Similar early intervention referral rates following in-person administration of the Bayley Scales of Infant and Toddler Development, 4th Edition versus Telehealth Administration of the Developmental Assessment in Young Children, 2nd Edition in the high-risk infant population.

BACKGROUND: Infants with prematurity, low birthweight, and medical comorbidities are at high risk for developmental delays and neurodevelopmental disabilities and require close monitoring. Due to the COVID-19 pandemic, high-risk infant follow-up (HRIF) programs have adapted to perform developmental assessments via telehealth. OBJECTIVES: Describe the referral rates to initiate, continue, or increase/add early intervention (EI) therapies based on in-person use of the Bayley Scales of Infant and Toddler Development, 4th Edition (BSID-IV) or telehealth use of the Developmental Assessment in Young Children, 2nd Edition (DAYC-2). METHODS: A retrospective chart review was conducted on 203 patients seen in the HRIF program at an academic medical center in Southern California. Patients were divided into in-person (BSID-IV) and telehealth (DAYC-2) assessment groups. Statistical analyses were performed to describe demographic characteristics, medical information, and referral rates for EI therapies by the types of visits. RESULTS: The in-person and telehealth groups demonstrated similar demographic and clinical characteristics and comparable referral rates for initiating EI therapies. Telehealth patients already receiving therapies were recommended to increase/add EI therapies at a higher rate compared to in-person patients. CONCLUSIONS: The BSID-IV is widely used to assess for developmental delays in the high-risk infant population, but in-person administration of this tool poses limitations on its accessibility. Telehealth administration of an alternative tool, such as the DAYC-2, can lead to similar EI referral rates as in-person administration of the BSID-IV. Increased use of telehealth developmental assessments can promote timely detection of developmental delays and minimize gaps in healthcare access.

Impact of COVID-19 on mental health: Effects on screening, care delivery, and people with cystic fibrosis.

BACKGROUND: Depression and anxiety are two to four times more prevalent in people with CF (pwCF) than the general population. COVID-19 may exacerbate mental health challenges, increasing demand for psychological services, while decreasing their availability. We assessed the impact of the pandemic on depression and anxiety in pwCF, including how COVID-19 affected the frequency of mental health screening and the types of services provided. METHODS: A 38-item internet survey, completed in June 2020, assessed how COVID-19 affected: 1) the mental health clinician's role and screening processes; 2) barriers to screening and resource needs; 3) impact of COVID-19 on depression and anxiety, and 4) positive outcomes and confidence in sustaining mental health screening and treatment, including telehealth services, after the pandemic. RESULTS: Responses were obtained from 131 of the 289 US CF programs. Overall, 60% of programs (n=79) continued mental health screening and treatment, although less frequently; 50% provided individual tele-mental health interventions, and 9% provided telehealth group therapy. Clinically elevated depression symptoms (PHQ-9≥10; moderate to severe), were found in 12% of 785 pwCF, with 3.1% endorsing suicidal ideation. Similarly, elevated anxiety (moderate to severe; GAD-7≥10) was found in 13% of pwCF (n=779). CONCLUSIONS: The COVID-19 pandemic created an opportunity to implement innovative solutions to disruptions in mental health screening and treatment in CF programs. We found that pwCF had increased access to psychological interventions during the pandemic via telehealth, supporting the continued integration of tele-mental health screening and treatment into CF care.

Insights to Identifying and Managing Pain in Persons With Dementia in Long-Term Care: A Mixed Methods Study Comparing the Abbey Pain Scale and Pain Assessment in Advanced Dementia Scale.

Pain is usually identified by specific behaviors driven by the need for relief; however, persons with dementia present a unique challenge for nurses in assessing and managing pain. The aim of this mixed methods study was to explore the relationship between two observational pain scales, expressed need-driven behaviors, and likelihood of medication administration for persons with dementia. The qualitative strand examined nurses' perceptions regarding facilitators and barriers to pain scale use. Quantitative data analysis indicated the Abbey Pain Scale was significantly correlated with behaviors (r[26] = 0.41, p < 0.05) and approached significance with medication administration (r[26] = 0.35, p = 0.067). Qualitative analysis identified three core themes: (a) Challenges in Assessing Persons With Dementia for Pain; (b) Facilitators and Barriers to Pain Management; and (c) Difficulty Caring for Persons With Dementia. Clinical implications suggest the need for a systematic, consistent method of observing pain-related behaviors in persons with dementia. [Journal of Gerontological Nursing, 47(2), 21-30.].

Promoting emotional wellness in children with CF, part II: Mental health assessment and intervention.

This is the second of two companion papers that examine the emotional wellness of children with cystic fibrosis (CF) during the early years of life, defined here as the period between birth and age 12. Both papers promote optimal mental health and well-being, with an emphasis on early identification and intervention. The first paper explores child and family resilience. Here, we discuss strategies for pediatric CF teams to provide routine, systematic mental health assessment, anticipatory guidance, brief intervention, and triage to evidence-based treatment when needed, while addressing barriers to accessing care. Many mental health conditions emerge before the age of 12, with the potential for lifelong effects on individuals, their families, and society. Living with a chronic illness such as CF can further increase the risk of mental health concerns and, in a bidirectional manner, their consequences for the quality of life, sustaining daily care, and health outcomes. There has been a significant focus in recent years on the mental health and wellness of adolescents and adults with CF, but less attention to specifics of depression and anxiety in younger children, or to other common pediatric comorbidities including trauma, developmental disorders such as attention-deficit/hyperactivity disorder or autism spectrum disorder, and oppositional behavior. Given the availability of psychometrically sound screening instruments and effective interventions, routinely addressing the mental health of children with CF and their families is feasible to integrate within multidisciplinary CF care, allowing for a personalized approach respecting individual needs, values, and goals.

Survey of patients with cystic fibrosis and caregivers decisions regarding CFTR modulators.

Cystic fibrosis transmembrane conductance regulator (CFTR) modulators are a novel approach to CF management that has become more readily available chronic CF therapies for certain populations of patients with CF. A cross-sectional survey of adults with CF and caregivers of pediatric patients with CF was done in two CF Centers to better understand the decision-making process including the potential influence of social media, CF care-teams, and family members on their decision whether to begin a CFTR modulator. For the 90 participants, the most common influences in the decision to start modulator therapy were the CF providers/care teams (n = 63), parents (n = 49), and individuals with CF (n = 27). The most impactful influence in the decision-making process were providers/care team (n = 47) and parents (n = 18). Social media was an influence for only 12 respondents, with an overall positive impact. Information from the CF Foundation was an influence for 12 participants and the main influence for six participants. The most common reasons for stopping lumacaftor-ivacaftor were having tezacaftor-ivacaftor as an option (n = 25) and side-effects (n = 15). Family and CF clinicians were the two main influences on the decision to initiate modulator therapy. CF clinicians were seen to be the most influential source. Social media had less influence on the decision-making process than expected despite the wide presence of the CF community online.

Addressing future demands: Development of an online gerontological nursing course.

Nursing students often hold negative views of and do not want to work with older people. Innovative approaches to engage nursing students in geriatric content hold the potential to improve attitudes, a crucial step in meeting the aging population's healthcare needs. This article describes the process of developing, implementing and evaluating an online, undergraduate nursing gerontology course. Development was based on Mezirow's Transformative Learning Theory. Student reflections collected from approximately 200 individuals over two semesters about knowledge gained and the effect on attitudes about aging and older adults are summarized.

Consistency in Administration and Response for the Backward Push and Release Test: A Clinical Assessment of Postural Responses.

BACKGROUND AND PURPOSE: The backward push and release test (PRT) is a standardized clinical test of postural responses elicited by perturbations. Our goal was to determine reliability of administration and response. This will inform clinical administration and determine whether to develop an instrumented version. METHODS: One examiner administered 10 backward PRT trials to adults with Parkinson disease (12), multiple sclerosis (14) and controls (12). We used three-dimensional motion analysis, force plates and instrumented gloves to measure administration and response. Administration variables were angle of posterior trunk lean and the distance of the centre of mass (CoM) behind the ankle. Postural response variables were latency of postural response from release to step initiation and first compensatory step length. Reliability was measured using the range of variables across trials, comparison of first and later trials, intraclass correlations (ICCs) to measure consistency and correlations between administration and response. RESULTS: There was inherent variability in administration, which affected postural response characteristics. Larger trunk angle and greater CoM-ankle distance were correlated with shorter postural response latencies and larger step lengths. Participant height also had an effect; taller participants had larger trunk angles prior to release resulting in longer latencies and larger step lengths. Using ICCs, consistency of trunk angle was likely acceptable and CoM-ankle distance was high. Consistency of latency was low, while step length was likely acceptable. DISCUSSION: Despite variability in administration and inconsistency in response, different postural response characteristics were detected between patients with different disease states. Based on these results, we will create algorithms to instrument the PRT using inertial movement sensors to collect more sensitive measures of postural responses than observational clinical rating scales. Feedback for appropriate lean angle and calibration for participant height will improve consistency and usefulness of the instrumented PRT. Copyright © 2014 John Wiley & Sons, Ltd.

The lived experience of fathers whose children are diagnosed with a genetic disorder.

OBJECTIVE: To describe the father's experience of having a child diagnosed with a genetic disorder. DESIGN: Interpretive phenomenological analysis. SETTING: In-person interviews for participants living within 100 miles of the researcher; phone interviews with participants living more than 100 miles from the researcher. PARTICIPANTS: Six fathers of children diagnosed with genetic disorders. METHODS: Participants were recruited with the assistance of nurses, physicians, and genetic counselors. Snowball sampling, Internet and e-mail recruitment, and word of mouth were also used. Semistructured interviews were completed, audio recorded, and transcribed verbatim. RESULTS: Five themes emerged: the impact of diagnosis, seeking understanding, coping with effects of the disorder, looking to the future, and addressing a father's needs. CONCLUSION: Fathers of children diagnosed with genetic disorders described a lack of education and information regarding the diagnoses. They attributed this deficiency to a lack of knowledge among physicians, nurses, and other health care professionals. Coping with the effects of the disorder was identified as an integral part of adapting to meet the child's needs. Understanding the experience of a father whose child is diagnosed with a genetic disorder is necessary to ensure provision of proper intervention and care.

Cultural competencies for graduate nursing education.

Nursing is challenged to meet the health needs of ethnic and socioculturally diverse populations. To this end, American Association of Colleges of Nursing (AACN) charged an expert nursing faculty advisory group to formulate competencies for graduate nursing education, expanding them to integrate leadership and scholarship. The Cultural Competency in Baccalaureate Nursing Education served as the springboard for the initiative. In formulating the graduate cultural competencies and the toolkit, the advisory group reviewed all AACN Essentials documents and the cultural competency literature, drew upon their collective experiences with cultural diversity, and used cultural humility as the supporting framework. Six core competencies were formulated and endorsed by the AACN board of directors and key professional nursing organizations. A companion toolkit was compiled to provide resources for the implementation of the competencies. A 1-day conference was held in California to launch the cultural competencies and toolkit. Dissemination to graduate nursing programs is in process, with emphasis on faculty readiness to undertake this graduate educational transformation. The AACN Cultural Competencies for Graduate Nursing Education set national standards to prepare culturally competent nurses at the graduate level who will contribute to the elimination of health disparities through education, clinical practice, research, scholarship, and policy.

"Partnering with Seniors for Better Health": computer use and Internet health information retrieval among older adults in a low socioeconomic community.

PURPOSE: This health communication project measured the psychosocial influences of computer anxiety, computer confidence, and computer self-efficacy in older adults at six meal congregate sites. The adults completed a five-week education intervention, based on Bandura's self-efficacy model, designed to assist older adults in retrieving and evaluating health information resources on the Internet. METHODS: One hundred thirty-seven participants, ages sixty-five and older, were randomized in a controlled, two-group, pre-post, repeated measures design. Participants in the intervention group received a two-hour training session, once a week for five weeks. The Computer Confidence Subscale and Computer Anxiety Subscale of the Computer Attitude Scale and the Computer Self-Efficacy Measure were administered to both groups at three time intervals: at baseline, completion of the five-week intervention, and six weeks after completion of the intervention. Data were analyzed using repeated measures analysis of variance. RESULTS: Findings showed a reduction in computer anxiety and increases in computer confidence and computer self-efficacy in retrieving and evaluating online health information (P<0.001). DISCUSSION: The study suggests an array of possibilities to engage older adults in the use of Internet health information resources to better contribute to their health, independence, safety, and wellness.

Improving the health and health behaviors of women aging with physical disabilities: A peer-led health promotion program.

OBJECTIVE: To examine the efficacy of a health promotion program for women aging with physical disabilities. METHOD: A sample of 137 middle-aged and older women with physical disabilities was randomly assigned to either an 8-week health promotion program or to a wait-list control group. Both groups completed questionnaires before, immediately after, and 3 months after the intervention. RESULTS: Relative to women in the control group, women in the health-promotion program demonstrated improvements in health behaviors, most of which were maintained at follow-up. The intervention group showed some improvements on measures of physical health, but there was little evidence of improvement in psychological health outcomes. Testing our theoretical model, self-efficacy was supported as a mediator of the effect of the intervention on health behaviors, and health behaviors combined with self-efficacy were supported as mediators of the effect of the intervention on physical health outcomes. Contrary to our hypotheses, our measures of social support and social connectedness were not affected by the intervention. CONCLUSIONS: A brief, peer-led, group health promotion program resulted in improved scores on measures of self-efficacy, increased health behavior, and physical health. Self-efficacy, which was supported as a mediator in the effect of the intervention on behaviors and health outcomes, should remain an important focus of future interventions with this population.

Problem of nonadherence in chronically ill adolescents: strategies for assessment and intervention.

PURPOSE OF REVIEW: Nonadherence to medical treatment is a significant problem for adolescents with chronic illness, with significant morbidity and mortality. Yet efforts to assess and treat the problem have been limited. We reviewed the literature on the factors associated with nonadherence and focused on nonadherence in a series of interviews with staff at a pediatric transplant program. This paper describes some of our findings, offers guidelines for assessing nonadherence in a primary care setting, and discusses strategies and interventions aimed at enhancing adherence. We refer to clinical cases derived from our interviews with renal transplant staff and our own clinical practice. RECENT FINDINGS: Nonadherence to treatment recommendations occurs in approximately one-third of adolescents with a chronic illness. Factors that have been associated with nonadherence include psychiatric illness, psychological factors, family issues, and health problems. Although extensive research has been done on the problem of poor patient adherence in pediatric chronic illnesses, the prevalence of nonadherence remains high, and the research itself is problematic because of different definitions and methods of assessment used. Novel treatment strategies to improve adherence have been proposed, and data on these are emerging. SUMMARY: Nonadherence in adolescents with chronic illness is a serious problem in need of greater recognition and intervention and further research. The primary care physician may be able to reduce nonadherence by routinely evaluating for adherence issues and initiating a targeted strategy to combat nonadherence when it is found. This review describes strategies and specific approaches for identifying and treating nonadherence in adolescents and their families.

Cost comparison of anterior cruciate ligament reconstruction: autograft versus allograft.

PURPOSE: To compare the economic costs associated with anterior cruciate ligament (ACL) reconstruction using either autograft or allograft. The surgical costs are reported, including charge categories, for each procedure. All operations were performed in the Southern United States of America. TYPE OF STUDY: Evaluation of cost data collected from a group of patients participating in a prospective, nonrandomized trial. METHODS: A total of 122 patients with ACL-deficient knees undergoing surgical reconstruction using either bone-patellar tendon-bone autograft (n = 86) or freeze-dried Achilles tendon allograft (n = 37) were analyzed (1 patient underwent 2 allograft reconstructions). Patient selection for groups was based on the physician performing the surgery (2 surgeons performed autografts and 1 performed allografts). Groups were compared with respect to age, sex, race, and occupation. Hospital charge data were retrieved from the billing department and divided into various categories for comparison of the 2 groups. RESULTS: The mean hospital charge for ACL reconstruction was 4,622 dollars for allograft and 5,694 dollars for autograft (P < .0001). Differences included increased operating room time and a greater likelihood of overnight hospitalization for autograft procedures. This was slightly offset by higher charges for operating room supplies for allograft reconstructions owing to the cost of the graft itself. CONCLUSIONS: Allograft reconstruction of the ACL was significantly less expensive than autograft bone-patellar tendon-bone reconstruction. Allograft ACL reconstruction is a less costly alternative to autograft reconstruction. LEVEL OF EVIDENCE: Level IV, economic analysis with no sensitivity analysis.

Parent caregiver-related predictors of health care service utilization by children with cerebral palsy enrolled in Medicaid.

INTRODUCTION: This study examined the associations between characteristics of the parent caregiver and health care service utilization by children with cerebral palsy enrolled in Medicaid. METHODS: A questionnaire was administered to the parents of children with cerebral palsy being treated in a North Carolina hospital, and the responses were linked with health services claims data from Medicaid. Data were available for 93 patients who maintained 1 year of continuous enrollment. The impact of selected demographic variables (race, years the child had the condition, employment, transportation) and behavioral variables (belief the child was receiving appropriate care, willingness to use home nursing and respite services, self-assessment of the severity of the child's condition, and use of orthopedic aids) on the frequency and costs of health care services was explored with use of multiple regression analysis. RESULTS: Parents who were willing to use home nursing and respite services were more likely to utilize these services, as well as inpatient facilities and orthopedic care, for their children (P <.05). However, parents who perceived that their child was receiving adequate care were less likely to utilize orthopedic care and home nursing for their children (P <.05). DISCUSSION: The belief of the parents in the adequacy of care received by their child, as well as their willingness to utilize supplemental health care services, were major predictors of health care service utilization by children with cerebral palsy enrolled in Medicaid. Parents who believed that their children receive enough care may need to be targeted for care management and disease management programs to ensure the continuum of treatment and care for these children.

Cost impact of botulinum toxin use in Medicaid-enrolled children with cerebral palsy.

The use of botulinum toxin type A (BTX) in the management of spasticity in childhood cerebral palsy (CP) is increasing. This study examined annual health care service utilization and costs associated with BTX therapy for spastic CP in Medicaid-enrolled children receiving complete health care coverage (1997 to 1999). We used pair matching as well as recent statistical technique improvements (bootstrap method) to work with limited samples. The introduction of BTX was associated with an increase of approximately $62 per month in prescription costs for the patient. However, these costs were made up by reductions in hospitalization. When each year was examined individually, reimbursements for BTX users were not different from those for pair-matched non-BTX users. These data suggest that BTX therapy does not significantly add to the costs of treating Medicaid-enrolled children with CP.