Leber/ge [Genetics]; Leber/mo [Mortality]; MELAS Syndrome/mo [Mortality]; MELAS Syndrome/th [Therapy]; Mitochondrial Diseases/di [Diagnosis]; Mitochondrial Diseases/mo [Mortality]; Mitochondrial Encephalomyopathies/mo [Mortality]; Mitochondrial Encephalomyopathies/th [Therapy]; Mitochondrial Myopathies/di [Diagnosis]; Mitochondrial Myopathies/ge [Genetics]; Mitochondrial Myopathies/mo [Mortality]; Optic Atrophy
OBJECTIVES: We sought to determine the clinical spectrum, survival, and long-term functional outcome of a cohort of pediatric patients with mitochondrial diseases and to identify prognostic factors. METHODS: Medical charts were reviewed for 73 children diagnosed between 1985 and 2005. The functional status of living patients was assessed prospectively by using the standardized Functional Independence Measure scales. RESULTS: Patients fell into 7 phenotypic categories: neonatal-onset lactic acidosis (10%), Leigh syndrome (18%), nonspecific encephalopathy (32%), mitochondrial (encephalo)myopathy (19%), intermittent neurologic (5%), visceral (11%), and Leber hereditary optic neuropathy (5%). Age at first symptoms ranged from prenatal to 16 years (median: 7 months). Neurologic symptoms were the most common (90%). Visceral involvement was observed in 29% of the patients. A biochemical or molecular diagnosis was identified for 81% of the patients as follows: deficiency of complex IV (27%), of pyruvate dehydrogenase or complex I (25% each), of multiple complexes (13%), and of pyruvate carboxylase (5%) or complexes II+III (5%). A mitochondrial DNA mutation was found in 20% of patients. At present, 46% of patients have died (median age: 13 months), 80% of whom were 5 years (n = 32), 62% had Functional Independence Measure quotients of >0.75. CONCLUSIONS: Mitochondrial diseases in children span a wide range of symptoms and severities. Age at first symptoms is the strongest predictor mortality. Despite a high mortality rate in the cohort, 62% of patients aged >5 years have only mild impairment or normal functional outcome.
2007
Debray FG; Lambert M; Chevalier I; Robitaille Y; Decarie JC; Shoubridge EA; Robinson BH; Mitchell GA
Pediatrics
2007
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Journal Article
<a href="http://doi.org/10.1542/peds.2006-1866" target="_blank" rel="noreferrer">10.1542/peds.2006-1866</a>
Comparison of different bolus doses of morphine for patient-controlled analgesia in children
Child; Female; Male; Pain; Pain Measurement; Time Factors; Non-U.S. Gov't; Comparative Study; Nausea/chemically induced; Human; Support; Adolescence; Patient-Controlled; Sleep/drug effects; Vomiting/chemically induced; Appendectomy; Analgesia; Morphine/administration & dosage/adverse effects; Postoperative/prevention & control
Forty children undergoing appendicectomy were allocated randomly to receive one of two PCA regimens with morphine. Group B10 received bolus doses of 10 micrograms kg-1 and group B20 received bolus doses of 20 micrograms kg-1. In both groups there was a lockout interval of 5 min and a background infusion of 4 micrograms kg-1 h-1. Group B20 self-administered considerably more morphine (P < 0.01) than group B10. There was no difference between the pain scores of the groups at rest. Group B20 had significantly (P < 0.05) smaller pain scores during movement than group B10 and the latter group suffered significantly (P < 0.01) more hypoxaemic episodes than group B20. There were no differences between the groups in the incidence of vomiting, excess sedation or the amount of time spent asleep at night.
1994
Doyle E; Mottart KJ; Marshall C; Morton NS
British Journal Of Anaesthesia
1994
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Journal Article
<a href="http://doi.org/10.1093/bja/72.2.160" target="_blank" rel="noreferrer">10.1093/bja/72.2.160</a>
Hunger disease
Humans; Nutritional Support; Health Status; Time Factors; Adaptation; Energy Metabolism; Body Composition; Physiological; Starvation/metabolism; Adipose Tissue/metabolism; Appetite/physiology; Eating/physiology; Hunger/physiology; Nutrition Disorders/metabolism; Obesity/metabolism/physiopathology; Weight Loss/physiology
This paper examines three aspects of hunger disease: the effect of initial fat stores on macronutrient fuel selection during total starvation (no energy) and how it influences survival; the effects of different rates of weight loss on tissue and body function; and the importance of appetite sensations, including hunger, during malnutrition and during enteral and parenteral nutritional support. Long-term starvation studies in humans reveal major differences in fat carbohydrate and protein metabolism between lean and obese subjects, including a 2-4-fold lower contribution of protein oxidation to energy expenditure in obese subjects, which ensures that more of the excess body fat is oxidized. The rate of weight loss, determined by recent dietary intake, can have major effects on tissue and body function, including wound healing, the acute phase protein response, muscle fatigue and psychological/behavioural function in both clinical and non-clinical settings. In depleted states uncomplicated by disease, changes in appetite sensations can result in energy intakes as high as 6000 to 10,000 kcal/day ( 25-42 MJ/day). Long-term enteral tube feeding and parenteral nutrition are associated with frequent disturbances in appetite sensations, and in those able to eat normally they tend to add rather than replace oral intake to an extent that appears to depend on the regimen. It is concluded that 1) differences between lean and obese subjects in macronutrient fuel selection during starvation are adaptive because they optimize survival in both groups of subjects; 2) the rate of weight loss in health and disease has a major effect on certain tissue and body functions, independently of the magnitude of weight loss; and 3) clinically relevant disturbances in appetite sensations are common subjects receiving long-term enteral and parenteral nutrition. The clinical modulation of all these variables would be aided by greater knowledge of the mechanisms involved.
2000
Elia M
Clinical Nutrition (edinburgh, Scotland)
2000
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Journal Article
<a href="http://doi.org/10.1054/clnu.2000.0157" target="_blank" rel="noreferrer">10.1054/clnu.2000.0157</a>
Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study
Child Mortality; Infant Mortality; Caregivers/psychology; Child; Communicable Diseases/ mortality; Educational Status; Female; Health Services Accessibility/ statistics & numerical data; Humans; infant; infectious diseas; Length of Stay; Logistic Models; Male; Patient Acceptance of Health Care/psychology; Patient Discharge/ statistics & numerical data; Pediatrics; post-discharge mortality; Preschool; qualitative interviews; Time Factors; Uganda; Uganda/epidemiology; Water Supply
BACKGROUND: Out-of-hospital death among children living in resource poor settings occurs frequently. Little is known about the location and circumstances of child death following a hospital discharge. OBJECTIVES: This study aimed to understand the context surrounding out-of-hospital deaths and the barriers to accessing timely care for Ugandan children recently discharged from the hospital. METHODS: This was a mixed-methods sub-study within a larger cohort study of post-discharge mortality conducted in the Southwestern region of Uganda. Children admitted with an infectious illness were eligible for enrollment in the cohort study, and then followed for six months after discharge. Caregivers of children who died outside of the hospital during the six month post-discharge period were eligible to participate in this sub-study. Qualitative interviews and univariate logistic regression were conducted to determine predictors of out-of-hospital deaths. RESULTS: Of 1,242 children discharged, 61 died during the six month post-discharge period, with most (n=40, 66%) dying outside of a hospital. Incremental increases in maternal education were associated with lower odds of out-of-hospital death compared to hospital death (OR: 0.38, 95% CI: 0.19 - 0.81). The qualitative analysis identified health seeking behaviors and common barriers within the post-discharge period which delayed care seeking prior to death. For recently discharged children, caregivers often expressed hesitancy to seek care following a recent episode of hospitalization. CONCLUSION: Mortality following discharge often occurs outside of a hospital context. In addition to resource limitations, the health knowledge and perceptions of caregivers can be influential to timely access to care. Interventions to decrease child mortality must consider barriers to health seeking among children following hospital discharge.
2016-12
English L; Kumbakumba E; Larson CP; Kabakyenga J; Singer J; Kissoon N; Ansermino JM; Wong H; Kiwanuka J; Wiens MO
African Health Sciences
2016
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<a href="http://doi.org/10.4314/ahs.v16i4.2" target="_blank" rel="noreferrer">10.4314/ahs.v16i4.2</a>
Status epilepticus in children: aetiology, treatment, and outcome
Child; Female; Male; Prevalence; Follow-Up Studies; Treatment Outcome; Risk Factors; Time Factors; Chi-Square Distribution; Anticonvulsants; Drug Administration Schedule; Anesthetics; Preschool; Non-U.S. Gov't; infant; retrospective studies; Human; Age Distribution; Electroencephalography; Sex Distribution; Neuropsychological Tests; Support; Adolescence; Shock; Status Epilepticus/dt [Drug Therapy]; Status Epilepticus/et [Etiology]; Barbiturates/ad [Administration & Dosage]; Diazepam/ad [Administration & Dosage]; Encephalitis/co [Complications]; Intravenous/ad [Administration & Dosage]; Meningitis; Nervous System Diseases/ep [Epidemiology]; Septic/co [Complications]; Status Epilepticus/di [Diagnosis]; Status Epilepticus/ep [Epidemiology]; Streptococcal Infections/co [Complications]; Viral/co [Complications]
This retrospective study includes 65 children treated for status epilepticus at Tampere University Hospital in Finland. Aetiology of the condition, effectiveness of the treatment protocol, including short barbiturate anaesthesia to prevent prolonged status epilepticus episodes, and neurological outcome were evaluated. Symptomatic aetiology was present in 40% of status epilepticus episodes, and 37% of episodes were induced by fever. Neurological sequelae secondary to status epilepticus were identified in 15% of the cases and subsequent epilepsy in 23% during the mean follow-up time of 3.6 years. There were no status epilepticus-related deaths. The cut-off point of status epilepticus duration for significant risk for permanent neurological sequelae was 2 hours. Our treatment protocol, including short barbiturate anaesthesia in refractory cases, was able to abort status epilepticus in less than 2 hours in 75% of cases. We conclude that early and prompt use of barbiturate anaesthesia should be encouraged, and may explain our low morbidity figures.
1997
Eriksson KJ; Koivikko MJ
Developmental Medicine & Child Neurology
1997
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Journal Article
<a href="http://doi.org/10.1111/j.1469-8749.1997.tb07358.x" target="_blank" rel="noreferrer">10.1111/j.1469-8749.1997.tb07358.x</a>
No change in serum melatonin, or plasma beta-endorphin levels after sevoflurane anesthesia
Female; Humans; Cohort Studies; Adult; Prospective Studies; Middle Aged; Time Factors; Reference Values; Anesthetics; Anesthesia; beta-Endorphin/blood/drug effects; Blood Pressure/drug effects; Dilatation and Curettage/methods; Electroencephalography/methods; General/methods; Heart Rate/drug effects; Inhalation/administration & dosage/pharmacology; Melatonin/blood; Methyl Ethers/administration & dosage/pharmacology; Oximetry/methods; Oxygen/blood; Postoperative Period; Sleep/drug effects
STUDY OBJECTIVE: To investigate the effect of sevoflurane as single anesthetic on melatonin and beta-endorphin plasma levels during the first 24 hours postoperatively. DESIGN: Prospective, open-cohort study. SETTING: University hospital. PATIENTS: 13 ASA physical status I and II, adults, scheduled for dilatation and curettage of the uterus, and 13 healthy volunteers. INTERVENTIONS: Patients received general anesthesia with sevoflurane. MEASUREMENTS: Melatonin and beta-endorphin plasma levels were determined before anesthesia, immediately after, and two, 4, 8, and 24 hours after the end of anesthesia. Melatonin and beta-endorphin were also measured in 13 healthy subjects (controls) not undergoing anesthesia at similar times during the day. Systolic and diastolic blood pressure, heart rate, bispectral index, and oxygen saturation via pulse oximeter (SpO(2)) were recorded before and after anesthesia. Quality of sleep postoperatively was also assessed. MAIN RESULTS: Melatonin levels (pg/mL) in the patients and controls were 8.2 +/- 7.9 versus 15.2 +/- 15.0 before anesthesia and 7.7 +/- 7.9 versus 11.1 +/- 7.0, 6.5 +/- 6.1 versus 15.6 +/- 16.3, and 19.5 +/- 17.9 versus 23.7 +/- 23.3 at the end of anesthesia and 4 and 24 hours after the end of anesthesia, respectively (P = 0.057). At the same time points, beta-endorphin plasma levels (pmol/L) in patients and controls were 5.2 +/- 2.0 versus 4.0 +/- 2.3, 5.4 +/- 3.3 versus 3.9 +/- 2.5, 4.9 +/- 1.2 versus 4.4 +/- 1.7, and 3.7 +/- 2.6 versus 4.2 +/- 1.8, respectively (P= 0.285). The quality of sleep assessed clinically was not altered. CONCLUSION: Sevoflurane as a single anesthetic for minor gynecological procedures did not influence significantly melatonin or beta-endorphin plasma levels. Sleep quality assessed clinically was not influenced.
2007
Fassoulaki A; Kostopanagiotou G; Meletiou P; Chasiakos D; Markantonis S
Journal Of Clinical Anesthiology
2007
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Journal Article
<a href="http://doi.org/10.1016/j.jclinane.2006.07.003" target="_blank" rel="noreferrer">10.1016/j.jclinane.2006.07.003</a>
Methadone Conversion In Infants
And Children: Retrospective Cohort Study Of 199 Pediatric Inpatients.
Administration Oral; Adolescent; Age Factors; Analgesics Opioid/administration & Dosage; Analgesics Opioid/adverse Effects; Child; Child Preschool; Consciousness/drug Effects; Drug Administration Schedule; Drug Dosage Calculations; Drug Monitoring; Drug Overdose/etiology; Drug Substitution; Hospitals Pediatric; Humans; Infant; Infant Newborn; Inpatients; Intubation Intratracheal; Methadone/administration & Dosage; Methadone/adverse Effects; Minnesota; Pain/diagnosis; Pain/drug Therapy; Pharmacy Service Hospital; Respiration Artificial; Retrospective Studies; Risk Factors; Substance Withdrawal Syndrome/etiology; Tertiary Care Centers; Time Factors; Treatment Outcome; Substances; Analgesics Opioid; Methadone
OBJECTIVE:
Methadone administration has increased in pediatric clinical settings. This review is an attempt to ascertain an equianalgesic dose ratio for methadone in the pediatric population using standard adult dose conversion guidelines.
SETTING:
US tertiary children's hospital.
PATIENTS:
Hospitalized pediatric patients, 0-18 years of age.
MAIN OUTCOME MEASURES:
A retrospective chart review was conducted for patients who were converted from their initial opioid therapy regimen (morphine, hydromorphone, and/or fentanyl) to methadone. The primary endpoint was whether or not a dose correction was needed for methadone in the 6 days following conversion using standard dose conversion charts for adults. Documented clinical signs of withdrawal, unrelieved pain, or oversedation were examined.
RESULTS:
The majority (53.7 percent) of the 199 children were converted to methadone on intensive care units prior extubation or postextubation. The mean conversion ratio was 23.7 mg of oral morphine to 1 mg of oral methadone (median, 18.8 mg:1 mg, SD=25.7). Most patients experienced an adequate conversion (n=115, 57.8 percent), while 83 (41.7 percent) appeared undermedicated, and one child was oversedated. There were no associations found with conversion ratios for initial morphine dose, days to conversion, or effect of withdrawal of concomitant agents with potential for withdrawal.
CONCLUSIONS:
Opioid conversion to methadone is commonly practiced at our institution; however, dosing was significantly lower compared to adult conversion ratios, and more than 40 percent of children were undermedicated. The majority of children in this study received opioids for sedation while intubated and ventilated; therefore, safe and efficacious pediatric methadone conversion rates remain unclear. Prospective studies are needed.
Fife A; Postier A; Flood A; Friedrichsdorf SJ
Journal Of Opioid Management
2016
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Planning for the end of children's lives--the lifetime framework.
Child; Humans; Parent-Child Relations; Attitude to Death; Time Factors; Delphi Technique; adolescent; Preschool; decision making; infant; DNAR; Palliative Care/st [Standards]; Terminal Care/st [Standards]; Advance Care Planning/st [Standards]; Child Health Services/og [Organization & Administration]
AIM: This paper describes the development of 'a best practice framework', following review of a sample of notes of children known to the Lifetime Service, where the child has a non-malignant life limiting condition, to improve child and family engagement in the planning process at the end of life., BACKGROUND: There is very little literature about how to engage with families to decide end of life plans for children with life limiting conditions., METHOD: An audit of clinical case notes was followed by the development of 'a best practice framework' through a Delphi process involving clinical practitioners., RESULTS: The 3 x 3 framework is presented to aid communication with parents and children at this difficult time of decision-making., CONCLUSION: This new framework has been well received by both parents and practitioners, and its use will be audited in the future.
2008
Finlay F; Lewis M; Lenton S; Poon M
Child: Care, Health And Development
2008
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Journal Article
<a href="http://doi.org/10.1111/j.1365-2214.2008.00843.x" target="_blank" rel="noreferrer">10.1111/j.1365-2214.2008.00843.x</a>
Occurrence of withdrawal in critically ill sedated children
Child; Female; Male; Analgesics; Respiration; Time Factors; Medical Records; adolescent; Preschool; infant; retrospective studies; Dose-Response Relationship; Drug; Human; Artificial; Barbiturate/adverse effects; Critical Care/methods; Midazolam/adverse effects; Morphine/adverse effects; Nonbarbiturate/adverse effects; Opioid/adverse effects; Pentobarbital/adverse effects; Sedatives; Substance Withdrawal Syndrome/etiology/therapy
OBJECTIVES: To record the number of children with withdrawal symptoms after the administration of sedatives for mechanical ventilation, and to discuss the possible connection with the administration of midazolam. DESIGN: Retrospective data collection from case records and charts. SETTING: Medical and surgical intensive care unit (ICU) in a university hospital. PATIENTS: Children 6 months to 14 yrs of age who required sedation for mechanical ventilation (n = 40). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Kind and amount of sedatives and analgesics, duration of administration, and occurrence of withdrawal symptoms. The frequency of withdrawal symptoms was 35% (14/40) of the sedated children. A total dose of midazolam of >60 mg/kg was strongly significantly associated with occurrence of withdrawal. Statistical analysis to determine the occurrence of withdrawal associated with the administration of morphine was not possible. CONCLUSIONS: Signs and symptoms of a withdrawal reaction were observed in several children. The occurrence of withdrawal was statistically related to high doses of midazolam, but it was not possible to determine the influence of morphine. If large doses of midazolam and opioids have been administered, there may be justification for reducing the dose gradually instead of abruptly, or using longer-acting benzodiazepines or opioids on discontinuation of sedation.
1999
Fonsmark L; Rasmussen YH; Carl P
Critical Care Medicine
1999
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Journal Article
Bereaved Parents’ and Siblings’ Reports of Legacies Created by Children With Cancer
Child; Female; Humans; Male; Adult; Parents; Family Relations; Siblings; Qualitative Research; Time Factors; childhood cancer; adolescent; Adaptation; Psychological; bereavement; Psychological; Stress; bereaved parent; Neoplasms/psychology; sibling bereavement; bereaved sibling; legacy; pediatric death
This qualitative study explored bereaved parents’ and siblings’ reports of legacies created by children with advanced cancer. Participants included 40 families of children who died from cancer, with 36 mothers, 27 fathers, and 40 siblings (ages 8-18 years). Individual interviews were completed at home approximately 10.68 months (SD = 3.48) after the child’s death. Content analysis of interviews indicated that many children living with cancer did specific things to be remembered, such as making crafts for others, willing away belongings, writing letters to loved ones, and giving special gifts. Some children, particularly those who were very ill or died unexpectedly, did not intentionally do or say anything to be remembered. Legacies included bereaved individuals remembering children’s qualities, concern for family, and beliefs about afterlife. Having advanced cancer appeared to motivate children to influence others’ lives and prepare for their own deaths. Children’s advice about how to live life inspired bereaved family members. Findings contribute to the current knowledge of legacy-making in children and offer implications for practice and future research.
2009-11
Foster TL; Gilmer MJ; Davies B; Barrera M; Fairclough D; Vannatta K; Gerhardt CA
Journal Of Pediatric Oncology Nursing
2009
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Journal Article
<a href="http://doi.org/10.1177/1043454209340322" target="_blank" rel="noreferrer">10.1177/1043454209340322</a>
Changes in siblings after the death of a child from cancer.
adolescent; Child; Cross-Sectional Studies; Female; Humans; Male; bereavement; Death; Neoplasms; Adult; Parents; Middle Aged; Siblings; Qualitative Research; Time Factors; Nursing Methodology Research; Adaptation; Psychological; IM; sibling bereavement; N
IMPLICATIONS FOR PRACTICE: Our findings offer guidance to improve aftercare for bereaved siblings and their families. Additional research is needed to further delineate the needs of bereaved siblings and to develop strategies to promote adaptation to loss.
Foster TL; Gilmer MJ; Vannatta K; Barrera M; Davies B; Dietrich MS; Fairclough DL; Gerhardt CA
Cancer Nursing
2012
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/NCC.0b013e3182365646" target="_blank" rel="noreferrer">10.1097/NCC.0b013e3182365646</a>
Fasting associated with decrease in hypothalamic beta-endorphin
Male; Time Factors; Animals; Rats; Non-U.S. Gov't; Research Support; Fasting; Corticotropin/metabolism; Endorphins/metabolism; Hypothalamus/metabolism; Pituitary Gland/metabolism
In rats that were fasted for 2 to 3 days there was a decline in hypothalamic, but not pituitary, beta-endorphin. There was no change in pituitary or hypothalamic adrenocorticotropin content as a result of fasting. Endogenous opiates may be involved in physiological adaptation to fasting.
1980
Gambert SR; Garthwaite TL; Pontzer CH; Hagen TC
Science
1980
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1126/science.6254156" target="_blank" rel="noreferrer">10.1126/science.6254156</a>
The course of high-sensitive C-reactive protein in correlation with pain and clinical function in patients with acute lumbosciatic pain and chronic low back pain - a 6 months prospective longitudinal study
Female; Humans; Male; Pain Measurement; Cohort Studies; Adult; Middle Aged; Time Factors; Acute Disease; Chronic disease; C-Reactive Protein/metabolism; Low Back Pain/blood/physiopathology/therapy; Recovery of Function/physiology; Sciatica/blood/physiopathology/therapy
In this prospective longitudinal study with a follow-up of 6 months, the course of serum concentration of C-reactive protein was measured by an ultrasensitive immunoassay in 31 patients with acute lumbosciatic pain and 41 patients with chronic low back pain. High-sensitive CRP (hsCRP), pain and clinical function were assessed at ten fixed time-points during follow-up. The course of hsCRP values was assessed in relation to the course of pain and clinical function adjusting for possible confounding factors. At the beginning of the study, there were no statistically significant differences in mean hsCRP levels in patients with acute lumbosciatic pain (1.49mg/l) compared to the levels obtained in patients with chronic low back pain (1.30mg/l) and those in a control group from the general population (1.26mg/l). In patients with acute lumbosciatic pain, hsCRP declined significantly in the initial period of 3 weeks with a corresponding decrease in pain and improvement in function and clinical evaluation as assessed with the straight leg raising test (SLR), whereas after this period, the course of the hsCRP did not correspond with the clinical parameters. In patients with chronic low back pain, hsCRP remained approximately constant throughout the whole period with no correlation with pain or function. As a conclusion, according to this study levels of hsCRP do not have a major clinical relevance when evaluating the long-term course of patients with acute lumbosciatic pain and chronic low back pain and therefore should not be taken into primary consideration when decisions on therapy are made.
2006
Gebhardt K; Brenner H; Sturmer T; Raum E; Richter W; Schiltenwolf M; Buchner M
European Journal Of Pain
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.ejpain.2005.11.005" target="_blank" rel="noreferrer">10.1016/j.ejpain.2005.11.005</a>
Pediatric acute pain management
Child; infant; Analgesics; Time Factors; Acute Disease; Nebulizers and Vaporizers; Anesthetics; Preschool; infant; Chronic disease; Newborn; Infusions; Intravenous; Human; Local/therapeutic use; Nerve Block/methods; Non-Narcotic/administration & dosage/therapeutic use; Opioid/administration & dosage/blood/therapeutic use; Pain/drug therapy/physiopathology
The past decade has brought about an explosion of knowledge about the physiology of nociception and many new techniques for pain relief, new analgesic drugs, and new applications of old analgesic drugs. These techniques include methods of opioid administration by transdermal and transmucosal absorption and the use of neuraxial analgesia for the management of pain in children. Interest in the use of regional anesthesia in children has been rekindled, and analgesic properties and pre-emptive analgesic properties of many agents not typically considered analgesics, such as clonidine and ketamine, have been recognized. Perhaps the greatest advance has been the paradigm shift in the recognition that pain not only exists in infants and children but also is a significant cause of morbidity and even mortality. Given the unprecedented interest in pain management in adults and children, physicians can now look forward to the development of new methods of drug delivery and of receptor-specific drugs that divorce analgesia from the untoward side effects of existing analgesics. Improvement in the quality of life of hospitalized children also will occur.
2000
Golianu B; Krane EJ; Galloway KS; Yaster M
Pediatric Clinics Of North America
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0031-3955(05)70226-1" target="_blank" rel="noreferrer">10.1016/s0031-3955(05)70226-1</a>
Factors influencing death at home in terminally ill patients with cancer: systematic review
Humans; Attitude to Death; Health Services Accessibility; Death; Risk Factors; Patient Satisfaction; Time Factors; Residence Characteristics; House Calls; social support; Hospitalization/statistics & numerical data; Terminally Ill/statistics & numerical data; location of death; Neoplasms/psychology/therapy; Home Care Services/standards/statistics & numerical data/utilization; Terminal Care/psychology/statistics & numerical data/utilization
OBJECTIVES: To determine the relative influence of different factors on place of death in patients with cancer. DATA SOURCES: Four electronic databases-Medline (1966-2004), PsycINFO (1972-2004), CINAHL (1982-2004), and ASSIA (1987-2004); previous contacts with key experts; hand search of six relevant journals. REVIEW METHODS: We generated a conceptual model, against which studies were analysed. Included studies had original data on risk factors for place of death among patients, > 80% of whom had cancer. Strength of evidence was assigned according to the quantity and quality of studies and consistency of findings. Odds ratios for home death were plotted for factors with high strength evidence. RESULTS: 58 studies were included, with over 1.5 million patients from 13 countries. There was high strength evidence for the effect of 17 factors on place of death, of which six were strongly associated with home death: patients' low functional status (odds ratios range 2.29-11.1), their preferences (2.19-8.38), home care (1.37-5.1) and its intensity (1.06-8.65), living with relatives (1.78-7.85), and extended family support (2.28-5.47). The risk factors covered all groups of the model: related to illness, the individual, and the environment (healthcare input and social support), the latter found to be the most important. CONCLUSIONS: The ne of factors that influence where patients with cancer die is complicated. Future policies and clinical practice should focus on ways of empowering families and public education, as well as intensifying home care, risk assessment, and training practitioners in end of life care.
2006
Gomes B; Higginson IJ
Bmj (clinical Research Ed.)
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1136/bmj.38740.614954.55" target="_blank" rel="noreferrer">10.1136/bmj.38740.614954.55</a>
beta-Endorphin and adrenocorticotropin are selected concomitantly by the pituitary gland
Male; Time Factors; Animals; Rats; Stress; Biomarkers of Pain; Amino Acid Sequence; Hypophysectomy; Corticotropin-Releasing Hormone/pharmacology; Adrenocorticotropic Hormone/blood/secretion; Endorphins/blood/secretion; Peptides/secretion; Physiological/blood; Pituitary Gland/secretion; Protein Precursors/secretion
The opiate-like peptide beta-endorphin and adrenocorticotropin are concomitantly secreted in increased amounts by the adenohypophysis in response to acute stress or long-term adrenalectomy as well as in vitro in response to purified corticotropin releasing factor and other secretagogues. Conversely, administration of the synthetic glucocorticoid dexamethasone inhibits the secretion of both adrenocorticotropin and beta-endorphin. Thus, both hormones possess common and identical regulatory mechanisms and there may be a functional role for circulating beta-endorphin.
1977
Guillemin R; Vargo T; Rossier J; Minick S; Ling N; Rivier C; Vale W; Bloom F
Science
1977
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1126/science.197601" target="_blank" rel="noreferrer">10.1126/science.197601</a>
Course of disability and respiratory function in untreated late-onset Pompe disease
Child; Female; Humans; Male; Adult; Questionnaires; Follow-Up Studies; Aged; Middle Aged; Disease Progression; Disabled Persons; Time Factors; adolescent; Preschool; 80 and over; Q3 Literature Search; Age of Onset; Respiratory Function Tests; Glycogen Storage Disease Type II/physiopathology
Fifty-two untreated patients with late-onset Pompe disease completed questionnaires about their clinical condition and level of handicap at baseline and at 1-year (n = 41) and 2-year follow-ups (n = 40). During this period, declines in functional activities, respiratory function, handicap, and survival were recorded on a group level. This study illustrates the progressiveness of late-onset Pompe disease and indicates the need for close clinical follow-up of both children and adults with this disorder.
2006
Hagemans ML; Hop WJ; Van Doorn PA; Reuser AJ; Van der Ploeg AT
Neurology
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1212/01.wnl.0000198776.53007.2c" target="_blank" rel="noreferrer">10.1212/01.wnl.0000198776.53007.2c</a>
Ventilatory effects of morphine, pethidine and methadone in children
Child; Female; Humans; Male; Pain; Time Factors; Depression; Preschool; Non-U.S. Gov't; Research Support; Oxygen/blood; Postoperative/prevention & control; Respiration/drug effects; Chemical; Meperidine/pharmacology; Methadone/pharmacology; Morphine/pharmacology; Tidal Volume/drug effects
The ventilatory effects of single i.v. doses of morphine 0.1 mg kg-1, pethidine 0.67 mg kg-1 and methadone 0.1 mg kg-1 were compared after ophthalmic surgery in an open, randomized study in 30 children aged 3-8 yr. Ventilatory changes after each drug had distinctive profiles, with appreciable individual variation. Acutely, the decrease in ventilatory frequency was greater with pethidine and methadone than with morphine. The acute decrease in oxygen saturation was greater with methadone and pethidine than with morphine. Methadone produced a greater and longer lasting increase in end-tidal carbon dioxide and greater decrease in end-tidal oxygen than morphine or pethidine. Changes in end-tidal carbon dioxide and oxygen concentrations and saturation were most transient after pethidine and of longest duration after methadone. No child developed apnoea or hypoventilation requiring assistance.
1993
Hamunen K
British Journal Of Anaesthesia
1993
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Journal Article
<a href="http://doi.org/10.1093/bja/70.4.414" target="_blank" rel="noreferrer">10.1093/bja/70.4.414</a>
Brain metabolism during short-term starvation in humans
Female; Humans; Male; Adult; Time Factors; Tissue Distribution; Non-U.S. Gov't; Research Support; Emission-Computed; Tomography; Brain/metabolism; Starvation/metabolism; Blood Glucose/analysis; Ketone Bodies/metabolism; Arteries; Deoxyglucose/analogs & derivatives/metabolism; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Glucose/metabolism; Osmolar Concentration
During prolonged starvation, brain energy requirements are covered in part by the metabolism of ketone bodies. It is unknown whether short-term starvation of a few days' duration may lead to reduced brain glucose metabolism due to the change toward ketone body consumption. In the present study we measured the cerebral metabolism of glucose and ketone bodies in nine healthy volunteers before and after 3.5 days of starvation. Regional glucose metabolism was measured by dynamic positron emission tomography using [18F]2-fluoro-2-deoxy-D-glucose. The mean value of K1* in gray and white matter increased by 12% (p < 0.05), whereas k2* and k3* were unchanged compared with control values. Regional glucose metabolism in cortical gray matter was reduced by 26% from 0.294 +/- 0.054 to 0.217 +/- 0.040 mumol g-1 min-1 (p < 0.001). White matter glucose metabolism decreased by 27% (p < 0.02). The decrease was uniform in gray and white matter with regional decreases ranging from 24 to 30%. A determination using Fick's principle confirmed the reduction in glucose metabolism yielding a decrease of 24% from 0.307 +/- 0.050 to 0.233 +/- 0.073 mumol g-1 min-1 (p < 0.05), whereas CBF did not change (0.57 +/- 0.07 vs. 0.57 +/- 0.06 ml g-1 min-1). The global net uptake of beta-hydroxybutyrate increased 13-fold from 0.012 +/- 0.024 to 0.155 +/- 0.140 mumol g-1 min-1 (p < 0.05). Net uptake of acetoacetate and net efflux of lactate and pyruvate did not change significantly during starvation. The present study shows that the human brain adapts to the changes in energy supply as early as 3 days following initiation of starvation, at which time ketone bodies account for approximately one-fourth of the cerebral energy requirements.
1994
Hasselbalch SG; Knudsen GM; Jakobsen J; Hageman LP; Holm S; Paulson OB
Journal Of Cerebral Blood Flow And Metabolism
1994
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Journal Article
<a href="http://doi.org/10.1038/jcbfm.1994.17" target="_blank" rel="noreferrer">10.1038/jcbfm.1994.17</a>