Knowledge and Attitudes Regarding Category B ACIP Recommendations Among Primary Care Providers for Children.

OBJECTIVE: In 2015, the Advisory Committee on Immunization Practices (ACIP) made a category B recommendation for use of serogroup B meningococcal (MenB) vaccines, meaning individual clinical decision-making should guide recommendations. This was the first use of a category B recommendation pertaining to a large population and the first such recommendation for adolescents. As part of a survey regarding MenB vaccine, our objectives were to assess among pediatricians (Peds) and family physicians (FPs) nationally: 1) knowledge of the meaning of category A versus B recommendations and insurance coverage implications, and 2) attitudes about category A and B recommendations. METHODS: We surveyed a nationally representative sample of Peds and FPs via e-mail and mail from October to December 2016. RESULTS: The response rate was 72% (660 of 916). Although >80% correctly identified the definition of a category A recommendation, only 24% were correct about the definition for category B. Fifty-five percent did not know that private insurance would pay for vaccines recommended as category B, and 51% did not know that category B-recommended vaccines would be covered by the Vaccines for Children program. Fifty-nine percent found it difficult to explain category B recommendations to patients; 22% thought ACIP should not make category B recommendations; and 39% were in favor of category B recommendations because they provide leeway in decision-making. CONCLUSIONS: For category B recommendations to be useful in guiding practice, primary care clinicians will need to have a better understanding of their meaning, their implications for insurance payment, and guidance on how to discuss them with parents and patients.

Goal setting and strategies to enhance goal pursuit in adult rehabilitation: summary of a Cochrane systematic review and meta-analysis.

INTRODUCTION: Goal setting is considered an essential part of rehabilitation, but approaches to goal setting vary with no consensus regarding the best approach. The aim of this systematic review and meta-analysis was to assess the effects of goal setting and strategies to enhance the pursuit of goals on improving outcomes in adult rehabilitation. EVIDENCE ACQUISITION: We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trial registries for randomized control trials (RCTs), cluster RCTs, or quasi-RCTs published before December 2013. Two reviewers independently screened all search results, then critically appraised and extracted data on all included studies. We identified 39 trials, which differed in clinical context, participant populations, research question related to goal use, and outcomes measured. Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. EVIDENCE SYNTHESIS: These 18 studies provided very low-quality evidence for a moderate effect size that any type of goal setting is better than no goal setting for improving health-related quality of life or self-reported emotional status (N.=446, standard mean difference [SMD]=0.53, 95% confidence interval [CI]: 0.17 to 0.88), and very low-quality evidence of a large effect size for self-efficacy (N.=108, SMD=1.07, 95% CI: 0.64 to 1.49). Fourteen studies compared a structured approach to goal setting to "usual care" goal setting, where some goals may have been set but no structured approach was followed. These studies provided very low-quality evidence for a small effect size that more structured goal setting results in higher patient self-efficacy (N.=134, SMD=0.37, 95% CI: 0.02 to 0.71). No conclusive evidence was found to support the notion that goal setting, or structured goal setting in comparison to "usual care" goal setting, changes outcomes for patients for measures of participation, activity, or engagement in rehabilitation programs. CONCLUSIONS: This review found a large and increasing amount of research being conducted on goal setting in rehabilitation. However, problems with study design and diversity in methods used means the quality of evidence to support estimated effect sizes is poor. Further research is highly likely to change reported estimates of effect size arising from goal setting in rehabilitation.

Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices.

The Advisory Committee on Immunization Practices (ACIP) consists of 15 experts in immunization and related fields, selected by the Secretary of the U.S. Department of Health and Human Services, to provide advice and guidance on control of vaccine-preventable diseases. In its role as a federal advisory committee, the ACIP develops written recommendations, subject to approval of the Director of the Centers for Disease Control and Prevention, for administration of U.S. Food and Drug Administration-licensed vaccines to children, adolescents, and adults in the U.S. civilian population. On the basis of careful review of available scientific data, including disease morbidity and mortality in the general U.S. population and in specific risk groups, vaccine safety and efficacy, cost-effectiveness, and related factors, the ACIP recommends vaccines and age for vaccine administration, number of doses and dosing interval, and precautions and contraindications. The ACIP works closely with several liaison organizations, including the American College of Physicians, to develop immunization recommendations that are harmonized among key professional medical organizations in the United States. This report includes a description of the member composition of the ACIP, the degree to which Committee members are screened for conflicts of interest, the workgroups that gather information before full Committee consideration, and the process and types of evidence used to formulate recommendations.

Nurses' utilization of parent questionnaires for developmental screening.

In the United States it is estimated that 16% of children are affected by developmental disabilities (American Academy of Pediatrics, 2001). Unfortunately, national statistics indicate that fewer than 30% of children with developmental or behavior problems are identified prior to entering kindergarten (Glascoe & Macias, 2003). Early Intervention studies and research on brain development have demonstrated the short and long-range benefits of early identification of developmental delays and intervention in the preschool years (Glascoe & Macias, 2003). During the past decade several studies have validated the use of parent questionnaires that screen for developmental delays. The nurse in a clinic, private office, or community health center should become familiar with the vast array of developmental screening tools. With this knowledge, the nurse can become the champion of change in selecting and incorporating the best tools for the systematic screening of children for developmental delay, as part of the well-child check-up.