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BACKGROUND: Lack of diversity in participants throughout the research process limits the generalizability of findings and may contribute to health disparities. There are unique challenges to recruitment of families to pediatric cancer research studies, especially for those from disadvantaged backgrounds. Thus, there is a need to evaluate the most effective recruitment and retention strategies to optimize equitable recruitment of diverse participants. METHODS: The present study adapted and implemented methods outlined previously in the literature. These previous efforts were developed to address barriers to pediatric research, behavioral health intervention research and research with Black adolescents. Recruitment and retention strategies are described across four different time points: pre-approach, initial connection, building connection and follow-up. Eligible families of children with a pediatric cancer diagnosis were approached during a routine oncology visit. Once consented, enrollment and retention rates over three timepoints of data collection were recorded and evaluated. RESULTS: Results indicated high rates of enrollment (86%) and retention (95%) for eligible participants. There were no trends in heightened attrition for any specific subgroup. CONCLUSIONS: The findings of this study are promising and suggest these recruitment and retention strategies may be useful in recruiting individuals from disadvantaged backgrounds.
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Equidad en Salud , Neoplasias , Selección de Paciente , Humanos , Niño , Adolescente , Femenino , Masculino , Negro o Afroamericano/estadística & datos numéricos , Investigación Biomédica/estadística & datos numéricos , Investigación Biomédica/métodos , Pediatría/métodos , Pediatría/estadística & datos numéricosRESUMEN
A dramatic increase in firework-related blast injuries to the hand and upper extremity resulted in record-setting numbers at our institution over the July 4, 2018, holiday. This led our hand and upper extremity department to create a public service announcement (PSA) campaign regarding firework safety and injury prevention. This PSA was broadcast in advance of the next July 4 holiday via several media platforms including television, radio, and the internet. The following year only 4 patients required surgery for firework-related blast injuries to the hand and upper extremity over the same 10-day period, including the weekends before and after the July 4, 2019, holiday. This represented a considerable reduction compared with the 14 patients seen within the same time frame in 2018. The purpose of this article was to outline the process and report the impact of creating and disseminating a public service announcement for firework-related blast injury prevention.
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Traumatismos por Explosión , Traumatismos de la Mano , Procedimientos de Cirugía Plástica , Traumatismos por Explosión/prevención & control , Traumatismos por Explosión/cirugía , Explosiones/prevención & control , Mano/cirugía , Traumatismos de la Mano/cirugía , HumanosRESUMEN
PURPOSE: To assess the efficacy of tasimelteon to improve sleep in Smith-Magenis syndrome (SMS). METHODS: A 9-week, double-blind, randomized, two-period crossover study was conducted at four US clinical centers. Genetically confirmed patients with SMS, aged 3 to 39, with sleep complaints participated in the study. Patients were assigned to treatment with tasimelteon or placebo in a 4-week crossover study with a 1-week washout between treatments. Eligible patients participated in an open-label study and were followed for >3 months. RESULTS: Improvement of sleep quality (DDSQ50) and total sleep time (DDTST50) on the worst 50% of nights were primary endpoints. Secondary measures included actigraphy and behavioral parameters. Over three years, 52 patients were screened, and 25 patients completed the randomized portion of the study. DDSQ50 significantly improved over placebo (0.4, p = 0.0139), and DDTST50 also improved (18.5 minutes, p = 0.0556). Average sleep quality (0.3, p = 0.0155) and actigraphy-based total sleep time (21.1 minutes, p = 0.0134) improved significantly, consistent with the primary outcomes. Patients treated for ≥90 days in the open-label study showed persistent efficacy. Adverse events were similar between placebo and tasimelteon. CONCLUSION: Tasimelteon safely and effectively improved sleep in SMS.
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Síndrome de Smith-Magenis , Adolescente , Adulto , Benzofuranos , Niño , Preescolar , Estudios Cruzados , Ciclopropanos/farmacología , Ciclopropanos/uso terapéutico , Método Doble Ciego , Humanos , Sueño , Síndrome de Smith-Magenis/tratamiento farmacológico , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: The purpose of this project was to design, develop, implement, and manage a sustainable process for pediatric preoperative COVD-19 testing and use the test results to determine the level of personal protective equipment and infection control required for each patient for optimal surgical scheduling and preservation of resources. DESIGN: This quality improvement project used the Plan-Do-Study-Act methodology. Multiple cycles of re-evaluation refined this process which was standardized across the enterprise. METHODS: A process for preoperative testing for all patients undergoing procedures requiring anesthesia was developed and implemented. FINDINGS: A safe, feasible, timely process was developed and piloted to obtain COVID-19 test results to guide individualized interventions. During the pilot, 1,707 patients were screened, and five tested positive for COVID-19, eliminating the need to manage 1702 patients as COVID-19 positive. CONCLUSION: To continue to safely re-open, knowledge of the patient's COVID-19 status is imperative to ensure a safe journey through the perioperative area.
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COVID-19 , Pacientes Ambulatorios , Prueba de COVID-19 , Niño , Humanos , Mejoramiento de la Calidad , SARS-CoV-2RESUMEN
BACKGROUND: Patients with pelvic ring displacement and instability can benefit from surgical reduction and instrumentation to stabilize the pelvis and improve functional outcomes. Current treatments include iliosacral screw or transsacral-transiliac screw, which provides greater biomechanical stability. However, controversy exists regarding the effects of placement of a screw across an uninjured sacroiliac joint for pelvis stabilization after trauma. QUESTIONS/PURPOSES: Does transsacral-transiliac screw fixation of an uninjured sacroiliac joint increase pain and worsen functional outcomes at minimum 1-year followup compared with patients undergoing standard iliosacral screw fixation across the injured sacroiliac joint in patients who have sustained pelvic trauma? METHODS: All patients between ages 18 and 84 years who sustained injuries to the pelvic ring (AO/OTA 61 A, B, C) who were surgically treated between 2011 and 2013 at an academic Level I trauma center were identified for selection. We included patients with unilateral sacroiliac disruption or sacral fractures treated with standard iliosacral screws across an injured hemipelvis and/or transsacral-transiliac screws placed in the posterior ring. Transsacral-transiliac screws were generally more likely to be used in patients with vertically unstable sacral injuries of the posterior ring as a result of previous reports of failures or in osteopenic patients. We excluded patients with bilateral posterior pelvic ring injuries, fixation with a device other than a screw, previous pelvic or acetabular fractures, associated acetabular fractures, and ankylosing spondylitis. Of the 110 patients who met study criteria, 53 (44%) were available for followup at least 12 months postinjury. Sixty patients were unable to be contacted by phone or mail and seven declined to participate in the study. Outcomes were obtained by members of the research team using the visual analog scale (VAS) pain score for both posterior sacroiliac joints, Short Musculoskeletal Functional Assessment (SMFA), and Majeed scores. Patients completed the forms by themselves when able to return to the clinic. A phone interview was performed for others after they received the outcome forms by mail or email. RESULTS: There were no differences between iliosacral and transsacral-transiliac in terms of VAS injured (2.9 ± 2.9 versus 3.0 ± 2.8, mean difference = 0.1 [95% confidence interval, -1.6 to 1.7], p = 0.91), VAS uninjured (1.8 ± 2.4 versus 2.0 ± 2.6, mean difference = 0.2 [-1.3 to 1.6], p = 0.82), Majeed (80.3 ± 19.9, 79.3 ± 17.5, mean difference = 1.0 [-11.6 to 9.6], p = 0.92), SMFA Function (22.8 ± 22.2, 21.0 ± 17.6, mean difference = 1.8 [-13.2 to 9.6], p = 0.29, and SMFA Bother (24.3 ± 23.8, 29.7 ± 23.4, mean difference = 5.4 [-7.8 to 18.6], p = 0.42). CONCLUSIONS: Placement of fixation across a contralateral, uninjured sacroiliac joint resulted in no differences in pain and function when compared with standard iliosacral screw placement across an injured hemipelvis at least 1 year after instrumentation. When needed for biomechanical stability, transsacral-transiliac fixation across an uninjured sacroiliac joint can be used without expectation of positive or negative effects on pain or functional outcomes at minimum 1-year followup. LEVEL OF EVIDENCE: Level III, therapeutic study.
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Tornillos Óseos , Fijación Interna de Fracturas/instrumentación , Ilion/cirugía , Dolor Postoperatorio/etiología , Articulación Sacroiliaca/cirugía , Sacro/cirugía , Fracturas de la Columna Vertebral/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Femenino , Fijación Interna de Fracturas/efectos adversos , Humanos , Ilion/diagnóstico por imagen , Ilion/lesiones , Ilion/fisiopatología , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Articulación Sacroiliaca/diagnóstico por imagen , Articulación Sacroiliaca/lesiones , Articulación Sacroiliaca/fisiopatología , Sacro/diagnóstico por imagen , Sacro/lesiones , Sacro/fisiopatología , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/fisiopatología , Factores de Tiempo , Centros Traumatológicos , Resultado del Tratamiento , Adulto JovenRESUMEN
Purpose: To assess the feasibility and acceptability of yoga incorporated into a pediatric weight management program (promoting health in teens; PHIT Yoga) to racially diverse caregivers and youth and to compare this program with a cohort that received a program that did not include yoga (PHIT Kids). Methods: Thirty children with obesity were enrolled in a 12-week pediatric weight management intervention (PHIT Kids, n = 17; PHIT Yoga, n = 13). Weight, BMI z-score (BMIz), BMI percent of the 95th percentile, and health habits assessment were obtained from both cohorts pre- and post intervention. Acceptability was assessed in the yoga cohort. Results: Fifty-four percent of children in the PHIT Yoga cohort and 65% of children in the PHIT Kids cohort attended ≥75% of the intervention sessions. Survey results support that the PHIT Yoga was acceptable to both caregivers and children. Improvements in BMIz were observed in 50% of children in each cohort and both groups improved on five of seven health habits; cohorts overlapped on three habits (breakfast, screen time, and sugar-sweetened drinks). Conclusion: Findings support that yoga classes added to a pediatric weight management program are feasible and acceptable in racially diverse children with severe obesity and their caregivers.
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Obesidad Infantil , Yoga , Adolescente , Índice de Masa Corporal , Desayuno , Cuidadores , Niño , Humanos , Obesidad Infantil/prevención & control , Proyectos PilotoRESUMEN
Drawing on a wealth of primary documents, this historical research describes nurses' efforts regarding early 20th century pediatric tuberculosis care in Virginia. Virginia nurses played a leadership role in designing a template for children's care. Ultimately, however, their legacy is a mixed one. They helped forge a system funded by a complicated, poorly coordinated, race- and class-based mix of public and private support that is now delivered through an idiosyncratic web of community, state, and federal programs. However, they also took courageous action, and their efforts improved the lives of many children. By so doing, they helped invent pediatric nursing.
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Enfermería Pediátrica/historia , Tuberculosis Pulmonar/historia , Niño , Política de Salud , Disparidades en el Estado de Salud , Historia del Siglo XX , Humanos , Tuberculosis Pulmonar/etnología , Virginia/epidemiologíaRESUMEN
The purpose of this two-phase quality improvement audit was to analyze elective surgery cancellations in a tertiary pediatric care institution and identify and recommend nursing practice changes in the preoperative assessment clinic (POAC) to potentially influence the overall cancellation rate. A prospective review of cancellation data was conducted over a 6-month period in 2008 and again in 2010. In both phases of the audit, illness was the leading cause for surgical cancellation between the preoperative assessment and the day of surgery, with otolaryngology service representing the highest number of cancellations. Cancellations at or between the preoperative assessment and the day of surgery may be viewed as POAC successes that may have otherwise increased the day-of-surgery cancellation rate. Educating families on the prevention of illness in the perianesthesia period may be a critical nursing role in the prevention of surgical cancellations.
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Citas y Horarios , Procedimientos Quirúrgicos Electivos , Hospitales Pediátricos/organización & administración , Niño , HumanosRESUMEN
Pain relief during childbirth continues to stimulate controversy as new treatments emerge and continuing interventions in the birth process invoke concerns about safety, technologic imperatives, and informed consent. In this historical commentary, I identify a complex dissonance between scientific advances and women's needs and expectations regarding childbirth. Evidence-based practice became the standard during the last 50 years and has reinforced a more conservative and parsimonious use of technology to respond to women's needs for pain relief. In reviewing this history, it is apparent that pain relief during labor is inextricably linked to interventions. Nurses can advance evidence-based practice and facilitate robust informed consent as they support women during childbirth.
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Analgesia Obstétrica , Dolor de Parto , Trabajo de Parto , Femenino , Humanos , Dolor de Parto/terapia , Manejo del Dolor , Parto , EmbarazoRESUMEN
Introduction: Novel therapies are needed for the treatment of motion sickness given the inadequate relief and bothersome and dangerous adverse effects of currently approved therapies. Neurokinin-1 (NK1) receptor antagonists have the potential to be effective in improving the symptoms of motion sickness, given the involvement of Substance P in nauseogenic and emetic pathways and the expression of NK1 receptors in the gastrointestinal system. Here we evaluated the efficacy of tradipitant, a novel NK1 receptor antagonist, in preventing motion sickness in variable sea conditions. Methods: A total of 126 adults participated in the Motion Sifnos study. Groups of participants were assigned to one of seven boat trips lasting ~4 h on the Pacific Ocean. Participants were randomized 1:1 to tradipitant 170 mg or placebo and completed the Motion Sickness Severity Scale (MSSS) every 30 min, in addition to other assessments. Severity of motion sickness was assessed with the incidence of vomiting and the MSSS. Results: Participants on tradipitant had a significantly lower incidence of vomiting as compared to those on placebo across all boat trips (tradipitant = 17.5%, placebo = 39.7%, p = 0.0039). For trips exposed to rough sea conditions, the difference in the incidence of vomiting between the groups was more dramatic (tradipitant = 15.79%, placebo = 72.22%, p = 0.0009). Across these trips, motion sickness symptoms were significantly lower in the tradipitant group compared to the placebo group (tradipitant = 3.19, placebo = 4.57, p = 0.0235). Discussion: Tradipitant has the potential to be an effective therapy for the prevention of vomiting and treatment of nausea in people with motion sickness.
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OBJECTIVE: To determine the effects of low-dose prolonged methylprednisolone infusion on lung function in patients with early severe ARDS. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: ICUs of five hospitals in Memphis. PARTICIPANTS: Ninety-one patients with severe early ARDS (= 72 h), 66% with sepsis. INTERVENTIONS: Patients were randomized (2:1 fashion) to methylprednisolone infusion (1 mg/kg/d) vs placebo. The duration of treatment was up to 28 days. Infection surveillance and avoidance of paralysis were integral components of the protocol. MAIN OUTCOME MEASURE: The predefined primary end point was a 1-point reduction in lung injury score (LIS) or successful extubation by day 7. RESULTS: In intention-to-treat analysis, the response of the two groups (63 treated and 28 control) clearly diverged by day 7, with twice the proportion of treated patients achieving a 1-point reduction in LIS (69.8% vs 35.7%; p = 0.002) and breathing without assistance (53.9% vs 25.0%; p = 0.01). Treated patients had significant reduction in C-reactive protein levels, and by day 7 had lower LIS and multiple organ dysfunction syndrome scores. Treatment was associated with a reduction in the duration of mechanical ventilation (p = 0.002), ICU stay (p = 0.007), and ICU mortality (20.6% vs 42.9%; p = 0.03). Treated patients had a lower rate of infections (p = 0.0002), and infection surveillance identified 56% of nosocomial infections in patients without fever. CONCLUSIONS: Methylprednisolone-induced down-regulation of systemic inflammation was associated with significant improvement in pulmonary and extrapulmonary organ dysfunction and reduction in duration of mechanical ventilation and ICU length of stay.
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Glucocorticoides/administración & dosificación , Metilprednisolona/administración & dosificación , Síndrome de Dificultad Respiratoria/terapia , Proteína C-Reactiva/metabolismo , Catecolaminas/sangre , Relación Dosis-Respuesta a Droga , Femenino , Inmunoensayo de Polarización Fluorescente , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Hidrocortisona/sangre , Infusiones Intravenosas , Tiempo de Internación , Masculino , Persona de Mediana Edad , Respiración Artificial , Unidades de Cuidados Respiratorios , Síndrome de Dificultad Respiratoria/sangre , Síndrome de Dificultad Respiratoria/mortalidad , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
The contributions of America's family caregivers, along with many friends and neighbors, often go unrecognized in public policy discussions about the financing and costs of health care and long-term services and supports (LTSS). Yet these unpaid caregivers provide by far the majority of long-term services and supports received by persons with disabilities of all ages. Many of these "informal" caregivers also provide health-related services. In fact, their contributions to loved ones and friends are not only the foundation of the nation's long-term care system but an important component of the U.S. economy, with an estimated economic value of about $350 billion in 2006. This issue brief discusses the financial impact of caregiving on the caregivers themselves as well as the economic value of their contributions to society. It compares the economic value of informal caregiving to other benchmarks in order to underscore the magnitude of these unpaid contributions, presents estimates of productivity losses to U.S. businesses from caregiving, and highlights the critical role that family caregivers play in the nation's long-term care system. Finally, it recommends ways to support informal caregivers through public policies and in the private sector.
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Cuidadores/economía , Adulto , Cuidadores/legislación & jurisprudencia , Cuidadores/psicología , Cuidadores/estadística & datos numéricos , Costo de Enfermedad , Familia , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
Fear of pain often overshadows childbirth, and each woman must decide whether to receive anesthesia to combat labor pain. Historically, this choice resulted in unintended consequences and marked the beginnings of medical interventions in labor and birth. The purpose of this article is to trace the use of anesthesia in childbirth from the mid-19th to the mid-20th centuries and to explore its influence on childbearing women and nurses.
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Anestesia Obstétrica/historia , Dolor de Parto/historia , Trabajo de Parto/historia , Parto Obstétrico/historia , Femenino , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Dolor de Parto/terapia , EmbarazoRESUMEN
Management of nonobstetric pain in the pregnant patient presents unique challenges related to transplacental fetal exposure to opioids and the subsequent risk of neonatal withdrawal syndrome. We present the case of a pregnant patient suffering from the pain of a progressively enlarging thoracoabdominal sarcoma. Epidural analgesia (using local anesthetics with minimal opioid) was utilized over a span of weeks to manage oncologic pain, limiting fetal opioid exposure and culminating in the birth of a healthy infant. While nonobstetric abdominal pain during pregnancy is not that uncommon, neoplastic abdominal pain does appear to be rare. Combined local anesthetic and opioid continuous epidural infusion should be considered a viable option in the pain management approach to obstetric patients with nonobstetric pain associated with malignancy.
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OBJECTIVES: To review progress made during the past decade in late-life mood disorders and to identify areas of unmet need in health care delivery and research. PARTICIPANTS: The Consensus Development Panel consisted of experts in late-life mood disorders, geriatrics, primary care, mental health and aging policy research, and advocacy. EVIDENCE: (1) Literature reviews addressing risk factors, prevention, diagnosis, treatment, and delivery of services and (2) opinions and experiences of primary care and mental health care providers, policy analysts, and advocates. CONSENSUS PROCESS: The Consensus Development Panel listened to presentations and participated in discussions. Workgroups considered the evidence and prepared preliminary statements. Workgroup leaders presented drafts for discussion by the Consensus Development Panel. The final document was reviewed and edited to incorporate input from the entire Consensus Development Panel. CONCLUSIONS: Despite the availability of safe and efficacious treatments, mood disorders remain a significant health care issue for the elderly and are associated with disability, functional decline, diminished quality of life, mortality from comorbid medical conditions or suicide, demands on caregivers, and increased service utilization. Discriminatory coverage and reimbursement policies for mental health care are a challenge for the elderly, especially those with modest incomes, and for clinicians. Minorities are particularly underserved. Access to mental health care services for most elderly individuals is inadequate, and coordination of services is lacking. There is an immediate need for collaboration among patients, families, researchers, clinicians, governmental agencies, and third-party payers to improve diagnosis, treatment, and delivery of services for elderly persons with mood disorders.
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Atención a la Salud/normas , Necesidades y Demandas de Servicios de Salud , Trastornos del Humor/diagnóstico , Trastornos del Humor/terapia , Factores de Edad , Anciano , Envejecimiento/psicología , Actitud del Personal de Salud , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/terapia , Comorbilidad , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/normas , Investigación , Factores de Riesgo , Estados UnidosRESUMEN
BACKGROUND: The purpose of this study is to evaluate the current perceptions of breast-feeding support for active duty women serving in the U.S. Armed Forces. METHODS: An online survey based on the Workplace Breastfeeding Support Scale (WBSS) was used to collect data from active duty military mothers. Data were collected and analyzed using SPSS software to evaluate active duty women's perceptions of breast-feeding support in the military. RESULTS: 318 active duty women participated in the online survey. The average WBSS scores for active duty women was 50.20 (SD = 15.75). Comparing WBSS scores and branch of service, women in the Army had significantly lower WBSS scores (M = 45.85) then women in the Air Force (M = 53.96, p < 0.001). Enlisted women had significantly lower scores (M = 47.12) than officers (M = 54.62, p < 0.001). Also noted were significantly lower scores of active duty women who were Hispanic (M = 44.30) and women who had lower levels of education (M = 46.90, p = 0.006). CONCLUSIONS: The Department of Defense may be able to improve breast-feeding rates for all active duty mothers by implementing and adhering to lactation policies and focusing support efforts for enlisted women in all branches of service.
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Lactancia Materna/psicología , Personal Militar/psicología , Percepción/fisiología , Mujeres Trabajadoras , Lugar de Trabajo , Adulto , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Estados Unidos , Adulto JovenRESUMEN
An outline is given of the career of Alfred Fröhlich, and his correspondence with Sir Ronald Ross between 1901 and 1912 is described in detail.
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Correspondencia como Asunto/historia , Endocrinología/historia , Austria , Inglaterra , Historia del Siglo XIX , Historia del Siglo XXRESUMEN
This paper focuses on the creation of the criminal insane asylum in Italy between unification in 1861 and World War I. The establishment of criminal insane asylums was a triumph of the positivist criminology of Cesare Lombroso, who advocated for an institution to intern insane criminals in his classic work, Criminal Man (1876). As a context for the analysis of the birth of the criminal insane asylum in Italy, this essay also outlines the history of the insanity plea in Italian criminal law and the young discipline of psychiatry during the fifty years after Italian unification.