New Combination Asthma Drug.

A new asthma drug, Airsupra, combines the short-acting ß2-adrenergic agonist albuterol with the corticosteroid budesonide to treat acute asthma attacks.Patients should not stop their asthma maintenance therapy when albuterol-budesonide is prescribed.

Avaliação do conhecimento sobre a asma em servidores técnico-administrativos de uma universidade pública / Evaluación del conocimiento sobre el asma en servidores técnico-administrativos de una universidad pública / Evaluation of knowledge about asthma in technical-administrative public workers of a public university

Objetivo: estimar o nível de conhecimento sobre asma de servidores técnico-administrativos do curso de graduação e pós-graduação em Enfermagem de uma universidade pública em Salvador, Bahia. Método: estudo transversal, realizado com 18 servidores técnico-administrativos de uma universidade pública. A coleta de dados foi realizada mediante envio de e-mail com links do formulário no Google Forms, entre janeiro e maio de 2021. Os dados foram analisados por meio da estatística descritiva com uso do software SPSS, 28.0. Resultados: encontrou-se predominância do sexo feminino 77,8% (n=14), média de idade 42,11±10,98 anos. Verificou-se que 55,6% (n=10) da amostra apresentou conhecimento insatisfatório sobre asma na análise por domínio e pela média de acertos (X±DP=22,6±7,5 acertos). O tratamento da asma foi a temática mais desconhecida pela amostra (X±DP=2,77±1,73 acertos). Conclusão: o nível de conhecimento sobre asma dos servidores técnico-administrativos foi insatisfatório na maioria da amostra investigada.

Objetivo: estimar el nivel de conocimiento sobre asma de servidores técnico-administrativos del curso de graduación y posgrado en Enfermería de una universidad pública en Salvador, Bahía. Método: estudio transversal, realizado con 18 servidores técnico-administrativos de una universidad pública. La recopilación de datos se realizó mediante el envío de correos electrónicos con links del formulario en Google Forms, entre enero y mayo de 2021. Los datos fueron analizados por medio de la estadística descriptiva con uso del software SPSS, 28.0. Resultados: se encontró predominancia del sexo femenino 77,8% (n=14), media de edad 42,11±10,98 años. Se verificó que 55,6% (n=10) de la muestra presentó conocimiento insatisfactorio sobre asma en el análisis por dominio y por la media de aciertos (X±DE=22,6±7,5 aciertos). El tratamiento del asma fue la temática más desconocida por la muestra (X±DE=2,77±1,73 aciertos). Consideraciones finales: el nivel de conocimiento sobre asma de los servidores técnico-administrativos fue insatisfactorio en la mayoría de la muestra investigada.

Objective: to estimate the level of knowledge about asthma of technical-administrative public workers of graduate and postgraduate nursing courses of a public university in Salvador, Bahia. Method: cross-sectional study, conducted with 18 technical-administrative public workers of a public university. Data collection was performed by sending an email with links to the form in Google Forms, between January and May 2021. Data were analyzed using descriptive statistics using SPSS software, 28.0. Results: predominance of women, 77.8% (n=14), mean age 42.11±10.98 years. 55.6% (n=10) of the sample presented unsatisfactory knowledge about asthma in the analysis by domain and by the average of correct answers (X±SD=22.6±7.5 correct answers). Asthma treatment was the most unknown theme in the sample (X±SD=2.77±1.73 correct answers). Final considerations: the level of knowledge about asthma of technical-administrative workers was unsatisfactory in the majority of the sample investigated.

Cuidados de enfermería en paciente con crisis asmática utilizando el modelo de Virginia Henderson / Nursing care in patients with asthmatic crisis using the Virginia Henderson model

La incidencia del asma varía extensamente en diversas regiones del mundo, se tiene un estimado de que 334 millones de personas padecen de asma bronquial y que 250,000 muertes son producto de una complicación de esta enfermedad. En este caso clínico se implementaron las intervenciones por parte de los profesionales de enfermería aplicando el proceso de atención de enfermería (PAE) orientado en la teoría de Virginia Henderson la cual se basa en las necesidades de las personas sanas y enfermas ya sea en la familia, comunidad, ya que estas necesidades son la bases que orientan las cinco fases del cuidado: valoración, diagnóstico, planificación, ejecución y evaluación, cada una se implementó en paciente. El objetivo principal es: mejorar la salud del paciente utilizando la teoría de Virginia Henderson, e implementando su respectivo tratamiento y cuidados de enfermería, para que su respiración sea estable y su saturación sea de un 100%. Se presenta caso de paciente masculino de 22 años de edad con educación universitaria en curso, vive con su madre y hermana, con una economía adecuada y con las necesidades básicas cubiertas. Causa de la consulta dificultad respiratoria, presencia de dolor torácico acompañada de tos sin esputo, Se diagnostica paciente con una crisis moderada de asma bronquial, teniendo en cuenta que tiene antecedentes de asma bronquial, se le dió manejo con administración de oxígeno para mantener la saturación, incluyendo el tratamiento y cuidados de enfermería adecuado y oportuno los cuales mejoraran la salud del paciente dando una recuperación ideal...(AU)

Experiencia enfermera en la realización de espirometrías en un equipo pediátrico / Nurse experience in performing spirometry in a pediatric team

Introducción: en España el asma constituye la segunda causa de morbilidad y enfermedad crónica infantil. Es una de las causas más frecuentes de consulta en el ámbito de la Atención Primaria, y su diagnóstico y tratamiento precoz permiten el control de la enfermedad modificando el curso de esta y la calidad de vida de los pacientes. Objetivo: describir la experiencia en la realización de espirometrías en la población pediátrica e impulsar a otros centros de Atención Primaria la incorporación de esta prueba en su cartera de servicios. Material y métodos: se realizaron 81 espirometrías a 67 pacientes con edades comprendidas entre los 5 y 14 años, entre enero 2019 y febrero 2020. De las 81 espirometrías, el 16% fueron basales, el 32,1% basales con prueba broncodilatadora (PBD) y el 51,9% con ejercicio y PBD. Se realizaron con un espirómetro Sibelmed Datospir Touch 511-B00-MU1. Resultados: de las 26 espirometrías con PBD, 15 fueron negativas y 11 positivas. De las 32 espirometrías con ejercicio que se realizaron, 9 fueron positivas respecto a la espirometría basal, y en 23 no se obtuvieron diferencias significativas, pero 5 de ellas si dieron positivo al realizar PBD. Conclusiones: es posible realizar espirometrías forzadas con resultados de calidad en el ámbito de Atención Primaria pediátrica, si se disponen de recursos materiales y de personal especializado. De esta forma, se contribuye a reducir las listas de espera y favorece un mayor control de la enfermedad (AU)

Introduction: in Spain, asthma is the second leading cause of morbidity and chronic illness in the paediatric population, following obesity. Asthma is one of the most frequent presenting complaints at the primary care level, and its early diagnosis and treatment allow control of the disease, modifying its course and improving patient quality of life. Objective: the aim of the study was to describe our experience in performing spirometry in the paediatric population and encourage other primary care centres to offer this test to their patients. Material and methods: a total of 81 spirometry tests were performed in 67 patients aged 5 to 14 years between January 2019 and February 2020. Of the 81 tests, 16% were baseline tests, 32.1% were spirometry with bronchodilator responsiveness testing (BRT), and 51.9% spirometry with exercise challenge and BRT All tests were performed with a Sibelmed Datospir Touch 511-B00-MU1 spirometer. Results: twenty-six spirometry tests included a BRT, with negative results of the BRT in 15 and positive results in 11. Another 32 tests included an exercise challenge, which was positive compared to baseline in 9, while in 23 there were no significant differences relative to baseline, although in 5 of them the BRT was positive. Conclusion: it is possible to perform forced spirometry in paediatric patients with high-quality results at the primary care level if the necessary material resources and qualified personnel are available. Providing this service can reduce waiting lists and improve asthma control (AU)

Con E de enfermera Unidad de Asma Grave / With E for nurse Severe Asthma Unit

Yolanda García y Carmen Campos son enfermeras en la Unidad de Asma Grave del Hospital Fundación Alcorcón, ubicado en la Comunidad de Madrid. Según cuentan ellas mismas, en estos servicios se desarrollan actividades asistenciales, de educación y también de gestión de la unidad. “Al ser un equipo multidisciplinar, los diferentes tratamientos biológicos que tienen prescritos los pacientes necesitan una coordinación con la unidad de farmacia”, para abordar a este tipo de pacientes “complejos, habitualmente con comorbilidades, como obesidad, síndrome de apnea del sueño, ansiedad… en los que su enfermedad interfiere de manera importante con las actividades de la vida diaria” y cuyo principal factor de riesgo es el tabaquismo, pero también son importantes la enfermedad respiratoria exacerbada por AAS, la exposición a alérgenos, el asma inducido por ejercicio o el asma relacionado con el puesto de trabajo u ocupacional”, explican. Nos atienden para hablar de su labor diaria en la Unidad de Asma Grave, de las principales necesidades de los pacientes, a los que les puede costar aceptar que el asma es una enfermedad crónica, y de la importancia de la Educación para la Salud y la adherencia a los tratamientos, especialmente a los biológicos, ya que “la mejoría tanto clínica como subjetiva de la mayoría de los pacientes que inician este tipo de terapia es muy grande”, en el manejo de esta patología.(AU)

Examining Social Determinants of Health in Childhood Asthma Management.

PURPOSE: Social determinants of health (SDoHs) influence how well a family manages children's asthma. The aim of this study was to examine the influence of SDoHs on family asthma management. DESIGN: A cross-sectional exploratory study was conducted with 292 children in grades 2 to 5 who had current asthma and their parents to examine associations between SDoHs and the families' asthma management, quality of life, and healthcare utilization. METHODS: Data were collected from both child and parent. Social determinants of health include the child's race/ethnic group, age, gender, and asthma severity and the family's socioeconomic status and language spoken in the home, and the school was the community-level variable. Parents and children completed asthma management and quality-of-life scales and parents reported on the children's emergency department visits and hospitalizations for asthma. RESULTS: Worse quality of life was reported by families with lower socioeconomic status and African American children. Asthma severity was associated with parents' asthma management but not children's asthma self-management. Families who spoke Spanish at home had the lowest socioeconomic status yet performed significantly more asthma management than English-speaking families. CONCLUSIONS: The findings highlight factors the clinical nurse specialist should address in educational interventions.

Improving asthma care with Asthma-COPD Afterhours Respiratory Nurse at Emergency (A-CARE).

BACKGROUND: Emergency departments (ED) are important providers of asthma care, particularly after-hours. We identified gaps for quality improvement such as suboptimal adherence rates to three key recommendations from the Global Initiative for Asthma (GINA) guidelines for discharge management asthma guidelines. These were: the prescription of oral and inhaled corticosteroids (OCS and ICS) and issuance of outpatient follow-up for patients discharged from the ED. AIM: To achieve an adherence rate of 80% to GINA guidelines for ED discharge management by providing after-hours asthma counselling services. METHODS: We implemented Asthma-COPD Afterhours Respiratory Nurse at Emergency (A-CARE) according to the Plan-Do-Study-Act (PDSA) framework to provide after-hours asthma counselling and clinical decision support to ED physicians three nights a week. Data on adherence rates to the GINA guidelines were collected and analysed on a run chart. RESULTS: After 17 months' follow-up, a sustained improvement was observed in patients reviewed by A-CARE in the median adherence rates to OCS prescription (58% vs 86%), ICS initiation (27% vs 67%) and issuance of follow-up (69% vs 92%), respectively. The overall impact was, however, limited by a suboptimal referral rate to A-CARE (16%) in a clinical audit of all ED patients with asthma. Nonetheless, in this audit, attendance rates for patients referred to our respiratory department for follow-up were higher in those receiving asthma counselling compared with those who did not (41.7% vs 15.9%, p=0.0388). CONCLUSION: Sustained improvements in the adherence rates to guidelines were achieved for patients reviewed by A-CARE but were limited in overall impact due to suboptimal referral rate. We plan to improve the quality of asthma care by implementing further PDSA cycles to increase the referral rates to A-CARE.

Evaluating outcomes of children's asthma self-management education through sustainable community-university partnerships.

OBJECTIVE: To evaluate the outcomes of a children's asthma management education program delivered through a community-university partnership. DESIGN: Quasi-experimental pretest/posttest. SAMPLE: Convenience sample of 50 children with asthma, grades 2-5, and their parent/caregiver from nine elementary schools in New York State. MEASUREMENTS: Child Asthma Management Self-Efficacy Survey, Child Asthma Control Test© , Parent Asthma Knowledge Test. INTERVENTION: Nursing students certified as Open Airways for Schools facilitators administered the program once weekly for 5 weeks. Parent handouts were sent home after each session. Pre/posttests for all measures were completed prior to Open Airways and at completion. RESULTS: Improved asthma management self-efficacy (p < .001) and improved asthma control (p = .013) for children with asthma were noted. Parent asthma knowledge was high pre- and posttest with no significant change. Parental knowledge regarding inhaled corticosteroids was consistently low. CONCLUSIONS: Collaboration between universities and local school systems allows for mutually beneficial exchange of knowledge and resources to address the need for asthma self-management for children with asthma. Nursing students trained in asthma management develop expertise and provide sustainable resources for this education.

Examining the clinical management of asthma exacerbations by nurse practitioners in a pediatric emergency department.

BACKGROUND: Little is known about the clinical management or quality of asthma care provided by nurse practitioners (NP) in a pediatric emergency setting. OBJECTIVE: To describe the clinical management of asthma by NPs in our institution's emergency department, and to compare the treatment strategies between NPs, pediatricians, and pediatric emergency physicians. METHODS: We conducted a retrospective chart review at a level-one pediatric trauma center. Data were extracted from electronic medical records for all patients between 2 and 18 years of age presenting to the emergency department with an asthma exacerbation. Data were analyzed using binary logistic regression with generalized estimating equations. RESULTS: NPs evaluated 18% of all children presenting for asthma care. When compared to pediatric emergency physicians, patients treated by NPs had approximately twice the odds of receiving a ß2-agonist (OR = 2.02; 95% CI 1.02 - 3.99) or a systemic corticosteroid (OR = 2.31; 95% CI 1.35 - 3.95) within 60 minutes of clinical evaluation. Adherence rates were similar for the other asthma quality measures between these two clinician groups. CONCLUSIONS: NPs were best able to meet time-sensitive asthma quality measures in the emergency department. The addition of NPs to emergency staffing models may improve access to timely care for children with asthma.

Clinical and lung function outcomes in a cohort of children with severe asthma.

BACKGROUND: Uncontrolled severe asthma in children is burdensome and challenging to manage. This study aims to describe outcomes in children with uncontrolled severe asthma managed in a nurse-led severe asthma clinic (SAC). METHODS: This retrospective analysis uses data collected from children referred by a paediatric respiratory specialist to a nurse-led SAC for uncontrolled severe asthma between 2014 and 2019. The pre-clinical assessments included a home visit to assess modifiable factors that could be addressed to improve control. A comprehensive lung function analysis was conducted at each visit. Interventions were personalised and included biologic agents. Statistical analysis was performed using nonparametric, two-tailed Mann-Whitney U-test, the parametric Student's t-test, or analysis of variance (ANOVA) as appropriate. RESULTS: Twenty-three children with a median age of 12 years were seen once, and 16 were followed up. Compared to a non-asthmatic (NA) and asthmatic (A) age-matched cohort, children with severe asthma (SA) had a lower FEV1, and FVC% predicted before and after bronchodilator inhalation, and a higher mean Lung Clearance Index [LCI] (10.5 [SA] versus 7.3 [NA] versus 7.6 [A], p = 0.003). Almost 80% of children with SA had an abnormal LCI, and 48% had a reduced FEV1% at the first SAC visit. Asthma control and FEV1% predicted significantly improved at a follow-up visit, while LCI remained abnormal in the majority of children (83%). CONCLUSION: Over time, many children with severe asthma showed improved clinical outcomes and lung function while lung ventilation inhomogeneities persisted. Future appropriately controlled studies are required to determine if a nurse-led multidisciplinary SAC is associated with better outcomes.

A randomized controlled trial of a nurse-led education pathway for asthmatic children from outpatient to home.

BACKGROUND: Education for asthmatic children in the outpatient department is insufficient. AIM: To evaluate the efficacy of a nurse-led education pathway, a standard education programme, on children with asthma. METHODS: One hundred and eighty participants enrolled and were randomly assigned to either the control group or the intervention group. The intervention group received predetermined step-by-step education sessions based on the self-designed education pathway, while the control group received usual care. Asthma control, health-related quality of life, and health-care utilization measures were taken at baseline and at follow-up visits between February 2016 and May 2018. RESULTS: Significantly higher scores for health-related quality of life and inhaler technique at the third-month visit and asthma control test at the sixth-month visit were seen in the intervention group. The numbers of unscheduled physician visits and school absences were lower in the intervention group than in the control group within 6 months. However, no significant differences were observed in emergency department visits and hospitalizations. CONCLUSION: The nurse-led education pathway could be considered effective for children with asthma visiting the outpatient department.

Moving Upstream From the Individual to the Community: Addressing Social Determinants of Health.

School nurses are often the primary health professional promoting children's health-and address not just individuals, but communities. This article, featuring the key principle of community/public health, is the first in a series focusing on The Framework for 21st Century School Nursing Practice™ and presents a case study on asthma and air quality issues comparing the more traditional individual approaches to health (labeled downstream and midstream) with population-level approaches (labeled upstream). Through collaboration with key community stakeholders, school nurses can successfully implement policies and programs to address social determinants of health and, in turn, improve the health of the entire community. As we look to advance school nursing and support best practices, concentrating on population-level, upstream approaches align with recommendations outlined in the Framework for 21st Century School Nursing Practice™.

Control del asma infantil: principales factores asociados / Controlo da asma infantil: principais fatores asociados / Child asthma control: main associated factors

INTRODUCCIÓN: El asma aparece como una enfermedad inflamatoria crónica de las vías respiratorias y se caracteriza por episodios de obstrucción bronquial reversible pudiendo ser desencadenada por varios factores. Se constituye como la enfermedad infantil más común, una importante causa de internamiento hospitalario y un problema de salud pública. Las directrices internacionales sobre la gestión del asma reconocen que el tratamiento reside en el control actual y en el riesgo de exacerbaciones, basándose en la gestión de los síntomas. En cuanto a la percepción del control del asma infantil, existen discrepancias entre la percepción de los cuidadores y las indicaciones internacionales. OBJETIVOS: Describir y analizar los datos clínicos, sociodemográficos y factores asociados al control del asma infantil. METODOLOGÍA: Estudio metodológico, cuantitativo y transversal, en una muestra de niños, entre los 6 y los 11 años, con asma y cuidadores. El control del asma ha sido evaluado por el instrumento Childhood Asthma Control Test. RESULTADOS: La muestra fue compuesta por 60 niños y cuidadores. 12% (n = 7) de los niños presentan asma no controlada y 53% (n = 32) asma parcialmente controlada. En el 38% (n = 23) de los cuidadores existieron discrepancias entre el grado clasificado mediante las pautas internacionales y su percepción. El análisis de Regresión Logística confirma que los niños con necesidades de terapia inhalatoria de rescate presentan 7 veces mayor probabilidad de que el asma no esté controlada. CONCLUSIÓN: Resulta perentoria la necesidad de aprehender la complejidad de los factores que interfieren en el control del asma, existiendo necesidad de programas de intervención de gestión de síntomas centrados en los cuidadores, en el niño y en las necesidades identificadas

INTRODUÇÃO: A asma apresenta-se como uma doença crónica e inflamatória das vias aéreas caracterizada por episódios de obstrução brônquica reversível podendo ser desencadeada por diversos fatores. Constitui-se como a doença infantil mais comum, uma importante causa de internamento hospitalar e um problema de saúde pública. As diretrizes internacionais sobre a gestão da asma reconhecem que o tratamento reside no controlo atual e no risco de exacerbações, sendo baseados na gestão de sintomas. Relativamente à perceção do controlo da asma infantil, existem discrepâncias entre a perceção dos cuidadores e as indicações internacionais. OBJETIVOS: Descrever e analisar os dados clínicos, sociodemográficos e fatores associados ao controlo da asma infantil. METODOLOGIA: Estudo metodológico, quantitativo e transversal, numa amostra de crianças, entre os 6 e os 11 anos, com asma e cuidadores. O controlo da asma foi avaliado pelo instrumento Childhood Asthma Control Test. RESULTADOS: A amostra foi composta por 60 crianças e cuidadores. 12% (n=7) das crianças apresentam asma não controlada e 53% (n=32) asma parcialmente controlada. Em 38% (n=23) dos cuidadores existiram discrepâncias entre o grau classificado mediante as guidelines internacionais e a sua perceção. A análise de Regressão Logística confirma que as crianças com necessidades de terapêutica inalatória de resgate apresentam 7 vezes maior probabilidade da asma estar não controlada. CONCLUSÃO: Torna-se perentório a necessidade de apreensão da complexidade dos fatores que interferem no controlo da asma, existindo necessidade de programas de intervenção de gestão de sintomas centrados nos cuidadores, na criança e nas necessidades identificadas

INTRODUCTION: Asthma is an airways chronic and inflammatory disease characterized by episodes of reversible bronchial obstruction and can be triggered by several factors. It is the most common childhood disease, an important hospitalization cause and a public health problem. International guidelines of asthma management recognize that treatment based on current management and exacerbations risk, which are based on symptom management. Regarding the control perception of childhood asthma, there are discrepancies between the caregiver's perception and the international indications. OBJECTIVES: To describe and analyze the clinical, sociodemographic and factors associated with childhood asthma control. METHODOLOGY: Methodological, quantitative and transversal study, in a sample of 60 children, between 6 and 11 years, and caregivers. Asthma control was evaluated by the instrument childhood Asthma Control Test. RESULTS: The sample consisted of 60 children and caregivers. 12% (n = 7) of the children had uncontrolled asthma, 53% (n = 32) partly controlled asthma. In 38% (n = 23) of the caregivers there were discrepancies between the grade classified through the international guidelines and their perception. Logistic Regression analysis confirms that children with inhalational rescue therapy needs 7 times more likely asthma to be uncontrolled. CONCLUSION: The complexity of the factors that interfere in the control of asthma is urgent and there is a need for symptom management intervention programs focused on the caregivers, the child and the identified needs

A School Nurse-Led Asthma Program Reduces Absences: Evaluation of Easy Breathing for Schools.

OBJECTIVE: To evaluate whether school nurses can assist pediatricians in providing asthma care and reduce school absenteeism through a program called Easy Breathing for Schools (EzBfS), a 5-element school nurse-led asthma management program and the effectiveness in reducing school absenteeism. METHODS: Fifteen public school nurses in an urban community implemented EzBfS during the 2015-16 and 2016-17 school years. Program elements included assessment of asthma risk and asthma control, asthma education, medication review, and a pediatrician communication tool. School absence for any reason was the primary outcome; absentee rates for students with asthma enrolled in the program were compared to students with asthma in the entire school population using negative binomial regression. RESULTS: School nurses enrolled 251/2,126 students with physician-confirmed asthma (2015-16: n = 114 and 2016-17: n = 137). Sixty eight percent of participants were Latino and 25% were Black with a mean age of 8.7 ± 2.2 years. Absentee rates were higher in children with asthma compared to children without asthma (8.3% vs 7.0% absent, respectively P < .001). Students enrolled in the program experienced a 25% decrease in absentee rate after adjusting for age, sex, race/ethnicity, and school year (rate ratio = 0.75, 95% confidence interval, 0.67, 0.85) as compared to students with asthma not enrolled in the program. Participants also demonstrated improvement in inhaler technique score (P < .001). Ninety two percent of the nurses were satisfied with the program. CONCLUSION: EzBfS, a pragmatic, nurse-led asthma management program, was successfully implemented by school nurses and significantly decreased school absences among a sample of students with asthma.

Explanatory Model for Asthma Disparities in Latino Children: Results from the Latino Childhood Asthma Project.

BACKGROUND: Little research has been conducted that integrates, in one explanatory model, the multitude of factors potentially leading to disparities among Latino children. PURPOSE: A longitudinal, observational study tested an explanatory model for disparities in asthma control between Mexican and Puerto Rican children with persistent asthma requiring daily controller medication use. METHODS: Mexican and Puerto Rican children aged 5-12 years (n = 267) and their caregivers (n = 267) were enrolled and completed interviews and child spirometry at baseline and 3, 6, 9, and 12 months postenrollment. A 12 month retrospective children's medical record review was completed. Participants were recruited from two school-based health clinics and the Breathmobile in Phoenix, AZ, and two inner-city hospital asthma clinics in the Bronx, NY. RESULTS: Statistically significant differences in the social/contextual predictors of asthma illness representations (IRs) were noted between Mexican and Puerto Rican caregivers. The structural equation model results revealed differences in asthma control over time by ethnicity. This model accounted for 40%-48% of the variance in asthma control test scores over 12 months. Caregivers' IRs aligned with the professional model of asthma management were associated with better children's asthma control across 1 year. These results also supported the theoretical notion that IRs change over time impacting caregivers' treatment decisions and children's asthma control. CONCLUSIONS: These findings extend a previous cross-sectional model test using a more comprehensive model and longitudinal data and highlight the importance of considering within-group differences for diagnosis and treatment of children coming from the vastly heterogeneous Latino umbrella group. TRIAL REGISTRATION: Trial number NCT01099800.

School Nurses and Student Academic Outcomes: An Integrative Review.

The empirical evidence from previous studies has demonstrated that school nurses are effective in assisting children and families to address health concerns, reduce absenteeism, and provide children with the opportunity to reach their potential academically. Impoverished children and those with disabilities and chronic illness are at risk of school failure. An integrative review was undertaken to critique the research between 2002 and 2018 that addressed the influence of school nurses on academic outcomes such as absenteeism, missed class time, grades, and test scores. The findings of the review suggest that the presence of a school nurse is associated with reduced absenteeism and missed class time but not with academic achievement. Overall, the research in this area is weak and future research using more rigorous study designs, examining broader school nurse roles, and long-term academic outcomes is indicated to evaluate the impact of school nurses on educational outcomes.

Association between family management and asthma control in children with asthma.

PURPOSE: The purpose of this study is to investigate the association between family management and asthma control in children with asthma. DESIGN AND METHODS: This cross-sectional descriptive study recruited 142 children with asthma and their parents. We used the Family Management Measure (FaMM), the Childhood Asthma Control Test (C-ACT), and fractional exhaled nitric oxide (FeNO) detectors to assess family management and asthma control. The McNemar's test was used to determine the proportional difference between C-ACT and FeNO in evaluating asthma control. Pearson correlation analysis and multiple linear regression analysis were used to assess the relationship between family management and asthma control in children with asthma. RESULTS: There was no significant difference in the proportion of C-ACT and FeNO in evaluating asthma control (McNemar's test p = .593). Child's Daily Life, Condition Management Ability, and Parental Mutuality were positively correlated with C-ACT (r = 0.398 to 0.655; all p < .05) and negatively correlated with FeNO (r = -0.245 to -0.402; all p < .05); Condition Management Effort, Family Life Difficulty, and View of Condition Impact were negatively correlated with C-ACT (r = -0.416 to -0.672; all p < .05) and positively with FeNO (r = 0.248 to 0.427; all p < 0.05). Child's Daily Life, Condition Management Effort, and View of Condition Impact dimensions significantly predicted the C-ACT results, and the Condition Management Effort and View of Condition Impact dimensions significantly predicted the FeNO results (p < .05). PRACTICAL IMPLICATIONS: Pediatric nurses could provide family management education for parents to improve asthma control in children. In addition, pediatric nurses might assess asthma control condition of asthmatic children in combination with C-ACT and FeNO levels.

The modification of three vulnerability theories to assist nursing practice for school-age children with severe asthma.

PURPOSE: Severe asthma is an inflammatory illness associated with adverse health outcomes and behaviors in children, such as decreased quality of life, impaired sleep, and increased medical costs and morbidity. CONCLUSIONS: Children with severe asthma frequently exhibit a cycle of health and behaviors which contribute to these adverse health outcomes, consisting of decreased physical activity, increased stress, and increased airway inflammation and asthma exacerbations. School-age children, in particular, are a vulnerable population because they not only rely on others for their care but also suffer from a chronic illness and are at risk for unequal healthcare access and health outcomes. PRACTICE IMPLICATIONS: Currently, there is no one nursing theory that adequately addresses the vulnerability, cycle of health and behaviors, and adverse health outcomes of children with severe asthma. By integrating key concepts from three vulnerability theories and presenting a modified conceptual framework, this paper aims to demonstrate how the use of this new conceptual framework may assist nurses in evaluating the unique needs of school-age children with severe asthma to provide best practices and develop appropriate interventions.

Protocolled practice nurse-led care for children with asthma in primary care: protocol for a cluster randomised trial.

INTRODUCTION: In children with asthma, daily symptoms and exacerbations have a significant impact on the quality of life of both children and parents. More effective use of asthma medication and, consequently, better asthma control is advocated, since both overtreatment and undertreatment are reported in primary care. Trials in adults suggest that asthma control is better when patients receive a regular medical review. Therefore, protocolled care by the general practitioner may also lead to better asthma control in children. However, such protocolled care by the general practitioner may be time consuming and less feasible. Therefore, this study aims to determine whether protocolled practice nurse-led asthma care for children in primary care provides more effective asthma control than usual care. METHODS AND ANALYSIS: The study will be a cluster-randomised open-label trial with an 18-month follow-up. Practice nurses will be the units of randomisation and children with asthma the units of analysis. It is planned to include 180 children aged 6-12 years. Primary outcome will be average asthma control during the 18-month follow-up measured by the Childhood Asthma Control Test (C-ACT). Secondary outcomes include C-ACT scores at t=3, t=6, t=12 and t=18 months; the frequency and severity of exacerbations; cost-effectiveness; quality of life; satisfaction with delivered care; forced expiratory volume in 1 s and forced expiratory flow at 75% and the association of high symptoms scores at baseline and baseline characteristics. Besides, we will conduct identical measurements in a non-randomised sample of children. ETHICS AND DISSEMINATION: This will be the first trial to evaluate the effectiveness of protocolled practice nurse-led care for children with asthma in primary care. The results may lead to improvements in asthma care for children and can be directly implemented in revisions of asthma guidelines.The study protocol was approved by the Medical Research Ethics Committee of the Erasmus Medical Centre in Rotterdam. TRIAL REGISTRATION: NTR6847.