Preparedness for Pediatric Office Emergencies: A Multicenter, Simulation-Based Study.

OBJECTIVES: Pediatric emergencies can occur in pediatric primary care offices. However, few studies have measured emergency preparedness, or the processes of emergency care, provided in the pediatric office setting. In this study, we aimed to measure emergency preparedness and care in a national cohort of pediatric offices. METHODS: This was a multicenter study conducted over 15 months. Emergency preparedness scores were calculated as a percentage adherence to 2 checklists on the basis of the American Academy of Pediatrics guidelines (essential equipment and supplies and policies and protocols checklists). To measure the quality of emergency care, we recruited office teams for simulation sessions consisting of 2 patients: a child with respiratory distress and a child with a seizure. An unweighted percentage of adherence to checklists for each case was calculated. RESULTS: Forty-eight teams from 42 offices across 9 states participated. The mean emergency preparedness score was 74.7% (SD: 12.9). The mean essential equipment and supplies subscore was 82.2% (SD: 15.1), and the mean policies and protocols subscore was 57.1% (SD: 25.6). Multivariable analyses revealed that independent practices and smaller total staff size were associated with lower preparedness. The median asthma case performance score was 63.6% (interquartile range: 43.2-81.2), whereas the median seizure case score was 69.2% (interquartile range: 46.2-80.8). Offices that had a standardized process of contacting emergency medical services (EMS) had a higher rate of activating EMS during the simulations. CONCLUSIONS: Pediatric office preparedness remains suboptimal in a multicenter cohort, especially in smaller, independent practices. Academic and community partnerships using simulation can help address gaps and implement important processes like contacting EMS.

Using Simulation to Measure and Improve Pediatric Primary Care Offices Emergency Readiness.

INTRODUCTION: Emergencies in the pediatric primary care office are high-risk, low-frequency events that offices may be ill-prepared to manage. We developed an intervention to improve pediatric primary care office emergency preparedness involving a baseline measurement, a customized report out with action plans for improvement (based on baseline measures), and a plan to repeat measurement at 6 months. This article reports on the baseline measurement. METHODS: This baseline measurement consisted of 2 components: preparedness checklists and in situ simulations. The preparedness checklists were completed in person to measure compliance with the American Academy of Pediatrics Policy Statement: preparation for emergencies in the offices of pediatricians and pediatric primary care providers, in the domains of equipment, supplies, medication, and guidelines. Two in situ simulations, a child in respiratory distress and a child with a seizure, were conducted with the offices' interprofessional teams; performance was scored using checklists. RESULTS: Baseline measurements were conducted in 12 pediatric offices from October to December 2018. Wide variability was noted for compliance with the American Academy of Pediatrics recommendations (range = 47%-87%) and performance during in situ simulations (range = 43%-100%). CONCLUSIONS: Pediatric primary care office emergency preparedness was found to be variable. Simulation can be used to augment existing measures of emergency preparedness, such as checklists. By using simulation to measure office emergency preparedness, areas of knowledge deficit and latent safety threats were identified and are being addressed through ongoing collaboration.

Perceived barriers and facilitators for healthy behaviours among parents of adolescents receiving mental health care in a public hospital in Cape Town, South Africa: A qualitative study.

Objective: To explore the perceived barriers and facilitators for healthy behaviours among parents and caregivers of adolescents receiving mental health care in Cape Town, South Africa. Method: Thirty-five qualitative in-depth interviews were conducted with parents and caregivers of adolescents receiving mental health treatment by six facilitators matched for language. The data was analysed using thematic analysis. Results: The participants were predominantly female (n = 28, 80%) and parents (n = 29, 83%) of the adolescents. Personal barriers to good health included unhealthy eating, substance use and physical inactivity. Environmental barriers were inherited medical conditions, the easy availability of unhealthy foods and the absence of recreational facilities in communities. Perceived facilitators to good health were parental role modelling, planning and preparing healthy meals, exercise opportunities providing by walking long distances to work, and doing physically demanding jobs and household chores. Conclusion: Parents and caregivers are essential to adolescents' healthy development as they may influence adolescent health behaviours. It is likely that the promotion of positive health behaviours may be achieved though family-based interventions.

Priority areas for cannabis and cannabinoid product research in South Africa.

No abstract available.

Technology, Educator Intention, and Relationships in Virtual Learning Spaces: A Qualitative Metasynthesis.

BACKGROUND: A main concern that remains with the continued growth of online nursing education programs is the way educator and student relationships can be affected by new technologies. This interpretive study aims to gain an understanding of how technology influences the development of interpersonal relationships between the student and faculty in a virtual learning environment. METHOD: Using an established structured approach to qualitative metasynthesis, a search was conducted using PubMed, EBSCO, CINAHL, Medline, ProQuest, Ovid Nursing databases, and Google Scholar, focused on caring and relational aspects of online nursing education. RESULTS: Technology alters communication, thereby positioning the intentionality of the educator at the heart of interpersonal relationship development in virtual learning spaces. CONCLUSION: This interpretive synthesis of prior qualitative research supports the development of a framework for online nursing courses, the need for continuing education of nursing faculty, the value of caring intentions, and enhancement of the educator's technological proficiency. [J Nurs Educ. 2018;57(4):197-202.].

Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study.

Breastfeeding is a cost-effective, yet underutilized strategy to promote maternal and infant health in low and middle income countries (LMICs). Breastfeeding remains challenging for mothers living with HIV in LMICs, yet few studies have examined mental health predictors of breastfeeding initiation and continuation. We investigated breastfeeding among mothers by HIV status in South Africa, evaluating predictors of breastfeeding initiation and continuation to identify intervention-targets. Breastfeeding patterns were investigated in a subsample of 899 breastfeeding mothers from the Drakenstein Child Health Study; a prospective birth cohort of 1225 pregnant women, between March 2012 and March 2015 in a peri-urban area. Breastfeeding was assessed at 5 time-points between 6weeks and 24months' infant age. Cox proportional hazard models evaluated breastfeeding initiation and duration. Logistic regression models with breastfeeding non-initiation as the outcome parameter were performed to determine associations with maternal sociodemographic, psychosocial factors and gestational outcomes. More HIV-uninfected mothers initiated breastfeeding (n=685, 97%) than HIV-infected mothers (n=87, 45%). Median duration of exclusive breastfeeding was short (2months), but HIV-infected mothers engaged in exclusive breastfeeding for longer duration than uninfected mothers (3 vs 2months). Despite concerning high rates, mental disorders were not significant predictors of breastfeeding behaviour. Employment and HIV diagnosis during pregnancy predicted a lower likelihood of breastfeeding initiation among HIV-infected mothers, while employment was associated with earlier breastfeeding-discontinuation in HIV-uninfected mothers. Findings indicate that future interventions should target sub-populations such as HIV-infected women because of distinct needs. Workplace interventions appear particularly key for mothers in our study.

Mothers' pupillary responses to infant facial expressions.

BACKGROUND: Human parental care relies heavily on the ability to monitor and respond to a child's affective states. The current study examined pupil diameter as a potential physiological index of mothers' affective response to infant facial expressions. METHODS: Pupillary time-series were measured from 86 mothers of young infants in response to an array of photographic infant faces falling into four emotive categories based on valence (positive vs. negative) and arousal (mild vs. strong). RESULTS: Pupil dilation was highly sensitive to the valence of facial expressions, being larger for negative vs. positive facial expressions. A separate control experiment with luminance-matched non-face stimuli indicated that the valence effect was specific to facial expressions and cannot be explained by luminance confounds. Pupil response was not sensitive to the arousal level of facial expressions. CONCLUSIONS: The results show the feasibility of using pupil diameter as a marker of mothers' affective responses to ecologically valid infant stimuli and point to a particularly prompt maternal response to infant distress cues.

Novel pharmacological treatment strategies for posttraumatic stress disorder.

INTRODUCTION: A wide range of medications have been studied for posttraumatic stress disorder (PTSD) and a number are registered for this indication. Nevertheless, current pharmacotherapies are only partially effective in some patients, and are minimally effective in others. Thus novel treatment avenues need to be explored. Areas covered: In considering novel pharmacological agents for the treatment of PTSD, this paper takes a translational approach. We outline how advances in our understanding of the underlying neurobiology of PTSD may inform the identification of potential new treatment targets, including glutamatergic, noradrenergic and opioid pathways. Expert commentary: Continued investigation of the neural substrates and signalling pathways involved in responses to trauma may inform the development of novel treatment targets for future drug development for PTSD. However, the translation of preclinical findings to clinical practice is likely to be complex and gradual.

Sniffing out olfactory reference syndrome.

Olfactory reference syndrome is characterised by the erroneous belief that one emits an unpleasant body odour. This results in significant distress and is often accompanied by repetitive behaviour such as frequent showering in an attempt to camouflage the perceived odour. The body odour concerns may have a delusional quality and do not respond to simple reassurance or counterexample. Herein, we report the case of an olfactory reference disorder (ORD) patient who had received multiple medical interventions and undergone polysurgery prior to an accurate diagnosis being established. ORD may lead to significant disability, yet often goes unrecognised for many years. For many patients, poor insight will contribute to their reluctance to consider psychiatric treatment. This case demonstrated that a multimodal treatment approach comprising judicious medication use, combined with cognitive behavioural therapy, in the context of a therapeutic alliance yielded therapeutic success.

Methamphetamine-induced psychosis: Clinical features, treatment modalities and outcomes.

OBJECTIVE: To investigate the clinical features, prescribing patterns and outcomes of psychiatric inpatients admitted with methamphetamine-induced psychosis. METHOD: A cross-sectional, descriptive pilot study was conducted between March 2014 and August 2014 at three South African Mental Health Care Act designated hospitals prior to admission to a psychiatric hospital. Patients with methamphetamine-related psychotic symptoms according to the DSM-5 criteria were eligible. Structured face-to-face interviews were conducted and the Brief Psychiatric Rating Scale was employed as a measure of current psychopathology. RESULTS: Fifty-six participants were included. Positive psychotic symptoms (e.g. hallucinations) were more prominent than negative symptoms (e.g. affective blunting). Almost half the participants (43%) had previous episodes of methamphetamine-induced psychosis. Within this group, all had defaulted on the prescribed treatment prior to admission. Only 29% of the participants had received prior formal substance-use rehabilitation as treatment for their disorder. High rates of comorbid cannabis and alcohol use (51%) were recorded. Most of the participants required transfer to specialist psychiatric hospitals. The amounts of methamphetamine used were not a predictor of the persistence of psychosis; however, the pattern of use was. CONCLUSION: Clinical features correspond with other international findings. The currently employed model of sequential, non-integrated psychiatric and substance use treatment in this setting appears ineffective.

Olfactory Reference Disorder: Diagnosis, Epidemiology and Management.

Although not included as a disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), olfactory reference disorder (ORD) is being considered for inclusion as a discrete disorder in the ICD-11 (International Classification of Diseases, 11th edition). ORD is likely underdiagnosed and undertreated. The purpose of this paper is to provide information to clinicians and researchers on the epidemiology, clinical presentation and treatment options for this condition. A narrative overview of the literature as retrieved from a computerized database search is provided. ORD is a condition that is characterized by the erroneous belief that one emits a foul or unpleasant body odour, resulting in significant distress and impairment. It is often accompanied by referential thinking and repetitive behaviours aimed at camouflaging the perceived odour. Level of insight varies, with some patients having concerns that are delusional. Patients usually do not spontaneously report their symptoms and so screening in suspected cases is crucial. The literature regarding ORD treatment remains limited.

The value of staff nurse involvement in decision making.

OBJECTIVES: The objectives of this study were to explore the perceptions of hospital-based staff nurses regarding their involvement in decision making and to gain an understanding of the ways nurses would like to be involved in decision making. BACKGROUND: How nurses want to be involved and the extent to which hospital-based staff nurses are involved in formal and informal structures for decision making remain unknown. METHODS: Stratified cluster random sampling was used to identify hospitals to participate in the study. Staff nurses and chief nursing officers (CNOs) from 10 hospitals in Colorado were invited to participate in this qualitative descriptive study informed by grounded theory. Focus groups with staff nurses and individual interviews with CNOs were also conducted. RESULTS: Safe quality patient care was threaded throughout discussions among the staff nurses and CNOs. CONCLUSIONS: Staff nurses viewed involvement in decision making through the lens of an egalitarian process, whereas administration viewed involvement as soliciting input but making decisions unilaterally.

Household air pollution from cooking fires: a challenge for nurses globally and a call to action.

The global burden of disease from exposure to household air pollution related to cooking fires is ranked as the 6th leading cause of death, primarily impacting poor women and children in low-income countries. Globally, smoke exposure from household air pollution is attributed to approximately 1/3 of chronic obstructive pulmonary deaths, 1/4 of pneumonia deaths, and 3% of lung cancer deaths. Nurses are increasingly working in global health arenas but are typically ill-prepared to address this complex environmental health problem. Nurses can play a key role in education, practice, and research to develop and support interventions, both in the United States and abroad, which may reduce this substantial burden of disease.

Original Research: Men's awareness and knowledge of male breast cancer.

OBJECTIVE: This article reports on the findings of a qualitative study that explored the awareness and knowledge of male breast cancer among English-speaking men. The primary goal was to elicit information to guide both clinical practice and the development of gender-specific educational interventions. METHODS: Interviews with 28 adult men, all of whom had no history of breast cancer themselves but had at least one maternal blood relative with the disease, were conducted and analyzed, using qualitative methods, to describe participants' awareness of male breast cancer, their knowledge of the disease, and how they thought awareness of male breast cancer could be increased in health care providers and the lay public. RESULTS: Nearly 80% of participants weren't aware that men can get breast cancer; and although all were at higher risk given their positive family history, all reported that their providers had never discussed the disease with them. A majority couldn't identify any symptoms other than a lump in the breast. About 43% voiced concerns that a diagnosis of breast cancer would cause them to question their masculinity. Participants also suggested ways that men, as well as providers and the lay public, could be better made aware of and educated about their risk for this disease. CONCLUSION: This study provides much-needed insight into men's awareness and knowledge of male breast cancer. While further research with larger samples is needed, these findings offer a starting point for the development of evidence-based, gender-specific, health promotion and disease prevention interventions for men. KEYWORDS: male breast cancer; breast cancer, male; breast neoplasms, male; men's health; patient education; qualitative research.

One more hurdle to increasing mammography screening: pubescent, adolescent, and prior mammography screening experiences.

BACKGROUND: Approximately $8.1 billion dollars is spent each year in the United States alone on the treatment of breast cancer. Survival rates are dependent on access to, and utilization of, early detection services. The primary reason for disparity in breast cancer mortality is the delay in time to diagnosis, resulting in poor prognosis. Despite ongoing research to understand barriers to mammography screening, recent studies report a decrease in mammography screening among all racial groups. METHODS: A qualitative approach was used to elicit information from 36 White non- Hispanic, African-American, Hispanic, and Native American women without a history of breast cancer. Women were invited to share written or audiotape-recorded narratives about experiences pertaining to their breasts and their mammography screening experiences. FINDINGS: Major categories identified were: teasing, family norms and values, media/societal influence, body image, and mammography screening experiences. The resulting effects of these experiences left these women with feelings of shame and "conflict" regarding their breasts. The major theme identified was breast conflict. Findings suggest that breast conflict may persist throughout the lifespan and can have a negative influence on a woman's decision to participate in mammography screening. CONCLUSION: The authors hypothesize that experiences that occur during adolescence pertaining to young girls' breasts can influence a women's body image, which in turn can later in life affect health-seeking behaviors related to mammography screening. These findings have implications for public health practice in planning for breast cancer screening, education, and interventions for women from diverse racial/ethnics groups.

Cost and utilization avoidance with mail prompts: a randomized controlled trial.

OBJECTIVE: To study the medical service utilization changes and return on investment from a health plan's direct mailings that either encouraged members to receive influenza vaccinations or encouraged members to call a nurse advice service. STUDY DESIGN: Randomized controlled trial with 2 intervention groups and 1 control group consisting of all members over age 65 years who were enrolled in 5 states in the Blue Cross and Blue Shield Government-wide Service Benefit Plan. Sample size was 134,791 individuals. METHODS: Administrative claims-based influenza, pneumonia, heart failure, and respiratory inpatient bed days, emergency department (ED) visits, physician evaluation and management visits, other outpatient visits, and nurse advice call rates were compared between the intervention and control groups. RESULTS: The influenza mailing intervention group experienced 2.87% (P = .033) fewer conditionrelated inpatient bed days and 7.25% (P = .101) fewer condition-related ED visits. The nurse advice service mailing intervention group experienced 7.65% (P <.001) fewer condition-related inpatient bed days and 6.75% (P = .125) fewer condition-related ED visits. Per dollar spent, the return on investment was estimated to be $2.51 for the influenza mailing intervention and $24.24 for the nurse advice mailing intervention. CONCLUSIONS: Administrative claims data suggest that members respond to health plan mailings. By mailing information to their members, health plans can affect rates of medical service utilization and generate cost savings.

Lessons learned from China's healthcare system and nursing profession.

PURPOSE: To examine the healthcare policy and the nursing profession in China and to share insights learned from that country, which can be used to inform health-policy decision makers in the US. ORGANIZING CONSTRUCT: Despite their significant cultural, political, and historical differences, many healthcare issues are the same for China and the US. Both countries face rising healthcare costs and widening disparities between wealthy and poor individuals, and between urban and rural sectors. CONCLUSIONS: Some of the ideas that can be gleaned from China's healthcare system include rewarding physicians for prescribing preventive services; using trained laypeople as gatekeepers to the healthcare system in rural areas; communicating to the public and to health-policy decision makers the importance of nurses so that staffing, work conditions, and professional status can be improved; and including nurses in health-policy decisions. CLINICAL RELEVANCE: Lessons learned from China's healthcare policy and healthcare system have implications for public health policy change that could lead to improved patient outcomes in the US. The current changing global health environment calls for healthcare providers to learn from and work with our international neighbors to improve health outcomes for all patients.

Stages of change: Korean women's attitudes and barriers toward mammography screening.

The positive and negative aspects of breast cancer screening were measured to gain insight into the barriers that prevent Korean women from participating in mammography screening. Breast cancer screening behaviors, attitudes, and barriers were identified from a convenience sample of 328 Korean women recruited in Seoul, Gyeonggi, and Jeju, South Korea. Pros, cons, and decisional balance constructs of the transtheoretical model of behavior change were used to identify stages of change in attitude related to mammography screening. There were significant differences in pros (F = 5.175, p = .001) and cons (F = 3.357, p = .012) across the five stages of change for mammography. Participants indicated that the major barriers to mammography screening were, in order of frequency, the belief that an absence of symptoms meant there was no need for a breast examination, the high cost of breast cancer screening, lack of time, lack of information, embarrassment, fear about x-rays and test results, reliance on breast self-examination (BSE), and discomfort or pain. The benefits of breast cancer screening should be emphasized among Korean women.