Do High-Risk Young Adults Use the HIV Self-Test Appropriately? Observations from a Think-Aloud Study.

The purpose of this study was to understand high-risk young adults' use of the rapid human immunodeficiency virus (HIV) self-test. The highest rate of new HIV infections occurs in people between 15 and 24 years. Improving identification of young people infected with HIV is a critical public health priority. The first rapid HIV self-testing kit was approved in the US in 2012. Despite the product's promise, its use by untrained young adults is not well-understood. We conducted a mixed methods study using surveys, a think-aloud protocol, observations, and in-depth interviews. A systematic checklist was developed to assess participants' use of the test. A total of 21 racial and/or ethnic minority young adults aged 18-24 participated in this study. Analysis of our interview data was guided by the theory of reasoned action (TRA). Participants completed the initial procedures of the test with a mean time of 8:36 min (range of 2:04'-16:33'). On a 14-point checklist, participants had a mean score of 10.8 (SD 2.26, range 3-14). In the qualitative analysis of the participants' interviews, guided by the theoretical constructs of the TRA, the following themes emerged: "Did I use it correctly?", "Can I trust the results?" (attitude); "How will my partner react?!", "What will people think?" (subjective norm); "Quick, easy and blood free," and "Avoids the hassle of dealing with the healthcare system" (behavioral intention). This study provided evidence of the usefulness of the test perceived by young adults, especially in light of their concerns about lack of privacy in medical settings. Since many participants did not follow all of the instructions while using the test, it is not evident that young adults can correctly use the HIV self-test. Development of instructions manuals that are understandable and guide proper use of medical devices is a great need, especially in the context of home testing technology.

Information, Motivation, and Behavioral Skills of High-Risk Young Adults to Use the HIV Self-Test.

HIV self tests (HIVST) have the potential to increase testing among young adults. However, little is known about high-risk young adults' perception of the HIVST as a risk reduction tool and how they would use the HIVST in their everyday lives. Our study sought to examine these factors. Twenty-one ethnically diverse participants (ages 18-24) used the HIVST at our study site, completed surveys, and underwent an in-depth interview. Descriptive statistics were used to analyze the survey responses, and interview data were coded using constructs from the information-motivation-behavioral skills model. Information deficits included: how to use the HIVST and the "window period" for sero-conversion. Motivations supporting HIVST use included: not needing to visit the clinic, fast results, easy access, and use in non-monogamous relationships. Behavioral skills discussed included: coping with a positive test, handling partner violence after a positive test, and accessing HIV services. These findings can inform the use of the HIVST for improving HIV testing rates and reducing HIV risk behavior.

Understanding disorders of sexual development.

Studies estimate that the incidence of genital anomalies could be as high as 1 in 300 births. While it is rare for an infant to present with truly ambiguous genitalia, it is plausible that the pediatric nurse will encounter a patient with disorders of sexual development in his or her career. Cases of disorders of sexual development are challenging due to complexities of diagnosis, gender assignment, uncertain outcomes, treatment options, and psychosocial stressors. This article discusses the evaluation and management of children with disorders of sexual development and the nurse's role as child advocate and family educator.

Advanced practice nursing students' identification of patient safety issues in ambulatory care.

Despite more than a decade of patient safety initiatives in our health care system, nurses (N = 172) identified a large number of safety issues in the ambulatory care setting, including issues in their own practice (50.7% of the encounters), feeling rushed or hurried (34.8% of encounters), and being interrupted (27.0% of encounters). Greater patient complexity was a significant predictor of identifying a diagnostic or management and treatment issue. The presence of an electronic health record was not related to reporting of a patient safety issue.

Patient safety issues in advanced practice nursing students' care settings.

The purpose of this project was to identify and characterize patient safety issues across advanced practice nursing (APN) care settings including ambulatory care visits. A total of 162 registered nurses enrolled in an APN education program completed an online survey. Respondents reported patient safety issues related to diagnosis or management and treatment in almost half of 489 encounters. The most common issues were clinician communication problems with patients, which occurred during 42.4% of encounters. Adoption of information technology may be a pathway for improving patient safety issues in APN practice settings.

Psychometric evaluation of the attitudes toward Handheld Decision Support Software Scale in a sample of nursing students.

Valid measures of attitudes are an important component of developing and testing educational interventions aimed at improving technology acceptance. The aim of this study was to assess the construct validity (factor analysis and discriminant validity), internal consistency reliability (Cronbach α), and responsiveness (independent-samples t test) of the Attitudes toward Handheld Decision Support Software Scale in a sample of 103 nursing students engaged in a set of curricular activities focused on enabling safe and evidence-based nursing practice through the use of information technology. Principal components factor analysis resulted in three factors (ease of use and usefulness, clinical support, and barriers to use) that explained 55.49% of the variance. Internal consistency reliability estimates ranged from .61 to .82. Factor scores did not discriminate between nursing students who owned a PDA and those who did not. There were no significant changes in factors scores over time (responsiveness). This study provides preliminary evidence for the factorial structure of the Handheld Decision Support Software Scale and internal consistency of two of the three factor scales. Further exploration of the construct validity, internal consistency, and responsiveness is warranted.

Predictors of depression screening rates of nurses receiving a personal digital assistant-based reminder to screen.

The purpose of this study was to determine if race/ethnicity, payer type, or nursing specialty affected depression screening rates in primary care settings in which nurses received a reminder to screen. The sample comprised 4,160 encounters in which nurses enrolled in advanced practice training were prompted to screen for depression using the Patient Health Questionnaire (PHQ)-2/PHQ-9 integrated into a personal digital assistant-based clinical decision support system for depression screening and management. Nurses chose to screen in response to 52.5% of reminders. Adjusted odds ratios showed that payer type and nurse specialty, but not race/ethnicity, significantly predicted proportion of patients screened.

Idiopathic anaphylaxis: What you do not know may hurt you.

Idiopathic anaphylaxis (IA), like immunologic and nonimmunologic anaphylaxis, is a life-threatening, sometimes fatal allergic disease. Although the priority is immediate recognition and initiation of treatment, long-term care planning is important to help reduce anxiety and promote healthy growth and development. Learning to recognize, manage, and stabilize the child is an essential part of improving the family dynamics. Despite advancements in the management of anaphylaxis, research has shown a need for continued patient education and training to improve timely recognition and treatment. This article focuses on elucidating the clinical presentation, theories of pathogenesis, and diagnosis, treatment, and management of IA.

Pediatric metabolic syndrome.

Although the prevalence of obesity and its related complications are increasing among pediatric patients, appropriate management can prevent chronic disease. This article will present an overview of metabolic syndrome, pediatric metabolic syndrome guidelines, pathophysiology, associated risk factors, and clinical practice implications.

Development of a self-report instrument to measure patient safety attitudes, skills, and knowledge.

PURPOSE: To describe the development and psychometric testing of the Patient Safety Attitudes, Skills and Knowledge Scale (PS-ASK). METHODS: Content validity of a 35-item instrument was established by a panel of experts. The instrument was pilot tested on 285 nursing students. Principal components analysis (PCA) with varimax rotation was conducted, and Cronbach's alphas were examined. Paired samples t-tests were used to show responsiveness of the scales pre- and post-patient safety curriculum. RESULTS: The final instrument consists of 26 items and three separate scales: attitudes, skills, and knowledge. The attitudes and skills scales each had a three-factor solution. The knowledge items had a one-factor solution. Both skills and knowledge were significantly increased at Time 2 (p<0.001). CONCLUSIONS: The skills and knowledge subscales had satisfactory internal consistency reliability, evidence for construct validity, and responsiveness for use as independent scales in future studies. The attitudes subscale needs further refinement before implementation. Comparison with other measures of patient safety skills (e.g., observation) and knowledge are warranted. CLINICAL RELEVANCE: A tool to measure clinicians' attitudes, skills, and knowledge about patient safety might be useful to evaluate nurses and other clinicians during educational preparation and in practice.

Mind & body practices in the treatment of adolescent anxiety.

Although anxiety is the most common mental health condition among adolescents in the United States, the current standards of practice for treatment are expensive, may be difficult to obtain, and potentially harmful. Although mind and body practices show great promise in the treatment of adolescent anxiety, financial constraints, lack of education, and structural barriers can hinder the integration of these practices into primary care.

Diagnosis and primary care management of focal segmental glomerulosclerosis in children.

Focal segmental glomerulosclerosis (FSGS) is a pattern of kidney damage that can occur in individuals at any age, including children. Pediatric patients with FSGS require medication monitoring, growth, and psychological health. This article discusses the NP's role in the clinical presentation, diagnostic workup, and treatment of FSGS in pediatric patients.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Children and Adolescents.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease that is becoming increasingly recognized in the pediatric population. It may be the most common cause of treatable autoimmune encephalitis. The majority of cases of anti-NMDAR encephalitis are idiopathic in etiology, but a significant minority can be attributed to a paraneoplastic origin. Children with anti-NMDAR encephalitis initially present with a prodrome of neuropsychiatric symptoms, often with orofacial dyskinesias followed by progressively worsening seizures, agitation, and spasticity, which may result in severe neurologic deficits and even death. Definitive diagnosis requires detection of NMDAR antibodies in the cerebrospinal fluid. Optimal outcomes are associated with prompt removal of the tumor in paraneoplastic cases, as well as aggressive immunosuppressive therapy. Early detection is essential for increasing the chances for a good outcome. Close follow-up is required to screen for relapse and later onset tumor presentation. The nurse practitioner plays a major role in the research, screening, diagnosis, treatment, follow-up, and rehabilitation of a child or adolescent with anti-NMDAR encephalitis.

Unaccompanied Immigrant Minors: Where to Begin.

The number of unaccompanied immigrant minors (UIMs) from Central America significantly increased in 2014. Nearly 50,000 children from El Salvador, Guatemala, and Honduras crossed the United States-Mexico border in 2014, compared with 3,933 in 2011. Few resources exist to guide pediatric nurse practitioners (PNPs) in their care of UIM. The multifactorial reasons behind migration and the state of children's health in Central America provide insight into the needs of UIMs. Guidelines for similar groups such as foreign-born children and refugees offer direction for the health care considerations of UIMs. This article provides demographic information on UIMs, highlights the unique and challenging medical and mental health issues facing UIMs, and discusses the role of the PNP. A UIM's initial visit with a PNP serves as an opportunity to build trust through culturally competent, trauma-informed care, provide preventive care, assess for unmet health needs, and screen for mental health conditions.

Jaw disorders in the pediatric population.

PURPOSE: This article will review the etiology, risk factors, history, and physical assessment of temporomandibular joint disorders (TMDs). In particular, this article discusses the role of the pediatric provider in diagnosing and beginning the initial treatment of TMDs, as well as the appropriate treatment plans. It also reveals some of the controversies regarding etiology and treatment of TMDs, as well as the paucity of research specific to TMDs in pediatrics. DATA SOURCES: A computerized search in PubMed and Ovid Medline, from 2006 to 2012, was conducted. A few seminal articles were included that were published before 2006. Hand searching was also performed, which included a few articles between 2012 and 2015. CONCLUSIONS: Although TMDs are mostly found in adults, it is also a finding in pediatrics, which increases in prevalence during adolescence. More research specific to pediatric patients with TMDs needs to be conducted so that pediatric-specific care can be provided. IMPLICATIONS FOR PRACTICE: TMD is a condition found in the pediatric population, and it is important for providers to take an adequate history and physical examination that incorporates the temporomandibular joint (TMJ) and muscles of mastication. It is also critical that providers begin initial education and management, followed by appropriate referrals.

A review of knee pain in adolescent females.

Primary care practitioners are in a position to educate patients and parents about the risk factors that may increase the incidence of knee pain in adolescent females. This article highlights patellofemoral pain syndrome, Sinding-Larsen-Johansson syndrome, Osgood-Schlatter disease, and meniscal tears.

The effect of breastfeeding on childhood overweight and obesity: a systematic review of the literature.

BACKGROUND: Childhood obesity has reached epidemic proportions. There is increasing attention to the topic of prevention and continued debate as to whether breastfeeding (BF) is protective against childhood obesity. Previous systematic reviews on this topic were done in 2005 showing that BF was protective against childhood obesity but, because of confounding variables, the evidence was weak. OBJECTIVE: To explore the current evidence of the effect of BF on childhood obesity and provide recommendations for the nurse practitioner (NP) as a primary care provider. METHODS: A systematic review of the literature from 1/2005 to 3/2012 was done to assess the evidence on the relationship between BF and childhood obesity. RESULTS: The majority of studies identified in this article showed a relationship between BF and obesity prevention, but because of confounding maternal, child, cultural, genetic, and environmental variables, the relationship remains unclear. CONCLUSIONS: While it is possible that there are protective benefits of BF on childhood obesity, it is difficult to prove because of confounding variables. However, because of other benefits for the mother and child, BF should be encouraged. Whether obesity in childhood can be prevented by BF remains unclear. Further research controlling for confounding variables is needed to provide concrete evidence.

Early identification of tethered cord syndrome: a clinical challenge.

Tethered cord syndrome (TCS) is a progressive clinical condition that arises from excessive spinal cord tension. The clinical signs and symptoms of TCS may be cutaneous, neurologic, musculoskeletal, genitourinary, and/or gastrointestinal. Patients also may be asymptomatic, which does not exclude the diagnosis of TCS. Although the exact etiology is unknown, early identification and lifelong surveillance or surgical treatment is an essential component of patient management. In this article we review the pathophysiology, various etiologies, clinical presentation, and long-term sequelae of TCS. This information will help pediatric nurse practitioners identify TCS early and anticipate the patient's needs and management requirements.

Childhood lead poisoning and the new Centers for Disease Control and Prevention guidelines for lead exposure.

PURPOSE: This article will give a brief history, review the latest guidelines, discuss risk factors and sources, and discuss screening, diagnosis, and management of lead poisoning in children. Additionally, the role of the nurse practitioner (NP) caring for children will be reviewed. DATA SOURCES: Review of published literature on lead poisoning and the 2012 lead prevention guidelines of the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) of the Centers for Disease Control and Prevention (CDC). CONCLUSIONS: While lead poisoning levels have decreased over the past several decades, newer research has shown that even low levels of lead in the blood can have negative effects on children's intelligence and neurodevelopment. As a result, ACCLPP of the CDC issued new, stricter lead prevention guidelines in 2012. IMPLICATIONS FOR PRACTICE: Lead exposure and lead poisoning are pediatric public health risks. Studies have shown that no level of lead is considered safe, and the emphasis has shifted to primary prevention of lead exposure. Despite the focus on primary prevention, the NP must remain vigilant in history taking, exploring risk factors, and screening children in order to assure the best possible outcome.