Evaluation of the Impact of Optical Coherence Tomography on Pediatrician Otologic Examination Judgment.

Accurate diagnosis of otitis media is imperative to judicious antibiotic prescription. Visualization of the tympanic membrane and accurate identification of middle ear effusion with standard otoscopy is inherently challenging in pediatrics, especially in the youngest children who are most at risk for otitis media. With the average diagnostic accuracy among primary care physicians of 50% and accurate identification of normal tympanic membrane versus acute otitis media versus otitis media with effusion ranging from 30% to 84% among pediatricians, there is great opportunity for diagnostic improvement and decreasing unnecessary antibiotic use. In a 96-pediatrician-blinded otoscopy diagnosis quiz, addition of optical coherence tomography, a novel depth-imaging technology, resulted in a 32% improvement in fluid identification, and 21% increase in diagnostic accuracy. This study suggests that the clinical use of this technology promises to improve diagnostic accuracy and antibiotic stewardship in pediatrics.

Incorporating a Patient Education Video With Provider Consultation to Improve Patient Satisfaction and Reduce Consultation Time Among New Patients Seeking Cosmetic Injections.

The field of aesthetics is expanding more rapidly than ever before, bringing with it an influx of new-to-aesthetics patients who lack industry knowledge. We investigated ways to bridge this gap in knowledge and provide patients with important procedural information and also increase their satisfaction and confidence. We implemented this project to improve the delivery of preprocedural patient education via the implementation of an educational video. We collected data over a 16-week period and analyzed the results of the pre- and post-video implementation. We found that implementing the educational video decreased the average time the provider spent consulting with new patients considering injectable neuromodulators or dermal fillers. We also found that using the video increased the patient's preprocedural confidence and postprocedural satisfaction. Based on the results of our quality improvement project, we concluded that implementing a patient education video before performing cosmetic injectable procedures improved patient confidence and satisfaction and decreased provider consultation times.

An Evaluation of Websites Offering Caregiver Education for Tracheostomy and Home Mechanical Ventilation.

BACKGROUND: Parental and familial caregivers of a child with a tracheostomy, and possibly home mechanical ventilation (HMV), face the overwhelming task of learning to medically care for their child prior to discharge. Caregivers may cope by seeking health information on the Internet. This is concerning because information found during an Internet search may not be accurate, comprehensive, or up to date. The purpose of this project was to evaluate the quality and content of websites offering information about tracheostomies and HMV using a valid assessment tool. METHODS: A total of 46 websites were identified for evaluation using the DISCERN instrument for quality and reliability, and the Flesch Reading Ease (FRE) and Flesh- Kincaid (FK) grade level instruments for readability. Accuracy of content was determined by expert opinion. FINDINGS: Few of the websites met the recommended quality and/or readability levels. The websites recommended had a range of DISCERN scores 21-40, adjusted FRE 61-89.1, and adjusted FK 3.4-6.9. Many of the highest quality websites had a readability level at high school or college levels. DISCUSSION: The quality and readability of websites offering caregiver education for tracheostomy and HMV are not at a level suitable for caregivers. There was often a mismatch between DISCERN quality and readability. Many high-quality websites would not be easily read and understood by the general lay population. APPLICATION TO PRACTICE: DISCERN alone is not sufficient to determine whether a website should be recommended. One should consider reliability, quality, and readability when developing patient education materials, including those on the Internet.

Sleep Evaluation in the Assessment of Pediatric Attention Deficit Disorders.

INTRODUCTION: Examining the impact of appropriate sleep evaluation on diagnosis of attention deficit disorders can improve the standard of care in pediatrics. This quality improvement project examined current practice and subsequent implementation of a validated standardized sleep evaluation tool in the assessment of children with symptoms of attention deficit. METHODS: Retrospective chart review and implementation of the Children's Sleep Habits Questionnaire (CSHQ) for children 6 to 14years old with attention deficit symptoms. MEASURES: Rates of sleep screening, sleep referrals, diagnosis of sleep and attention deficit disorders, Vanderbilt scores, CSHQ scores. RESULTS: In the retrospective group (n = 41), 76% of patients had attention deficit disorder/attention deficit hyperactivity disorder, 19.5% had sleeping disorders. There were significant provider differences in diagnosing sleep problems (p = .007). In the intervention group (n = 5), 60% had abnormal CSHQ scores. DISCUSSION: There was considerable incidence of sleeping problems in children with symptoms of attention deficit and provider variation in sleep evaluation and diagnosis, with minimal referral to specialist care. Our findings support a more comprehensive and standardized evaluation of sleep when assessing for attention deficit disorders to improve appropriate referrals, diagnosis, and treatment in pediatrics.

Pediatric rheumatologic diseases: A review for primary care NPs.

Rheumatologic diseases are uncommon in children but have the potential for significant morbidity, mortality, and disability. This article reviews the most common rheumatologic diseases in children, their diagnostic evaluations, and the NP's role in the management and coordination of these conditions.