Childhood and adolescent attention-deficit hyperactivity disorder: Diagnosis, clinical practice guidelines, and social implications

Purpose: To review the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), present an overview of the effects that ADHD has on family dynamics, school performance, and substance abuse, and provide an overview of the American Academy of Pediatrics (AAP) clinical practice and treatment guidelines.
Data sources: An extensive health science literature review was carried out using PubMed and Cumulative Index to Nursing and Allied Health Literature. Other information was collected by searching reference lists of published reports.
Conclusions: The diagnostic criteria and guidelines are important to make an accurate clinical assessment and manage a child with ADHD. Early diagnosis and treatment of ADHD decreases academic failure, family conflict, social isolation, substance abuse, and occupational adversity in later years for these children.
Implications for practice: Often primary care nurse practitioners are the first healthcare provider a child with ADHD will see. Awareness of the diagnostic criteria and treatment for children with ADHD can assist with early identification and perhaps eliminate much impairment that accompanies this chronic disorder.     

Pressure ulcers in older persons: a preventive approach

Strategies for the prevention of pressure ulcers are presented on the basis of the Agency for Health Care Policy and Research guidelines. A broad, holistic approach to care of the elderly, focusing on rehabilitative and restorative measures is introduced. Topics include the effects of bed rest and deconditioning, nutrition, and mobility issues. A broad approach to care, involving the expertise of multiple disciplines, is advocated.     

Assessment of Hospital-Related Stress in Children and Adolescents Admitted to a Psychiatric Inpatient Unit

PROBLEM: The assessment of hospital-related stressors experienced by child and adolescent patients on a psychiatric inpatient unit. SUBJECTS: Child and adolescent inpatients (N = 40) admitted to an acute, short-term psychiatric unit. METHODS: A newly developed stressor survey was administered to subjects to identify the most problematic stressors. Correlation analyses were used to assess associations between hospital-related stress and adjustment variables. FINDINGS: Broad domains and specific items of the most problematic hospital-related stressors were revealed. Also, higher levels of hospital-related stress were consistently associated with poorer hospital-based adjustment. CONCLUSIONS: Implications for treatment include identifying hospital-related stressors for individual patients and providing interventions to enhance coping.     

The Dynamic Characteristics of the Circumvaginal Muscles

Circumvaginal muscle (CVM) maximum pressure was studied as related to the postpartal period, parity, type of birth, episiotomy, age, breastfeeding, physical activity, body mass, stress urinary incontinence, and orgasm in a sample of 98 healthy postpartal and nonpostpartal women. Circumvaginal muscle pressure tracings were obtained from these women using a pressure-sensitive, intravaginal balloon device. Correlations between circumvaginal muscle maximum pressures and episiotomy, age, breastfeeding, physical activity, body mass, stress urinary incontinence, and orgasm were either not significant or only weakly significant. However, Duncan's multiple range test showed differences in the maximum pressures between groups (nulliparous, parity greater than 0, cesarean delivery, and vaginal delivery) and indicated that vaginal birth has a marked weakening effect on the circumvaginal muscles.