Quality improvement project to reduce pain and distress associated with immunization visits in pediatric primary care.

This quality improvement project implemented an evidence-based immunization protocol aimed at decreasing pain and distress associated with immunizations for children ages 4 to 6 by utilizing distraction and a benzocaine-based anesthetic spray. The original protocol is used at a large, university-based pediatric primary care hospital. A convenience sample of 30 children from a community-based healthcare center was utilized to assess effectiveness in alternate settings. This quasi-experimental project collected survey information from child participants and consenting caregivers. Statistical analysis by paired t-test indicated a statistically significant decrease in reported distress by both the child and the caregiver utilizing the immunization protocol.

Identifying symptoms of depression and anxiety in students in the school setting.

Early detection of mental health problems in school-age children offers the opportunity for prompt referral to treatment which is critical to their success in school. School nurses are in a key position to screen for mental health issues in the school setting. This article discusses how school nurses began a new initiative to use two validated screening tools, the Patient Health Questionnaire-9 item for detecting depression and the 5-item Screen for Child Anxiety Related Emotional Disorders for detecting anxiety in middle school/high school-aged children in selected urban schools. Students having positive screens were referred to the multidisciplinary school-based Student Assistance Program team for further evaluation and referral. These screens improved the identification and referral for treatment of children suffering from anxiety and/or depression by expediting the connection to services.

Occlusive bags to prevent hypothermia in premature infants: a quality improvement initiative.

The aim of this quality improvement initiative was to improve the neonatal intensive care unit (NICU) admission rectal temperatures of premature infants less than 28 weeks' gestation by placing them in an occlusive bag from the neck down immediately after birth. The historical control group consisted of a convenience sample of 46 very low-birth-weight infants from March 1, 2010, to August 31, 2010. A convenience sample of 35 very low-birth-weight infants from October 1, 2010, to April 30, 2011, was recruited during the prospective phase. A quasi-experimental design was used. A retrospective medical record review was performed to collect data on NICU admission rectal temperatures for the historical control group. During the prospective phase, infants were placed in a bag from the neck down immediately after birth and NICU admission rectal temperatures were recorded. In both groups, NICU rectal temperatures were measured immediately upon admission. Application of the bag resulted in a higher mean NICU admission rectal temperature in the intervention group compared with the historical control group. Occlusive bags applied at delivery decreased heat loss in premature infants. The results support previous findings and resulted in a change in clinical practice.

Impact of Doctor of Nursing Practice education in shaping health care systems for the future.

The approval of the Doctor of Nursing Practice (DNP) by the American Association of Colleges of Nursing in 2004 and publication of The Essentials of Doctoral Education for Advanced Nursing Practice in 2006 promised significant benefit to nursing and to shaping health care systems. Currently, 229 DNP programs exist and more are planned. This article provides an overview of program types, graduates, and postgraduation placement, using Pennsylvania as an exemplar, to describe the potential impact of DNP education in health care systems. Nurse educators need to consider whether our current directions enable us to realize opportunities for shaping health care systems or whether we need to make course corrections. [

Medical Marijuana in the Pediatric Population With Epilepsy-What You Should Know.

This article discusses the controversial but promising topic of medical marijuana (MM) use in the pediatric population with epilepsy. Included is the importance of MM throughout history, the pharmacodynamics and pharmacokinetics, and a literature review that provides anecdotal evidence of the positive effect MM has on children suffering from seizures. From this literature review, dosage for treatment and management is provided. Also discussed is the recent FDA-approved pharmaceutical grade CBD product, Epidiolex, for treatment of two pediatric-onset seizure syndromes, Lennox-Gastaut and Dravet. Clinical implications regarding adverse side effects of MM use are also discussed. The aim of this article is to arm providers with contemporary knowledge on the risks and benefits of MM use in the pediatric population with epilepsy, which may boost their skills and confidence in educating and advocating for children with seizures. This novel, ever-changing medication is in the forefront of history and the news, making this topic especially important for review.

Unique Factors Affecting the Management and Prevention of Caries in the Childhood Cancer Survivor.

Childhood cancer survivors are at high risk for a myriad of complications secondary to oncologic treatment regimens. Caries is one of the major sequela of oncologic treatment that place the childhood cancer survivor at risk for complications in adulthood. Dental caries can be prevented with optimum dental care, early identification, and patient education. A barrier to their prevention is the lack of routine dental care received by this population. Health care providers are in a prime position to remedy this problem through their frequent contact with the childhood cancer survivor during sick and well-child office visits. The purpose of this article is to convey information and tools related to dental caries in the pediatric cancer survivor younger than 18 years to enhance primary care providers', acute care pediatric nurse practitioners', and oncology providers' knowledge of risk stratification, early identification, and treatment regimens for caries in the childhood cancer survivor.

Addressing pediatric intoeing in primary care.

Primary care providers frequently encounter children with an intoed gait. Intoeing is most often a normal variation of development that resolves without treatment. The well-informed primary care NP can identify the small subset who need referral through child and/or family history, physical exam, and identification of red flags.

Gender dysphoria in youth: An overview for primary care providers.

BACKGROUND AND PURPOSE: Primary care providers who encounter children are often the first line of contact for individuals with gender dysphoria, which occurs when sex assigned at birth is incongruent with one's true, expressed sexual identity. Because those with untreated gender dysphoria are at risk of a variety of negative outcomes, including mood symptomatology, suicidality, substance use disorders, and other psychosocial risk factors, it is critical that health care providers are adept in the provision of holistic, patient-centered care. The purpose of this report is to provide an updated review of the current evidence from the literature pertaining to the identification, treatment, and coordination of care among children with gender dysphoria within the primary care setting or medical home. METHODS: Using PubMed and CINAHL, a literature review spanning from 2012 to the present was conducted using the following key words: gender dysphoria, transgender health, LGBT health, and hormone therapy. Reference lists of identified articles were also explored for relevance. CONCLUSIONS: Treatment may include a social transition, hormone antagonist therapy, or the administration of cross-sex hormone therapy, with a medical home needed to facilitate coordination of care. Best practice guidelines vary across pediatric and developmental groups and include both reversible and nonreversible modalities. Screening for negative psychosocial sequelae must be completed to include mood symptomatology, suicidality, substance use disorders, and risky sexual behavior, so that appropriate screening, identification, and treatment interventions can be implemented. IMPLICATIONS FOR PRACTICE: The primary care medical home must act as a foundation for the identification of gender dysphoria and/or associated comorbidities and must treat, when able, or refer, when indicated. In addition, because of structural barriers and stigmatization, public policy often fails the transgender community and can exacerbate the aforementioned psychosocial comorbidities faced by the transgender youth community. Health care providers, particularly nurse practitioners, are in a unique position to expand on the face-to-face care provided to the community and engage in advocacy efforts to dismantle structural barriers impeding transgender individuals and communities while also providing primary health care, anticipatory guidance, and care coordination.

The genetics, diagnosis, and management of Prader-Willi syndrome.

The Human Genome Project, molecular genetic technology, and other ongoing research into our genetic makeup are having a profound effect on the work of primary care clinicians. New knowledge of inheritance patterns and diagnostic tests, leading to management changes, becomes available almost daily. The diagnosis and management of Prader-Willi syndrome is no exception. A few years ago diagnosis was dependent on the clinical manifestation of behavioral and physical stigmata, and a definitive diagnosis often was missed or delayed for years. Current laboratory procedures play a prominent role in confirming this condition, and diagnosis in neonates is now possible, but diagnosis is often delayed because of clinicians' lack of familiarity with the disorder. Management varies with the age of the patient and the degree to which the disease is manifest. Sensitive care with lifelong surveillance is required. Well- informed nurse practitioners working in primary care can play an important role in early detection, care coordination, education, and long-term management for persons with Prader-Willi syndrome.