MRI of the knee at 7.0 Tesla.

PURPOSE: Measurement protocols which have been optimized for MRI at field strengths of 1.5 T or 3 T cannot be directly transferred to 7 T. Specific absorption rate limitations, different tissue relaxation times, as well as new image artifacts require adjustments of the sequence parameters. The goal of our study was to investigate and optimize various sequences for 7 T imaging of the knee. MATERIALS AND METHODS: Starting with sequences used on a standard 1.5 T scanner, the parameters were modified to obtain optimal image contrast, maximum coverage, and the highest spatial resolution within a reasonable acquisition time. All sequences were optimized in two healthy volunteers and then tested in 10 patients with various pathologies. High-resolution 7 T images with several SE and GRE sequences were acquired and compared to 1.5 T images. RESULTS: A comparison of 1.5 T and 7 T images clearly shows the advantage of MRI at higher field strengths, especially the higher SNR which could be translated into higher spatial resolution. The MEDIC sequence appears to be very well suited for the assessment of cartilage pathologies at 7 T. Using the DESS sequence, full coverage of the knee can be obtained with a very high resolution of 0.4 x 0.4 x 1.0 mm(3) within 7 minutes. Despite optimization of the STIR sequence parameters, bone marrow edema is better visualized at 1.5 T compared to 7 T. The PD TSE renders excellent image quality at 7 T. The total acquisition time of the 7 T protocol is approximately 40 minutes. CONCLUSION: Gradient echo sequences provide excellent image contrast at very high spatial resolution in a reasonable scan time. However, not all sequences used at 1.5 T are currently well suited for high-field imaging, in particular SAR-intensive sequences. Imaging of meniscal tears and lesions of the cruciate ligaments may benefit from the higher spatial resolution. The most favorable clinical indication for knee examinations at 7 T currently appears to be cartilage imaging.

Women's perception of provider, social, and program support in an outpatient drug treatment program.

The purpose of this study was to explore perceptions of pregnant and parenting substance-abusing women in an outpatient drug treatment program regarding provider and social support. Also identified were aspects of the rehabilitation program perceived by the women as assisting them to maintain abstinence from substance use. Data were collected through a demographic questionnaire and a tool designed by the authors based on the Social Stress Model of Substance Abuse (Lindenberg et al., 1993) and the literature of social support. The majority of the women were satisfied with their social support from family and friends. Sixty-seven percent of the women felt the support received from medical providers were not adequate. Also, the majority of the women received no information on risks of drug use and pregnancy from their medical providers. The women felt the program helped maintain abstinence by providing education, coping mechanisms, resources, 12-step programs, and spiritual guidance.

Linking nursing care interventions with client outcomes: a community-based application of an outcomes model.

This article describes a conceptual model that provides an organizing framework for assessing client outcomes in community-based settings. The "Outcomes Model for Community-Based Settings" (OMCBS) examines the relationships among structure, process, and outcomes juxtaposed to the dimensions of client, provider, and setting including sample measures for each variable. OMCBS incorporates the Omaha System including its comprehensive list of client health problems, nursing interventions, and an outcome rating scale assessing client knowledge, behavior, and health status to standardize nursing care and client outcomes. The OMCBS provides a strategy to evaluate the effectiveness of nursing interventions for clients in a variety of milieus.

Drug-exposed infant cases in juvenile court: risk factors and court outcomes.

OBJECTIVE: The purpose of this study was to determine which factors were significantly associated with court outcomes for drug exposed infants in dependency court. METHOD: A longitudinal study of 118 drug exposed infant social services and juvenile court files of petitioned cases through all court hearings, using chi-squares and logistic regressions data analysis. RESULTS: There was an overrepresentation of minority mothers who were poor, unemployed, undereducated, and single, with prior referrals to the dependency system and criminal records. The chi-square analysis suggested that variables such as ethnicity, past referrals, and criminal record were significantly associated with court outcomes for all hearings, with minority cases less likely to receive family maintenance orders, and more likely to have their children placed out of home. The regression analysis however showed a different pattern. Ethnicity and prior referrals disappeared as significant risk factors altogether. Only at the initial dispositional hearing did a criminal record significantly influence court decisions. In subsequent hearings, mothers' compliance with court orders and attending court hearings became the significant factors associated with court outcomes. CONCLUSIONS: Mothers' behavior was more important for court outcomes than ethnicity, past referrals, and criminal record. It is therefore imperative that mothers are motivated to successfully comply with court orders by offering culturally appropriate services and facilitating attendance at court hearings.

Brief report: cautions against using the Stanford-Binet-IV to classify high-risk preschoolers.

OBJECTIVE: To explore concurrent and predictive validity of the Stanford-Binet: Fourth Edition (SB-IV) by comparing scores on the SB-IV with scores from the Battelle Developmental Inventory (BDI) and later achievement scores in preschoolers at risk due to very low birthweight, and/or intraventricular hemorrhage (IVH) and other medical complications. METHODS: At ages 3,4, and 5, 92 preschoolers were tested with the SB-IV and BDI as part of an 8-year early intervention follow-up. RESULTS: The SB-IV and BDI concurrent correlations at ages 3, 4, and 5 were statistically significant (r = .73-.78, p < .0001), as were predictive correlations (r = .58-.85, p < .0001). However, the BDI and SB-IV failed to place the children in the same categories for intervention services. With the BDI as the comparison measure, SB-IV failed to detect 87% of the children who were "delayed" (by BDI) at age 3 and 50% of the "delayed" children at age 5. CONCLUSIONS: Caution is recommended when using the SB-IV to assess high risk for early intervention eligibility.

An evaluation of a nurse case-managed program for children with diabetes.

This study evaluates an integrated model of care for children with diabetes that was developed at a health maintenance organization (HMO). This model program of 56 subjects included a nurse case manager, a multidisciplinary clinic team, and educational and counseling interventions to empower families to improve self-management of the children's diabetes. The purpose of the program was to improve diabetes self-management as measured by pre- and post-intervention glycosylated hemoglobin values, quality of life, and self-efficacy ratings. There were improvements in means of all measures of self-management and a statistically significant improvement in self-efficacy beliefs of the parents. The higher quality of life and self-efficacy ratings are related to adherence to a complex diabetic regimen that is critical to effective self-management. This model provides comprehensive, effective care to a service-intensive population.

Use of the child development inventory to screen high-risk populations.

This study examined the validity of a parent-report inventory, the Child Development Inventory (CDI), as a developmental screening instrument in high-risk toddlers and preschoolers. Seventy-six children, aged 15-70 months, were assessed in a neonatal high-risk developmental follow-up clinic. The data included the completion of CDIs by parents/caregivers and developmental evaluations by a physician using either the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale (CAT/CLAMS) (15-35 months) or Slosson Intelligence Test (36-70 months). Analysis revealed a good level of sensitivity (true "abnormals"--73%) and specificity (true "normals"--87%) for the CDI General Development score. The findings suggested that the CDI is a valid and useful screening instrument for high-risk infants.

The Child Development Inventory: A developmental outcome measure for follow-up of the high-risk infant.

OBJECTIVE: To examine the validity of the Child Development Inventory (CDI) compared with other commonly used measures of developmental outcomes in high-risk infants. STUDY DESIGN: Primary caregivers of 63 toddlers and preschoolers enrolled at a routine neonatal high-risk follow-up clinic completed a CDI describing their children. Only those with successfully completed CDIs were included in the analysis (n = 43). The CDI General Development Developmental Quotient was compared with the Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) and the Bayley Scales of Infant Development, 2nd Edition (BSID-II). RESULTS: Significant correlations were found between the CDI, the CAT/CLAMS (r =.87, P <.001), and the BSID-II (r =.86, P <.001). There were no significant correlations between the CDI and parent education and income. Findings revealed high sensitivity (80% to 100%) and specificity (94% to 96%) for the CDI. CONCLUSION: The CDI appears to be a useful and cost-effective screening measure for determining developmental outcomes among high-risk infants.

The pediatric emotional distress scale: a brief screening measure for young children exposed to traumatic events.

Introduced the Pediatric Emotional Distress Scale (PEDS), which was developed to quickly assess behaviors identified in empirical and theoretical literature as significantly elevated in children after experiencing traumatic events. The 21-item parent-report rating scale includes 17 general behavior items and 4 trauma-specific items. Factor analyses on the 17 items, with 475 two- to ten-year-olds (traumatic event exposure and nontraumatic event exposure), yielded 3 reliable factors labeled Anxious/Withdrawn, Fearful, and Acting Out. Factor and total scores were shown to have good internal consistency, and both test-retest and interrater reliability were at acceptable levels. Discriminant analyses demonstrated the PEDS could distinguish traumatic event exposure and nonexposure groups, although maternal education should be a significant consideration in interpretation. Future research with diverse populations who have documented trauma is needed to enhance the utility of the full PEDS scale.

Infant screening: the usefulness of the Bayley Infant Neurodevelopmental Screener and the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale.

We assessed the usefulness of the Bayley Infant Neurodevelopmental Screener (BINS) and the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale (CAT/CLAMS) for screening high-risk infant populations in a sample of 78 infants followed after premature birth and/or perinatal insults. Both measures were highly correlated with the Bayley Scales of Infant Development-II, but sensitivity and specificity analyses revealed disparities related to the tests administered and the cutoffs used. The BINS had optimal sensitivity (true positives) of 90% when referral was made for a BINS score of high or moderate. The CAT/CLAMS had excellent specificity (true negatives) of 95% to 98% but poor sensitivity (5%-36%). Until the cutoff issue can be clarified, clinicians should be cautious in using the CAT/CLAMS as the primary screening instrument in settings in which early identification of infants with developmental problems is the main goal.

Children with both developmental and behavioral needs: profile of two clinic populations.

Little has been written about evaluation and intervention services for children with a combination of behavioral and developmental needs. Two multidisciplinary clinic populations were compared, a traditional Developmental Disabilities (DD) clinic and a Behavioral-Developmental Problems (BDP) Clinic that had the additional services of a child psychiatrist. The BDP clinic children had lower IQ's and more severe overall behavioral problems than children in the traditional DD clinic, but differences were not statistically significant. Children with Attention Deficit Hyperactivity Disorder (ADHD) and other psychiatric diagnoses were referred to both clinics at comparable rates. The effort to involve qualified mental health professionals in all aspects of professional training and clinical service for the DD population should be accelerated.

Predictors of developmental outcomes for medically fragile early intervention participants.

Little is documented about the determinants of developmental outcomes for medically fragile infants who receive early intervention. In this controlled longitudinal study 65 premature infants with intraventricular hemorrhage (IVH) were randomly assigned to intervention groups beginning at 3 months adjusted age (Early) or 12 months adjusted age (Delayed). The sample was 65% African American and 35% Caucasian, and over half the youngsters were being raised by single mothers. Although cost analyses revealed that it was almost twice as expensive to begin sensorimotor intervention at the earlier age, annual comprehensive assessments revealed no significant differences in developmental outcomes based on age at start. Stepwise multiple regression analyses revealed that Maternal Education and Neonatal Medical Problems were significant predictors of outcomes at years 1, 3, 5, and 7 regardless of age at start. Related findings from other studies are discussed along with implications for policy and future research.

Impact of a natural disaster on preschool children: adjustment 14 months after a hurricane.

Fourteen months after a hurricane, young children who had experienced the storm showed significantly higher anxiety and withdrawal and more behavior problems than did children who had not. Behavioral problems decreased steadily over the six months following the storm. Mothers' distress in the hurricane's aftermath was associated with the longevity of their children's emotional and behavioral difficulties.

Determinants of responsiveness in mothers of children with intraventricular hemorrhage.

Explored relationships between maternal responsiveness and parenting stress, family, medical, and demographic factors in mothers of children born prematurely at very low birth weights with intraventricular hemorrhage. Mothers of 82 2-year-olds completed self-report questionnaires and were observed interacting with their children in free play during a yearly assessment. Path analysis (LISREL) revealed that lower maternal responsiveness, measured by the Parent/Caregiver Involvement Scale, was associated with greater demographic disadvantage and with high parent-related stress on selected subscales of the Parenting Stress Index. Child-related parenting stress was not associated with responsiveness, and severity of the child's medical condition at birth was weakly related. Results are discussed in the context of this unique population, and relevant research and measurement issues.

A comparison of children's behaviors following three types of stressors.

One purpose of this study was to examine the differences in behavior of children exposed to trauma versus no trauma. Another goal was to compare different types of traumatic events in terms of their effects on behaviors. Our analysis indicated significant differences between trauma and no trauma groups. Additional analyses indicated that those children who were allegedly sexually abused were rated as exhibiting higher levels of symptomatology on all three factors of the Pediatric Emotional Distress Scale (PEDS) as well as the Total PEDS score than the other three groups.

Drug exposed infants in the social welfare system and juvenile court.

The purpose of this research was to study how drug exposed infants were processed, following a positive toxicology screen, through the Social Services and Juvenile Court system and to construct a demographic profile of these cases. Using data (N = 284) from Social Services and Juvenile Court files in one large county this paper describes the socioeconomic profile of cases in the Social Services and Court system over an 18-month period and tracks the progress of these cases through their reviews and hearings. The data show an overrepresentation of African American and Hispanic cases compared to the relevant county population and an underrepresentation of Caucasian and Asian cases. A petition to Juvenile Court was filed in almost half of the initial cases. Among the children who were made dependents of the court, about 80% were removed from the mother and placed in reunification services. Of these one third were later returned to the family while the rest went to permanency placements outside the home.

A critical thinking model for nursing judgment.

Increasingly, the characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Critical thinking is an essential component of nursing. Yet, no clear definition or conceptualization of critical thinking for nursing judgment has existed. Lack of consensus and overlapping definitions may well diminish the profession's ability to articulate this concept and facilitate its development. This article proposes the Critical Thinking Model for Nursing Judgment, which specifies five components: specific knowledge base, experience, competencies, attitudes, and standards. The model has three levels of critical thinking: basic, complex, and commitment. It provides a definition and conceptualization of critical thinking based on a review of the literature and input from nurses and nurse educators. The model provides a first step for development of further research and educational strategies to promote critical thinking as an essential part of autonomous, excellent nursing practice.

Management style and staff nurse satisfaction in a changing environment.

In today's changing health care economic climate, attaining increased productivity of staff nurses without increasing costs is desirable. Employing a management style conducive to staff nurse job satisfaction may be one method. The article describes the findings of a research survey on perceived and desired nurse management styles and their relationship to staff nurse job satisfaction. A positive correlation (r = .48, p = .0001) was found between perceived management style and staff nurse job satisfaction. The closer the management style was to the participative group management style, the higher the level of staff nurse job satisfaction.

Concurrent validity of the Minnesota Child Development Inventory with high-risk infants.

Investigated the validity and clinical utility of the Minnesota Child Development Inventory (MCDI) as a developmental screening instrument with a sample of 280 premature infants identified as medically and socioeconomically high risk for developmental delays. Correlational analyses demonstrated significant correlations between the MCDI scales and the criterion Bayley Mental Age Equivalent score. Results of a moderator multiple regression analysis indicated that parent and child characteristics have a statistically significant "moderating" influence on the validity of the MCDI although the clinical significance of this finding may be minimal. A prediction-performance matrix analysis revealed a high degree of classification specificity (92%) but a relatively low sensitivity rating (56%). Findings suggest that the MCDI is a valid and useful screening instrument for high-risk infants but should be used diagnostically only in conjunction with other measures.