Adherence to a reproductive health intervention for young adults with sickle cell.

BACKGROUND: The CHOICES intervention is tailored specifically for young adults with sickle cell disease (SCD) or sickle cell trait (SCT). The face-to-face (F2F) delivery format is feasible with efficacy for improving knowledge about reproductive health for those with SCD or SCT. PURPOSE: The purpose of the study was to compare the participant adherence to a remote online CHOICES intervention study (N = 107) and a F2F CHOICES intervention study (N = 234). METHODOLOGY: In both studies, participants with SCD or SCT were randomized into experimental or usual care control groups. Descriptive statistics were collected for all participants by group in both studies. Adherence was measured by retention at each data collection time point. Independent t-tests were conducted to compare mean participant adherence of the F2F and online studies postbaseline (6, 12, 18, and 24 months). RESULTS: There was a significant difference in mean adherence postbaseline between the studies (p = .005). The results suggest that more research is necessary for proper online participant retention. CONCLUSION: Advance practice nurses that are well informed on CHOICES can transmit the availability of this evidence-based intervention to this special population. Special referral for the CHOICES intervention, which is tailored specifically for young adults with SCD or SCT, may increase adherence to the intervention if it comes from trusted health care providers. IMPLICATIONS: Nurse practitioners are educators in primary and acute care settings. Encounters with reproductive age populations with SCD or SCT can occur in both settings.

Use of a Data Repository to Identify Delirium as a Presenting Symptom of COVID-19 Infection in Hospitalized Adults: Cross-Sectional Cohort Pilot Study.

BACKGROUND: Delirium, an acute confusional state highlighted by inattention, has been reported to occur in 10% to 50% of patients with COVID-19. People hospitalized with COVID-19 have been noted to present with or develop delirium and neurocognitive disorders. Caring for patients with delirium is associated with more burden for nurses, clinicians, and caregivers. Using information in electronic health record data to recognize delirium and possibly COVID-19 could lead to earlier treatment of the underlying viral infection and improve outcomes in clinical and health care systems cost per patient. Clinical data repositories can further support rapid discovery through cohort identification tools, such as the Informatics for Integrating Biology and the Bedside tool. OBJECTIVE: The specific aim of this research was to investigate delirium in hospitalized older adults as a possible presenting symptom in COVID-19 using a data repository to identify neurocognitive disorders with a novel group of International Classification of Diseases, Tenth Revision (ICD-10) codes. METHODS: We analyzed data from 2 catchment areas with different demographics. The first catchment area (7 counties in the North-Central Florida) is predominantly rural while the second (1 county in North Florida) is predominantly urban. The Integrating Biology and the Bedside data repository was queried for patients with COVID-19 admitted to inpatient units via the emergency department (ED) within the health center from April 1, 2020, and April 1, 2022. Patients with COVID-19 were identified by having a positive COVID-19 laboratory test or a diagnosis code of U07.1. We identified neurocognitive disorders as delirium or encephalopathy, using ICD-10 codes. RESULTS: Less than one-third (1437/4828, 29.8%) of patients with COVID-19 were diagnosed with a co-occurring neurocognitive disorder. A neurocognitive disorder was present on admission for 15.8% (762/4828) of all patients with COVID-19 admitted through the ED. Among patients with both COVID-19 and a neurocognitive disorder, 56.9% (817/1437) were aged ≥65 years, a significantly higher proportion than those with no neurocognitive disorder (P<.001). The proportion of patients aged <65 years was significantly higher among patients diagnosed with encephalopathy only than patients diagnosed with delirium only and both delirium and encephalopathy (P<.001). Most (1272/4828, 26.3%) patients with COVID-19 admitted through the ED during our study period were admitted during the Delta variant peak. CONCLUSIONS: The data collected demonstrated that an increased number of older patients with neurocognitive disorder present on admission were infected with COVID-19. Knowing that delirium increases the staffing, nursing care needs, hospital resources used, and the length of stay as previously noted, identifying delirium early may benefit hospital administration when planning for newly anticipated COVID-19 surges. A robust and accessible data repository, such as the one used in this study, can provide invaluable support to clinicians and clinical administrators in such resource reallocation and clinical decision-making.

Care, lead, and inspire: Infusing innovation into nursing research and evidence-based practice course.

BACKGROUND: Today's nursing workforce is expected to know how to identify and understand research methods and procedures and apply the most current evidence into daily practice. However, teaching evidence-based practice (EBP) in an undergraduate nursing curriculum poses unique challenges in overcoming students' perception of content relevancy to their educational experience, but also offers opportunities for innovation to facilitate critical thinking and clinical application. AIMS: The aim of this article is to report on how teaching and learning innovation was infused into a research and evidence-based practice course and the effect on students' perceptions of course values and effectiveness. METHODS: We used a Plan-Do-Study-Act approach to introduce innovation in an undergraduate course within a university setting. Final student course evaluations were used to measure outcomes on a 5-point Likert scale (1 = low and 5 = high) on the following dimensions: (1) value of overall educational experience, (2) relevancy of course content, (3) improvement in critical thinking, and (4) level of student-instructor interaction. RESULTS: Overall course evaluation scores improved greatly from 2.69 to 3.90 between Spring 2020 and Fall 2021. This finding remained relatively consistent across subsequent semesters (3.79 [Spring 2022], 3.84 [Fall 2022]). Students also reported appreciation and increased engagement and interest with the material after transitioning from examinations to a project-based assignment that allowed them to walk through the steps of EBP in class. LINKING EVIDENCE TO ACTION: We identified and implemented several innovative strategies to improve student outcomes and increase the relevance of the course content. These innovations can be easily incorporated at other universities to enhance delivery and student engagement in this content that is essential to advancing quality care in nursing and developing future nurse scientists and practice leaders who care, lead, and inspire.

Factors Affecting Turnover of Advanced Practice Providers: A University Teaching Hospital Review.

GOAL: Retention of advanced practice providers (APPs) is an issue of critical importance to healthcare leaders. High APP turnover negatively affects an organization's ability to meet patient needs, maintain quality of care, and control costs. Our goal was to identify any association between intent to leave and specific survey factors; analyze the distribution of scale factors from the survey; and describe differences among the APP roles, specialties, and length of employment. METHODS: This study used a self-administered questionnaire for APPs at a large university medical center to determine job satisfaction rates and intent to resign. The survey used a modified Misener Nurse Practitioner Job Satisfaction Scale and Anticipated Turnover Scale. PRINCIPAL FINDINGS: We received surveys from 102 providers (for a 38.9% response rate). Results were used to determine the correlation between job satisfaction and intent to leave and to identify possible factors involved in APP commitment to the hospital and intent to stay. We found that APPs reported the most satisfaction in benefits, followed by time (i.e., time available for answering messages, reviewing laboratory and other test results, seeing patients, scheduling work). Intrapractice partnership/collegiality received the lowest satisfaction score. Extrinsic factors such as monetary bonuses available in addition to salary, reward distribution, involvement in research, conflict resolution, and opportunity to receive compensation for services performed outside normal duties were common dissatisfiers. PRACTICAL APPLICATIONS: This survey may help hospitals identify in real time the triggers of APP dissatisfaction and intent to resign. In addition, the results may guide possible revisions to hospital policies and practice procedures to improve APP commitment and decrease turnover intent. Additional surveys in similar university teaching hospital systems could confirm comparable intrinsic and extrinsic factors that are relevant to the satisfaction and turnover of APPs.

Adolescents' practical knowledge of asthma self-management and experiences in the context of acute asthma: a qualitative content analysis.

OBJECTIVE: To characterize adolescents' practical knowledge of asthma self-management and experiences during acute asthma episodes, and compare practical knowledge between minority and non-minority groups. METHODS: We conducted a secondary analysis using a qualitative descriptive design of textual data collected from 126 adolescents that participated in a randomized controlled trial of an asthma self-management program. Directed content analysis was conducted using four constructs of asthma self-management including symptom prevention, symptom monitoring, acute symptom management, and symptom communication. RESULTS: Most of the adolescents knew how to prevent exercised-induced bronchoconstriction, but had limited understanding about how to assess and monitor the severity of acute symptoms, appropriately use bronchodilators, seek timely medical help, and communicate acute symptoms to caregivers or healthcare providers during a slow-onset and rapid-onset asthma attack. More minority participants monitored asthma using peak expiratory flow than non-minority participants, who often relied on symptom-based monitoring. Minority adolescents more frequently mentioned bronchodilator use to manage asthma attacks, while non-minority adolescents often reported use of complementary and alternative approaches. Minority youth mentioned accessing healthcare services for acute episodes more often than their non-minority counterparts. Minority participants mentioned communicating acute symptoms to their providers, or family members less frequently than non-minority youth. CONCLUSIONS: Adolescents have insufficient practical knowledge about ways to prevent and manage acute asthma. Periodic assessment of learning needs related to asthma attacks should be considered a routine part of clinical visits for adolescents to provide targeted information support to address their identified needs.

Nursing Education for the Acute Care Nurse on Pain Mechanisms of Sickle Cell Disease.

Background It is unknown whether nurses' knowledge about pain among patients with sickle cell disease (SCD) reflects the current standard of care. The authors evaluated changes in nurses' knowledge and simulated practice behavior after a continuing education program. Method Inpatient nurses completed an e-learning program on SCD pain; a pretest and a posttest with the same 10 questions; and two patient cases with four pain intervention options at the posttest. Results On the pretest, the mean percentage of correct answers was 83% (SD = 13%). The mean percentage of correct answers increased by 12% (p < .0001) on the posttest. For the first simulated patient case, 100% (n = 31) of the nurses selected an appropriate pain intervention option based on the patient-reported pain score. For the second simulated patient case, 84% (n = 26) did so. Conclusion Increased knowledge does not always translate into simulated practice change. The reasons for this are unknown, but they could include implicit bias from exposure to patients who have high use of acute care, although the minority of patients with SCD fit this description. [J Contin Educ Nurs. 2022;53(3):137-144.].

Type 2 diabetes mellitus screening rates in racial and ethnic minority groups.

BACKGROUND: More than 7 million Americans aged 18 years and older have undiagnosed diabetes. As primary health care moves toward preventative medicine, it is important that diabetes screening deficits are addressed. PURPOSE: The purpose of this study was to identify current screening rates among racial and ethnic minorities who are considered at high risk of developing type 2 diabetes mellitus (T2DM). METHODOLOGY: Data were collected through an IRB-approved i2b2 database from previously consented patients who had been treated at a large academic health center and outpatient facilities. Patients who were included in this study were those seen in outpatient settings between June 2011 and June 2019, aged 18-39 years at high risk for developing T2DM, defined as those of a racial and ethnic minority background, obese, and with a family history of T2DM. RESULTS: Approximately 1,476 ± 3 individuals were identified as high risk, and of those, only 106 ± 3 (13.9%) were screened for T2DM between June 2011 and June 2019. Following the American Diabetes Association guidelines of including body mass index ≥25 kg/m2, approximately 1,263 ± 3 of the original 1,476 patients were identified as overweight with high risk, and of those patients, only 90 ± 3 (13.8%) were screened. CONCLUSIONS: Findings indicate that less than 14% of patients at high risk for developing T2DM in their lifetime are being screened. IMPLEMENTATIONS: Screening strategies need to be developed and implemented to better identify individuals at high risk of developing T2DM, which may lead to earlier diagnosis, treatment, and decreased disease burden.

Children's and adolescents' descriptors of asthma symptoms: An integrative review.

Background: Accurate assessment of asthma symptoms is central to appropriate treatment and management; however effective communication about symptoms-how it is perceived and reported-remain challenging in pediatric clinical and research settings. Objective: To synthesize the existing pediatric literature on children's and adolescents' word descriptors of asthma symptoms. Methods: In this integrative review, we systematically searched Cumulative Index of Nursing and Allied Health Literature and PubMed databases to identify original research studies from 1980 to 2021 on children and adolescents' word descriptors of asthma symptoms. Results: The search yielded 2,232 articles, of which 21 studies met the eligibility criteria. Scientific literature focused on children and adolescents' descriptions of asthma symptoms are limited. In addition to standard asthma symptom terminology (e.g. cough, wheeze, chest tightness, shortness of breath), pediatric populations used nonstandard word choices to describe the asthma symptom experience. Children and adolescents used a variety of affective (e.g. 'helpless', 'afraid of dying') and sensory words (e.g. 'pressure in chest', 'tightness, lungs feel shut') to describe the phenomena. Literature examining race differences in word descriptors in pediatrics is limited; thus it is unclear if word descriptors vary by race or ethnicity. Evidence of relationships between descriptors and gender and age are also lacking. Conclusions: Our review elucidates gaps in the literature regarding the full extent of the language common to racially and ethnically diverse samples of children and adolescents. Further research is warranted to help clinicians and researchers query children and adolescents' experience of asthma symptoms.

Navigating the Doctor of Nursing Practice project within an academic practice partnership.

ABSTRACT: The Doctor of Nursing Practice (DNP) curriculum was initially developed in 2004. The DNP degree is a practice doctorate, which educates nurses to the highest level of clinical nursing practice. DNP students must complete a scholarly project in accordance with the American Association of Colleges of Nursing (AACN) guidelines. The project is an opportunity for the student to integrate skills into practice and demonstrate principles of advanced nursing practice. The AACN provides recommendations for the DNP project, but much confusion regarding the context and implementation of the project still exists. At one academic health sciences center, DNP project students often complete their projects within academic practice partnerships. Such partnerships are encouraged by the AACN. Several DNP quality improvement (QI) projects were submitted a hospital's interdisciplinary quality week event. Upon review, some of the abstracts were found to contain aspects of research. This finding prompted the review of all DNP project processes to standardize methods for faculty, students, the University, and the academic practice partner.

Pain, symptom distress, and pain barriers by age among patients with cancer receiving hospice care: Comparison of baseline data.

OBJECTIVES: Age group differences have been reported for pain and symptom presentations in outpatient and inpatient oncology settings, but it is unknown if these differences occur in hospice. We examined whether there were differences in pain, symptom distress, pain barriers, and comorbidities among three age groups (20-64 years, 65-84 years, and 85+) of hospice patients with cancer. MATERIALS AND METHODS: Participants were recruited from two hospices. Half were women; 49% White and 34% Black. 42% were 20-64 y, 43% 65-84 y, and 15% 85+ y. We analyzed baseline data for 230 hospice patients with cancer (enrolled 2014-2016, mean age 68.2 ± 14.0, 20-100 years) from a stepped-wedge randomized controlled trial. Measures were the Average pain intensity (API, 0-10: current, least and worst pain intensity during the past 24 h), Symptom Distress Scale (SDS, 13-65), Barriers Questionnaire-13 (BQ-13, 0-5), and comorbid conditions. Descriptive, bivariate association, and multiple regression analyses were performed. RESULTS: Mean API scores differed (p < .001) among the three age groups (5.6 ± 2.0 [20-64 years], 4.7 ± 2.0 [65-84 years], and 4.4 ± 1.8 [85+], as did the mean SDS scores (36.1 ± 7.3, 33.5 ± 8.1, and 31.6 ± 6.6, p = .004). BQ-13 mean scores (2.6 ± 0.9, 2.7 ± 0.8, and 2.5 ± 0.7) and comorbidities were not significantly different across age groups. In multiple regression analyses, age-related differences in API and SDS remained significant after adjusting for gender, race, cancer, palliative performance score, and comorbidities. Comorbidities were positively associated with SDS (p = .046) but not with API (p = .64) in the regression model. CONCLUSION: Older hospice patients with cancer reported less pain and symptoms than younger patients, but all groups reported similar barriers to pain management. These findings suggest the need for age- and race-sensitive interventions to reduce pain and symptom distress levels at life's end.

Reflections of Healthcare Experiences of African Americans With Sickle Cell Disease or Cancer: A Qualitative Study.

BACKGROUND: The experiences of African American adult patients before, during, and after acute care utilization are not well characterized for individuals with sickle cell disease (SCD) or cancer. OBJECTIVE: To describe the experiences of African Americans with SCD or cancer before, during, and after hospitalization for pain control. METHODS: We conducted a qualitative study among African American participants with SCD (n = 15; 11 male; mean age, 32.7 ± 10.9 years; mean pain intensity, 7.8 ± 2.6) or cancer (n = 15; 7 male; mean age, 53.7 ± 15.2 years; mean pain intensity, 4.9 ± 3.7). Participants completed demographic questions and pain intensity using PAINReportIt and responded to a 7-item open-ended interview, which was recorded and transcribed verbatim. We used content analysis to identify themes in the participants' responses. RESULTS: Themes identified included reason for admission, hospital experiences, and discharge expectations. Pain was the primary reason for admission for participants with SCD (n = 15) and for most participants with cancer (n = 10). Participants of both groups indicated that they experienced delayed treatment and a lack of communication. Participants with SCD also reported accusations of drug-seeking behavior, perceived mistreatment, and feeling of not being heard or believed. Participants from both groups verbalized concerns about well-being after discharge and hopeful expectations. CONCLUSIONS: Race-concordant participants with SCD but not with cancer communicated perceived bias from healthcare providers. IMPLICATIONS FOR PRACTICE: Practice change interventions are needed to improve patient-provider interactions, reduce implicit bias, and increase mutual trust, as well as facilitate more effective pain control, especially for those who with SCD.

Feasibility and preliminary outcomes of an integrated pediatric sickle cell disease and pulmonary care clinic for children with sickle cell disease.

BACKGROUND: In children with sickle cell disease (SCD), comorbid asthma is associated with increased disease severity and morbidity, but it remains underdiagnosed and optimal management paradigms are not well defined. The purpose of this study was to determine the feasibility and preliminary outcomes of an integrated pediatric SCD and pulmonary care clinic in children with SCD. METHODS: We implemented a pre-post quality improvement (QI) project in our pediatric hematology clinic between 2017 and 2019. Guided by the chronic care model, patients who were ages 2-18 years, diagnosed with SCD and suspected pulmonary comorbidities, received care in an interdisciplinary clinic. We examined feasibility and compared clinical outcomes to 24 months prior (2015-2017) to the implementation of the integrated care model. RESULTS: Twenty-four patients were included in the QI project: 88% (n = 21) received pulmonary function testing, 92% (n = 22) were diagnosed with asthma, and 33% (n = 8) with obstructive sleep apnea. Adherence to pulmonary appointments was increased by 81% (mean difference [MD] = 1.3, 95% confidence interval [CI] = 0.71-1.92; P < .001). Unplanned acute health care utilization was reduced by 59% (MD = 2.9, 95% CI = 1.14-4.69; P < .01) and packed red blood cell transfusion was reduced by 81% (MD = 1.38, 95% CI = 0.71-2.04; P < .001). CONCLUSION: Asthma is prevalent in children with SCD, and interdisciplinary clinics can improve access to subspecialty pulmonary care and reduce unplanned acute care. Additional patients and a longer follow-up period are required to determine the true treatment effect.

Spirometry use in Patients with Sickle Cell Disease with and without asthma and acute chest syndrome: A Multicenter Study.

A de-identified data repository of electronic medical record (EMR) data, i2b2 (Informatics for Integrating Biology and the Bedside), including 4 geographically diverse academic medical centers, was queried to determine the use of diagnostic spirometry testing in African American children and young adults 5-34 years old with sickle cell disease (SCD) with or without a documented history of asthma and/or acute chest syndrome (ACS). A total of 2,749 patients were identified with SCD, of these 577 had asthma and 409 had ACS. Cross-referencing the CPT code for diagnostic spirometry showed that for patients identified as having SCD, a history or ACS, and a diagnosis of asthma, only 31% across all 4 centers had spirometry. Having an asthma diagnosis was associated with ACS. Among SCD patients with asthma, the proportion with ACS for the four centers was 47%, 75%, 38%, and 36% respectively. The bivariate association between asthma and ACS for each Center was significant for each (p<.001). To summarize, only one third of patients with co-morbid SCD, ACS, and asthma received the spirometry procedure as recommended in evidence-based guidelines, suggesting limited testing for changes in pulmonary function. Future studies to determine barriers and facilitators to implementation of pulmonary testing in SCD are warranted.

Proposed definitive grading system tool for the assessment of adenoid hyperplasia.

OBJECTIVES/HYPOTHESIS: To propose a definitive standard grading scale in the assessment of adenoid tissue in relation to size, position, and proximity to surrounding anatomic structures. This will allow for better clinical communications among practitioners when treating this pathology, a better understanding of its relationship and how it effects neighboring structures (eustachian tube and choanae), and allow for a more precise description of this tissue for the purpose of research data collection and analysis. STUDY DESIGN: A prospective evaluation of adenoid tissue during adenoidectomy was obtained documenting its size and descriptive relationship to adjacent structures (eustachian tube and choanae). METHODS: A convenience sample of 150 children undergoing adenoidectomy alone or concurrently with tonsillectomy and/or myringotomy and tubes were prospectively evaluated. Mirror nasopharyngeal exam was performed in all cases. Size of the adenoid, as well as its relationship to the choanae and eustachian tube were recorded. A descriptive grading system tool was created accounting for these relationships. Statistical analysis was performed to offer a preliminary validation of the tool. RESULTS: Adenoid grading scores were assigned to 150 pediatric patients, 74 males and 76 females, who underwent surgery for adenoidectomy with or without tonsillectomy and/or myringotomy and tube placement. Seven patients were found to have no adenoid tissue in the nasopharynx as they had previous adenoidectomy and received a grade of 0A-. The mean age was 5.71 years (range, 1-17 years). Of the 150 scores, 107 patients had an associated diagnosis of chronic hypertrophic adenoids and/or tonsils (CHAT) accounting for 71.3% of the sample. There was a significant increasing trend of CHAT with an increasing size and increasing blocking of the choanae. However, there is no relationship of this morbidity with blocking of the eustachian tube (ET). There is a strong inverse relationship between blocking of the choanae and chronic and recurrent adenotonsillitis. The percentage of patients with this morbidity significantly decreases with increasing blocking of the choanae. A total of nine patients with chronic sinusitis were found to have no relationship between size, blocking of the choanae, and abutting of the eustachian tube. Eustachian tube dysfunction (ETD) was significantly related to blocking of the eustachian tube (ET) in this study, as 54.3% experienced ETD in the presence of blocked ET compared to only 15% in the absence of a blocked ET. Among the components of the adenoid score, the diagnosis given preoperatively, and the surgical treatments performed, there were strong correlations found giving merit to the descriptive nature of this grading tool proposed. CONCLUSIONS: This grading system is simple, reliable, and easily used. It offers standardization for clinicians and researchers in facilitating communications, and allowing interpretation of adenoid tissue observed with its relationship to and effect on adjacent anatomic structures. This will allow more detailed information of findings during adenoid surgery to assist in future clinical research studies and outcomes analysis.

Infantile myofibroma of the nasal cavity; a case report and review of the literature.

Infantile myofibroma is the most common fibrous tumor of infancy. Although the etiology is unknown, some cases are associated with a genetic inheritance of variable penetrance. With a myriad of possible locations, the presenting symptoms and findings are highly variable making its diagnosis difficult. Worldwide, there have been close to three hundred reported cases. Approximately 90% of these cases presented before age 2 with over half present at birth. The incidence is likely to be greater as many asymptomatic or hidden lesions will regress prior to discovery. The following is a report on a 7 month old male diagnosed with an infantile myofibroma within his right nasal cavity originating from the anterior skull base. This case is unusual in both its symptom presentation as well as location of origin of this tumor.

Effect of oral arginine supplementation on exhaled nitric oxide concentration in sickle cell anemia and acute chest syndrome.

INTRODUCTION: Decreased exhaled nitric oxide levels (FE(NO)) have been described in patients with sickle cell disease (SCD) and a history of acute chest syndrome (ACS) when compared with non-ACS controls. Oral arginine supplementation has been shown to increase FE(NO) in healthy participants, but its effect in SCD patients is not known. OBJECTIVE: To determine the effect of oral arginine intake on FENO in sickle cell patients with and without history of ACS, and in healthy controls. HYPOTHESIS: No differences in the FE(NO) increase were seen in SCD patients with a history of ACS (ACS+) compared with healthy controls (HC) and SCD patients without history of ACS (ACS-). MATERIALS AND METHODS: ACS+ (n=6), ACS- (n=9), and HC (n=7) patients were studied. At baseline, and after the administration of escalating doses of oral L-arginine (0.1, 0.2, and 0.4 g/kg), serial measurements were made of the following: FE(NO), plasma concentrations of arginine, ornithine, citrulline, aspartate, glutamate, arginine/ornithine ratio, nitrite, nitrate, heart rate (HR), respiratory rate (RR), blood pressure (BP), oxygen saturation (SpO2), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). MAIN RESULTS: At baseline, FE(NO) did not differ among the groups. ACS- and ACS+ groups were deficient in arginine, and had decreased FEV1, FVC, and SaO2 when compared with HC patients. After arginine supplementation, FE(NO), arginine, ornithine, citrulline, nitrite, and the arginine/ornithine ratio increased similarly in all groups. Changes from baseline for HR, BP, SpO2, RR, FEV1, and FVC were minimal and similar in all groups. CONCLUSIONS: In contrast to our earlier study, ACS+ patients had similar FE(NO) values when compared with ACS- and HC patients. All SCD patients were arginine deficient at baseline and showed impairment in respiratory physiology when compared with HC patients. After arginine supplementation, FE(NO) concentration increased in all groups to a similar degree, and lung function and physiologic parameters were minimally affected. The physiologic significance of alterations in FE(NO) in SCD patients and its relationship to ACS predilection requires further delineation.

Neurilemmoma presenting as a midline nasal mass in a pediatric patient.

We report a case of a neurilemmoma presenting as a midline nasal mass in a 13-year-old girl. To the best of our knowledge, this is the first report of a nasal neurilemmoma in a pediatric patient. Although this neoplasm is benign in nature, surgical resection is warranted to prevent recurrence, and it is the sole means of treatment. The overall prognosis is excellent, as was the case for our patient. We discuss the diagnosis and management of neurilemmomas and urge physicians not to exclude nasal neurilemmoma from the differential diagnosis in a pediatric patient who presents with a nasal mass.

High yield technique to diagnose immotile cilia syndrome: a suggested algorithm.

OBJECTIVES: To determine the efficacy of our nasal brush biopsy technique to diagnose primary ciliary dyskinesia. STUDY DESIGN: Retrospective chart review at an urban children's hospital. METHODS: We obtained medical records of all patients who underwent an endoscopic guided ciliary brush biopsy from January 2000 to June 2008. Data recorded included the procedure date, biopsy location, presence of motility on light microscopy, and whether specimen was sent for electron microscopy and those results. RESULTS: Sixty pediatric patients between the ages of 16 months and 17.3 years with chronic sinusitis (35 males, 25 females) were identified. Three were excluded because biopsies were taken from a non nasal location. Forty-seven specimens had light microscopy evaluation only, as normal motile cilia were identified. Ten had haphazard or absent motility and required further evaluation with electron microscopy. Electron microscopy ruled out defects for three samples, was non-diagnostic for five, and the remaining two reports could not be found. Overall, in 47/57 (82%) cases, light microscopy alone ruled out primary ciliary dyskinesia (PCD). Using both methods, there was a 91% success rate in ruling out PCD. CONCLUSIONS: Obtaining an endoscopic biopsy with a cytosoft cytology brush (Camarillo California) from the posterior portion of the inferior turbinate gave sufficient specimen to examine for PCD. Light microscopy alone or in concert with evaluation by electron microscopy confirmed normal cilia in 91% of specimens ruling out the diagnosis of PCD. The algorithm suggested is simple and has high success in allowing the clinician to exclude the diagnosis of PCD in the patient with chronic or recurrent upper respiratory infections.

Humanitarian otologic missions: long-term surgical results.

OBJECTIVE: The purpose of this study was to determine the efficacy of treating chronic ear disease by performing a single surgical intervention in the austere environment of a developing nation. SUBJECTS AND METHODS: Data were collected from retrospective chart reviews on 121 patients who underwent surgical treatment of chronic ear disease during humanitarian surgical missions in South and Central America. Surgical outcomes and clinical course were assessed at 10 to 12 months after the initial surgery. RESULTS: A total of 117 patients were included in the study. Follow-up records were available for 75 patients (64%). A total of 20 surgeries were performed for dry perforations (group 1), 30 for chronically draining ears (group 2), and 25 for cholesteatomas (group 3). Surgical success was determined as 60 percent, 74 percent, and 92 percent for groups 1, 2, and 3, respectively. CONCLUSIONS: Surgical results during international otologic outreach missions to developing nations fall within the results expected in developed nations.

Association analyses of adrenergic receptor polymorphisms with obesity and metabolic alterations.

Genes involved in the regulation of catecholamine function may be important in obesity because of the role catecholamines play in energy expenditure and lipolysis. To determine if common single nucleotide polymorphisms (SNPs) in beta(1)-adrenergic receptor (ADRB1), beta(2)-adrenergic receptor (ADRB2), beta(3)-adrenergic receptor (ADRB3), and alpha(2)-adrenergic receptor (ADRA2A) genes associate with obesity and metabolic alterations, we recruited 74 healthy African American and 161 white men and women (age, 18-49 years) to participate in this case-control genetic association study. Genotypes were determined by polymerase chain reaction and restriction fragment length polymorphism. Associations between genotype and body mass index (BMI), percentage of body fat (by measuring skinfold thickness in 7 different sites), fasting (12-hour) plasma glucose, insulin, potassium concentrations, glycated hemoglobin, and insulin resistance (homeostasis model assessment [HOMA(IR)] score) were performed. Among whites, the ADRB1 Arg389-->Gly variant associated with insulin concentrations and HOMA(IR): mean +/- SD values for insulin and HOMA(IR) in Arg389 homozygotes and carriers of the Gly were 10 +/- 7.0 and 12 +/- 9.4 micro IU/mL (P = .02) and 2.1 +/- 1.7 and 2.6 +/- 2.2 (P = .057), respectively. Systolic blood pressure was higher in whites for carriers of the ADBR1 Ser49 compared to Gly49 homozygotes (124 +/- 12.6 vs 119 +/- 11.3 mm Hg, respectively; P = .02). Subsequent analysis revealed that these associations were attributable to a higher BMI among obese participants. The ADRA2A G1780A SNP associated with BMI and percentage of body fat in African Americans (P = .05). Interactions were detected between ADRA2A C-1291G and ADRB2 Gln27-->Glu variants for obesity in African Americans and between ADRA2A C-1291G SNP and ADBR1 haplotype for obesity in whites. We conclude that common SNPs in adrenergic receptor genes may be important susceptibility loci for obesity and related alterations. Because of the limited size of our populations, our results should be interpreted with caution and should be replicated in larger populations.