Spanish-Speaking Caregivers' Experience with an Emergency Department Pediatric Asthma-Care Bundle Quality Initiative.

Most pediatric emergency departments' (ED) quality improvement (QI) initiatives for asthma aim to standardize care based on the priorities of healthcare providers. Perceptions and priorities of the caregiver rarely are addressed, especially in families with limited English-language proficiency. We explored Spanish-speaking caregivers' perceptions, understandings, and barriers with the care they received for asthma, after exposure to an ED asthma-care bundle. This qualitative study was part of a larger QI initiative on Spanish-speaking caregivers of patients presenting to a children's hospital ED with an asthma exacerbation. Patients were exposed to an asthma-care bundle, which included timely administration of medication, home dose of medications, an educational intervention, asthma action plans (AAPs), and discharge instructions. Through semi-structured interviews and qualitative analyses, we assessed the perceptions, understandings, and barriers caregivers reported during their ED experience. From January 2015 to October 2016, 492 patients received AAPs in the ED. Of 128 families that preferred Spanish, 88 (69%) received a Spanish AAP, 41 (32%) received Spanish discharge instructions, and 34 (27%) received discharge materials in both languages. Thirteen families were interviewed. Three themes emerged regarding the caregivers' perceived barriers: (1) need for improved accessibility to medication, primary care, and insurance; (2) communication barriers, such as timeliness, availability of interpreters, and need for resources in their preferred language; and (3) uncertainty about the child's diagnosis and acuity. Incorporating the caregivers' perspectives into QI projects may yield valuable information when developing new interventions. In the ED, improving accessibility to interpreters and providing discharge materials in their preferred language, as well as addressing misconceptions about asthma, may enhance caregivers' satisfaction.

Growth patterns in pubertal HIV-infected adolescents and their correlation with cytokines, IGF-1, IGFBP-1, and IGFBP-3.

OBJECTIVE: This study aims to describe the final adult height (FAH) and pubertal growth patterns in human immunodeficiency virus (HIV)-infected adolescents and to compare these to an age-matched population of seroreverting HIV-exposed, uninfected (HEU) adolescents. It further aims to evaluate the interplay of proinflammatory cytokines with insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP-3), and IGFBP-1 during the pubertal growth spurt. METHODS: HIV-infected (n=34) and HEU (n=12) adolescents who had achieved FAH were evaluated. Auxologic data, viral load, CD4+ T-lymphocyte (CD4) count, and the use of highly active antiretroviral therapy were obtained via a retrospective chart review. Serum interleukin (IL)-1α, IL-6, tumor necrosis factor (TNF)-α, IGFBP-1, IGFBP-3, and IGF-1 were assessed. RESULTS: The mean FAH standard deviation score for the HIV-infected group was -0.78 (±1.1) compared to 0.05 (±0.78) for the HEU (p=0.034). There was a positive correlation between CD4 count and FAH (p=0.019). The mean age and magnitude of peak growth velocity (GV) was within normal limits. IL-1α, IL-6, TNF-α, IGFBP-3, and IGF-1 were not significantly correlated with HIV RNA or height. IGFBP-1 was detectable in 100% of poorly controlled HIV-infected patients and 25% of the HEU cohort (p=0.0003). CONCLUSIONS: The FAH of HIV-infected patients was significantly shorter than that of HEU patients, and it positively correlated with CD4 count. Our cohort demonstrated normal timing and magnitude of peak GV during puberty.