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PURPOSE: The purpose of this project was to improve the accuracy of newborn weight classification using a regional newborn growth reference (Olsen), an evidence-based method, to determine SGA, AGA and LGA in term infants compared to the current growth reference (Lubchenco). DESIGN: Quality improvement methods using Lewin's Change Theory guided the process. SETTING/LOCAL PROBLEM: At an academic medical center term infants were evaluated for weight-for-gestational age using the Lubchenco growth reference as well as other growth references based on provider preference. PATIENTS: All term newborns (N = 314) admitted to the newborn nursery during one month following a 3-months implementation of the practice change. INTERVENTION/MEASUREMENTS: Newborn nursery nursing staff and provider staff were provided education and training on using and interpreting the new growth reference. RESULTS: Use of the Olsen regional growth reference identified more infants as small and fewer infants as large for gestational age. Post hoc analysis with a more global growth reference (Fenton) also identified more infants as small and fewer infants as large for gestational age. There was no statistically significant difference between the Olsen or Fenton growth references. CONCLUSION: Use of either of these two updated growth references more accurately classifies infant weight for gestational age compared to the Lubchenco growth reference, potentially decreasing newborn health risks such as hypoglycemia.
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Peso ao Nascer/fisiologia , Feminino , Gráficos de Crescimento , Humanos , Recém-Nascido , Masculino , Melhoria de Qualidade , Valores de ReferênciaRESUMO
Late preterm (LPT) infants are at an increased risk for hyperbilirubinemia. Accurate identification and early treatment are needed for optimal health outcomes. In a newborn nursery at an academic medical center, bilirubin levels were drawn at 24 hours of life, per protocol. These infants were rarely treated at this time. Rather, predischarge bilirubin levels (at about 48 hours of life) would indicate treatment, often leading to increased length of hospital stay. The practice change evaluation was conducted using retrospective medical record review. Practice change to test serum bilirubin levels at 36 hours of life rather than 24 hours of life. Compliance with the practice change was achieved (P < .05). More LPT infants were identified and treated for hyperbilirubinemia without an increase in length of stay. Readmissions for hyperbilirubinemia and blood draw rates also declined. Although more LPT infants were identified and treated for hyperbilirubinemia, there is room for improvement, and increased adherence to the policy might yield an even greater impact on quality and safety of care surrounding bilirubin management.
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Bilirrubina/sangue , Procedimentos Clínicos/organização & administração , Hiperbilirrubinemia Neonatal , Recém-Nascido Prematuro/sangue , Triagem Neonatal , Medição de Risco/métodos , Tempo para o Tratamento/organização & administração , Feminino , Idade Gestacional , Humanos , Hiperbilirrubinemia Neonatal/sangue , Hiperbilirrubinemia Neonatal/diagnóstico , Hiperbilirrubinemia Neonatal/terapia , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Triagem Neonatal/métodos , Triagem Neonatal/organização & administração , Inovação Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Gravidez , Nascimento Prematuro , Melhoria de QualidadeRESUMO
Total elbow arthroplasty (TEA) has lower revision-free survivorship than other major joint replacement. Despite this, elbow replacement has remained popular. Surgical technique for TEA destabilizes the elbow by removing the medial and lateral collateral ligaments and, frequently, the radiocapitellar articulation. Current semiconstrained implants aim to allow for physiological varus and valgus motion by employing a sloppy hinge; however, over time, these designs fail owing to nonanatomic force transmission. Nonanatomic force transmission results from ligament release, force transmission primarily to the humeral and ulnar shafts, and radial head resection. These altered biomechanics may be the source of complications seen in semiconstrained arthroplasty. These complications perpetuate the cycle of failure and ultimately have poor salvage options.
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Artroplastia de Substituição do Cotovelo/métodos , Artroplastia de Substituição do Cotovelo/instrumentação , Fenômenos Biomecânicos , Ligamentos Colaterais/cirurgia , Humanos , Prótese Articular , Desenho de Prótese , Falha de PróteseRESUMO
Adolescents with overweight and obesity are at risk for future health problems. The purpose of this study was to examine the feasibility and initial efficacy of a weight management intervention to help adolescents develop healthy nutrition and physical activity behaviors and improve their anthropometrics. This study used a single-group repeated measures design in a small school in Durham, North Carolina (NC). The intervention consisted of a nurse-led and teacher-assisted nutrition and physical activity education and exercise classes that met twice each week for 45-60 minutes for 7 weeks. Data were collected at Time 1 (baseline), Time 2 (after intervention completion), and Time 3 (after 3 months on their own). Interview feedback, low cost, and successful completion of all planned activities indicated that all stakeholders found the project beneficial and suitable for their school. This study suggests that a weight management intervention for adolescents was feasible in the school setting.
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Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Obesidade Infantil/terapia , Avaliação de Programas e Projetos de Saúde/métodos , Serviços de Saúde Escolar , Adolescente , Adulto , Exercício Físico , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Enfermeiras e Enfermeiros , Educação Física e Treinamento , Serviços de Enfermagem Escolar/métodos , Professores EscolaresRESUMO
This qualitative study used a grounded theory approach to explore how pediatric sibling donors of a successful hematopoietic stem cell transplantation conceptualized their donation experiences. Saving my sister's (or brother's) life describes the central phenomenon identified by this purposive sample of 8 sibling donors. Five themes captured their memories: being the perfect match, stepping up, worrying about the outcome, the waiting process, and sharing a special bond. Further research surrounding changes in relational issues will provide insight into inter-sibling support and the developmental course of the sibling relationship into adulthood when intensified by a health crisis.
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Neoplasias Hematológicas/cirurgia , Transplante de Células-Tronco Hematopoéticas/psicologia , Irmãos/psicologia , Doadores de Tecidos/psicologia , Adolescente , Fatores Etários , Aloenxertos , Criança , Feminino , Teoria Fundamentada , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa , Relações entre Irmãos , Adulto JovemRESUMO
Polymethyl methacrylate remains the only US Food and Drug Administration-approved method of total elbow arthroplasty fixation and exhibits high aseptic loosening rates that result in challenging revision surgeries and potential morbidity secondary to bone-cement implantation syndrome. In this policy paper, the authors aim to explore the historical background of polymethyl methacrylate and the complications that arise in association with its use. We will review arthroplasty trends in the elbow and lower extremities and the challenges with the US Food and Drug Administration-approval process.
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This integrative review explored and described published research findings focused on the experiences of pediatric sibling hematopoietic stem cell donors. After a comprehensive search, nine studies met the inclusion criteria of the study. There was no evidence of coordinated programs of research to effectively advance and build knowledge about the experiences of pediatric sibling donors. The limited descriptive evidence revealed that differences in the experiences of sibling donors vary by age and developmental stages; however, the use of small or repeated samples and qualitative methods limited the generalizability of study findings. Collaborative research using prospective, longitudinal designs will build and advance the evidence base for the design of developmentally appropriate interventions for pediatric sibling donors and their families.
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Irmãos , Tomada de Decisões , Emoções , Culpa , Transplante de Células-Tronco Hematopoéticas/psicologia , Humanos , Irmãos/psicologia , Doadores de TecidosRESUMO
This article endeavors to be a resource to those individuals interested in becoming an ally or educating potential allies in the field of Hand Surgery. The definitions of allyship, its history, and its expected benefits are considered. The qualities of a good ally are enumerated, and approaches to becoming a better ally are described. The authors provide personal experience with impactful allies and describe strategies and resources on a local and national level. The authors conclude with "Bigger Questions": those issues that seem essential to have allyship succeed in expanding diversity, equity, and inclusion in the specialty.
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Mãos , Humanos , Mãos/cirurgiaRESUMO
OBJECTIVES: Peanut allergy in children is a population health problem. Evidence suggests early peanut introduction (EPI) for infants can reduce the development of peanut allergy. Primary care settings have not widely adopted guidelines recommending EPI. Peanut allergy prevention depends on primary care providers incorporating EPI guidelines into well-child check (WCC) encounters. We aimed to improve guideline adherence in a primary care setting by implementing a bundle of clinical decision support (CDS) tools. METHODS: Using quality improvement methodology, the team developed a standardized work protocol and CDS tools within an electronic medical record (EMR) at 4, 6, and 9-month WCC encounters. The team executed changes and modifications through plan-do-study-act cycles and analyzed results with statistical process control charts. RESULTS: We collected data from 445 WCC encounters from baseline through sustainability. EMR documentation of EPI guidance at 4, 6, and 9-month WCCs shifted from 13.9% to 83.5% over 12 months. Provider adoption of smart lists and templates increased from 2% to 73%, the distribution of home peanut introduction handouts increased from 5.2% to 54.1%, and caregiver-reported peanut ingestion increased from 0% to 34.6%. Diphtheria-tetanus-acellular pertussis vaccination rates remained at 100% for 6-month visits, and patient in-room time remained at 65 minutes. CONCLUSIONS: Quality improvement methodology improved documentation of EPI guidance and increased reported peanut ingestion at routine WCC encounters without impacting other measures. Broader use of bundled CDS tools and EMR standardization could further improve guideline adherence and increase early peanut introduction to prevent peanut allergy in infants.
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Arachis , Hipersensibilidade a Amendoim , Humanos , Lactente , Hipersensibilidade a Amendoim/prevenção & controle , Registros Eletrônicos de Saúde , Fidelidade a Diretrizes , Padrões de ReferênciaRESUMO
Purpose: The purpose of this study was to analyze the ability of patients to return to work after ORIF of isolated capitellar shear fractures and assess long-term functional outcomes. Methods: We retrospectively reviewed the cases of 18 patients with isolated capitellar shear fractures with or without lateral trochlear extension and investigated demographic data, occupation, worker's compensation status, injury characteristics, surgical details, motion, radiographic appearance at final in-person follow-up, complications, and return to work status via in-person and long-term telemedicine follow-ups. Results: Final follow-up was at an average of 76.6 (7-222.6) months or 6.4 (0.58-18.6) years. Of the 14 patients working at the time of injury, 13 patients had returned to work at final clinical follow-up. The work status of the remaining patient was not documented. Mean elbow motion at final follow-up was 4° (range, 0-30) to 138° (range, 130-145) of flexion, 83° of supination, 83° of pronation. Two patients had complications that required reoperation but had no further complications. For the 13 of 18 patients with long-term telemedicine follow-up, the average Quick Disabilities of the Arm, Shoulder, and Hand score was 6.8 (0-25). Conclusions: In our series, rates of return to work were high after ORIF of coronal shear fractures of the capitellum with or without lateral trochlear extension. This was true across all occupational classes including manual labor, clerical, and professional. With anatomic restoration of articular congruity, stable internal fixation, and postoperative rehabilitation, these patients had excellent ROM and functional scores at an average of 7.9 years of follow-up. Clinical relevance: After ORIF of isolated capitellar shear fractures with or without lateral trochlear extension, patients can expect a high rate of return to work with excellent ROM and functionality and low long-term disability.
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Background: The utility of electrodiagnostic studies (EDX) continues to be a point of debate in the diagnosis of carpal tunnel syndrome (CTS). If surgeons can predict the results of EDX with high accuracy, it may suggest that ordering the test is unnecessary from a diagnostic standpoint. Methods: Two surgeons with subspecialty training in hand surgery were asked to classify hands into "definitely having or not having CTS" or into an "unclear category" when presented with patients having a chief complaint of hand paresthesias. Clinical diagnosis was compared against EDX, ordered after the initial patient visit, as the reference standard. Results: Of the 175 hands, 111 hands were predicted to have CTS, 37 hands were predicted not to have CTS, and 27 hands had an unclear diagnosis. Overall surgeon accuracy was 86% (124/148). Accuracy was improved when subdivided by a positive prediction of CTS (88%) compared with a negative prediction of CTS (70%) (P = .03). Sensitivity was 90% and specificity was 67%. The senior surgeon had a higher accuracy at 90% than the more junior surgeon at 74% (P = .02). Conclusions: Surgeons with sub-specialty training in hand surgery are able to accurately diagnose CTS without EDX. Surgeon experience is important and resulted in a higher accuracy in predicting EDX results.
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Síndrome do Túnel Carpal , Cirurgiões , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/cirurgia , Mãos , Humanos , Nervo Mediano , Sensibilidade e EspecificidadeRESUMO
We report an international collaborative project to develop the first Doctor of Nursing Practice (DNP) program in Japan. We described the development and implementation of the first DNP program at the St. Luke's International University in Tokyo and the collaboration with the University of North Carolina at Chapel Hill in the United States. Faculty perceptions in both parties gradually evolved from the traditional perspective of international collaboration to the transitional and the beginning of the holistic partnership perspectives. The collaboration resulted in an innovative DNP program that directly addressed the gap between nursing education programs and Japan's clinical needs. The collaborative project cultivated a holistic international partnership. Rather than reporting a manual for international collaboration, we present our reflections and outcomes as narratives that others could use to achieve a holistic global partnership.
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Educação de Pós-Graduação em Enfermagem , Educação em Enfermagem , Currículo , Humanos , Japão , North Carolina , Estados Unidos , UniversidadesRESUMO
Purpose: Although the literature has shown that the cross-sectional area (CSA) of the carpal tunnel on ultrasound is enlarged in patients with carpal tunnel syndrome, it does not provide information regarding whether proximal nerve pathology, such as that seen in cervical radiculopathy, increases the CSA of the median nerve. Methods: In this study, 15 patients were enrolled who had a clinical diagnosis of cervical radiculopathy but not carpal tunnel syndrome. All patients underwent electrodiagnostic studies and ultrasound measurement of the CSA of the median nerve. Results: Increased median nerve CSA was seen in 1 of 15 patients (7%). Positive findings of cervical radiculopathy were found in 7 patients (47%) by electrodiagnostic studies. Conclusions: In patients clinically diagnosed with isolated cervical radiculopathy, the vast majority have normal median nerve CSA measured on ultrasound. Type of study/level of evidence: Prognostic IV.
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This integrative review described recent published data addressing parental perceptions of their child's overweight. Seventeen studies met the inclusion criteria for the study. Parents of overweight children underestimate their child's weight status or are not concerned about the risks associated with overweight. Child age, gender, and ethnicity may influence parental perceptions of child overweight. Some parents may use criteria other than growth charts to perceive overweight as a problem. Health care providers need to understand parents' perceptions to tailor effective child weight loss interventions. A formalized tool is needed to aid practitioners in identifying parental perceptions of child overweight.
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Atitude Frente a Saúde , Transtornos da Nutrição Infantil/prevenção & controle , Sobrepeso/prevenção & controle , Pais/psicologia , Adulto , Fatores Etários , Imagem Corporal , Criança , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/etiologia , Exercício Físico , Comportamento Alimentar , Feminino , Comportamentos Relacionados com a Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pesquisa Metodológica em Enfermagem , Sobrepeso/diagnóstico , Sobrepeso/etiologia , Pais/educação , Percepção , Preconceito , Pesquisa Qualitativa , Projetos de Pesquisa , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
Background: Ultrasound (US) measurement of cross-sectional area (CSA) of the median nerve has emerged as a viable alternative to electromyography/nerve conduction studies (EMG/NCS) for diagnosis of carpal tunnel syndrome (CTS). The purpose of this study is to compare CSA of the median nerve between US and MRI using current MRI and US technology. The null hypothesis is there is no difference between US and MRI CSA measurements. Methods: The study design was an observational cohort, enrolling patients presenting to clinic with MRI of the wrist. Participants with clinical signs and symptoms of CTS were excluded. The CSA measurements of the median nerve on MRI T1-weighted axial images were performed by a hand fellow blinded to results of US measurements, and US measurement of median nerve CSA was performed by a hand fellowship trained surgeon blinded to results of the MRI measurements. Results were analyzed via percent error, Pearson correlation, and t tests. Results: Twenty participants were enrolled with mean age of 29.4 years. Four left wrists and 16 right wrists were measured. The US mean CSA of the median nerve was 6.8 mm2 (±2.330 mm2). The MRI mean CSA of the median nerve was 6.8 mm2 (±2.153 mm2), P = .442. Pearson correlation between modalities was 0.93, suggesting near-perfect correlation. Mean percent error was 8.8%. Conclusions: Results of this study suggest that US is an accurate method to measure CSA of the median nerve at the carpal tunnel inlet. The mean difference between US and MRI was unlikely to be clinically significant.
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Síndrome do Túnel Carpal/diagnóstico , Imageamento por Ressonância Magnética/estatística & dados numéricos , Nervo Mediano/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos , Punho/inervação , Adulto , Feminino , Humanos , Masculino , Exame Neurológico/métodos , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Antibiotic stewardship efforts should standardize treatment of common infections when possible. Urinary tract infections (UTIs) are common in children and require appropriate diagnostic methods and treatment. A pediatric emergency department (ED) identified an opportunity to improve care by standardizing uncomplicated UTI diagnostic testing and treatment according to local bacterial resistance patterns from January 2017 to December 2018. METHODS: Using the Model for Improvement, researchers undertook a quality improvement (QI) initiative to standardize the diagnosis and treatment of uncomplicated UTI in children ages 3 months to 12 years in a pediatric ED. Multiple Plan-Do-Study-Act (PDSA) cycles were used, engaging both nurses and physicians, to implement an evidence-based clinical algorithm. Primary aims were to achieve 100% of targeted patients with suspected UTI having appropriately ordered and collected specimens and to increase the frequency of targeted patients receiving algorithm-recommended antibiotics at discharge to 80%. Balancing measures included ED length of stay and revisits to the ED related to UTI. RESULTS: During this initiative, 458 children were assessed for UTI, of whom 75 received a UTI diagnosis. Guideline-concordant urine collection procedure improved from 54.7% to 96.2%. After project initiation, 100% of all antibiotic prescriptions for UTI were guideline-concordant. These changes have been sustained for 19 months since the initiative began. There was no change in UTI-related ED revisits or ED length of stay. CONCLUSIONS: This QI initiative achieved standardization of specimen collection and treatment for pediatric UTI in the ED setting, and no adverse outcomes were observed at the institution.
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Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Melhoria de Qualidade/organização & administração , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Algoritmos , Antibacterianos/administração & dosagem , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Fidelidade a Diretrizes , Hospitais Pediátricos/organização & administração , Humanos , Lactente , Masculino , Guias de Prática Clínica como Assunto , Coleta de Urina/normasRESUMO
INTRODUCTION: The purpose of this study was to explore and describe content related to pacifier use on parenting Web sites. METHODS: Sixteen parenting Web sites met the inclusion criteria of the study. Two checklists were used to evaluate and describe different aspects of the Web sites. The first checklist provided a quality assessment of the Web sites. The second checklist was constructed to identify content categories of pacifier use. RESULTS: The majority of sites met quality assessment criteria. Eleven content categories regarding pacifier use were identified. Nine of the 16 sites contained eight or more of the 11 content areas. The most common types of Web pages containing pacifier information included pacifier specific (articles), questions and answer pages, and related content pages. DISCUSSION: Most of the parenting Web sites met the quality measures for online information. The content categories reflected the current controversies and information regarding pacifier use found in the expert literature. The findings of this study suggest the need to establish pacifier recommendations in the United States to guide parents and health care providers with decision making.
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Educação em Saúde , Internet , Chupetas , Poder Familiar , Qualidade da Assistência à Saúde , Humanos , LactenteRESUMO
INTRODUCTION: The purpose of this study was to explore and describe the early responses of human immunodeficiency virus (HIV)-positive mothers to the birth of an HIV-exposed infant during the first 8 months of life. METHOD: This descriptive, qualitative study was part of a larger prospective longitudinal study of HIV-exposed infants born to HIV-infected women. Participants in the present study were 26 HIV-positive biologic mothers recruited from one of two Southeastern tertiary pediatric infectious disease clinics where infants were being monitored to determine their HIV status. RESULTS: "Being there for my baby" was the central theme that captured the critical importance of the baby in the lives of these mothers. Three sub-themes characterized their stories: (a) giving the baby a chance, (b) taking care of the baby, and (c) parenting as a reason to live. DISCUSSION: Pediatric nurse practitioners have the unique opportunity to use the mother-infant relationship as a medium for health care delivery. They are a critical source of support for infants and their caregivers during the first year of life. They can assess the development of trust and attachment between infants and caregivers and implement a plan to strengthen family support and resources to provide a physically and emotionally secure environment.
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Infecções por HIV/psicologia , Transmissão Vertical de Doenças Infecciosas , Mães/psicologia , Adolescente , Adulto , Feminino , Infecções por HIV/transmissão , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Gravidez , Estudos Prospectivos , Sudeste dos Estados UnidosRESUMO
PURPOSE: To describe theoretical and methodological characteristics of effective school-based interventions that used healthy lifestyle education, dietary habits, and/or physical activity in children ages 4 to 14. DESIGN: Integrative research review. METHODS: Stetler's model of research utilization. RESULTS: Social Cognitive Theory was the stated or implied theory in eight of the 10 studies. Healthy lifestyle education was initiated in nine studies, dietary habits in four, and physical activity in eight. Four of the 10 studies used a combination of all three interventions; three used a combination of two interventions; and three used only one intervention. PRACTICE IMPLICATIONS: Social Cognitive Theory and the role of social learning are useful when designing interventions for preventing and treating childhood overweight.
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Obesidade/prevenção & controle , Serviços de Saúde Escolar/organização & administração , Serviços de Enfermagem Escolar/organização & administração , Adolescente , Terapia Comportamental , Índice de Massa Corporal , Criança , Ciências da Nutrição Infantil/educação , Pré-Escolar , Difusão de Inovações , Exercício Físico , Comportamento Alimentar , Promoção da Saúde , Humanos , Estilo de Vida , Modelos de Enfermagem , Pesquisa em Avaliação de Enfermagem , Obesidade/psicologia , Avaliação de Resultados em Cuidados de Saúde , Educação de Pacientes como Assunto/organização & administração , Avaliação de Programas e Projetos de Saúde , Teoria Psicológica , Psicologia da Criança , Projetos de Pesquisa , Redução de PesoRESUMO
INTRODUCTION: The purpose of this study was to describe the type and quality of health information about infant gastroesophageal reflux (GER) that a parent may find on the World Wide Web. METHODS: The data collection tool included evaluation of Web site quality and infant GER-specific content on the 30 sites that met the inclusion criteria. RESULTS: The most commonly found content categories in order of frequency were management strategies, when to call a primary care provider, definition, and clinical features. The most frequently mentioned strategies included feeding changes, infant positioning, and medications. Thirteen of the 30 Web sites included information on both GER and gastroesophageal reflux disease. Mention of the use of medication to lessen infant symptoms was found on 15 of the 30 sites. Only 10 of the 30 sites included information about parent support and coping strategies. DISCUSSION: Pediatric nurse practitioners (PNPs) should utilize well-child visits to address the normalcy of physiologic infant GER and clarify any misperceptions parents may have about diagnosis and the role of medication from information they may have found on the Internet. It is critical for PNPs to assist in the development of Web sites with accurate content, advise parents on how to identify safe and reliable information, and provide examples of high-quality Web sites about child health topics such as infant GER.