Creation and Implementation of a Pediatric Advanced Practice Nurse Critical Care Fellowship Program

Advanced practice registered nurses (APRNs) who begin their careers in the pediatric intensive care unit (PICU) may be challenged in this practice environment. Inadequate prior experience as a staff nurse, limited opportunities for clinical placements in the PICU during graduate education, and being in a fast-paced, high-acuity practice environment without prior exposure to critically ill children are practice challenges in the PICU setting. The goal of postgraduate education training programs (fellowship programs) for the acute care pediatric nurse practitioner (ACPNP) is to prepare students to become beginner practitioners who can function effectively in the acute care setting within a few months of being hired, much like that of their physician counterparts who complete a fellowship. The health care environment continues to be influenced by trends in national health care reform, shifts in the models for physician training, and the Accreditation Council for Graduate Medical Education resident duty hour restrictions. These emerging trends have given health care organizations the opportunity to evaluate their current care delivery and training models. It is expected that the demand for APRNs with specialty training will increase. The aim of this article is to describe our experience in the creation and implementation of a critical care pediatric nurse practitioner (CCPNP) fellowship training program at a large midwestern U.S. tertiary care center. It is expected that the demand for APRNs with specialty training will increase. When this fellowship was created, there were no known fellowships available for pediatric nurse practitioners (PNPs) interested in pediatric critical care. To meet the needs of these providers, a focused training program is required to provide specific preparation and competencies to practice to the full extent of the provider\u27s license. A recent recommendation is for health care administrators to consider implementing fellowship training programs to assist nurse practitioners transitioning into specialty roles (Kells, Dunn, Melchiono, & Burke, 2015). We used several online search engines to identify pediatric health care institutions with active advanced practice provider postgraduate fellowships. Our search in June 2017 identified fellowship programs in primary care, pediatric hematology/oncology, palliative care, neuro-critical care, and urgent care/emergency department. To our knowledge, this fellowship program was the first of its kind and seeks to provide postgraduate specialty training and education focused on the unique requirements of critically ill children and their families to help fill a knowledge gap when entering practice in this highly specialized practice environment

A Family Study to Assess Genetic and Environmental Risk Factors in Inflammatory Bowel Disease.

A Family Study to Assess Genetic and Environmental Risk Factors in Inflammatory Bowel Disease

© 2009 The WJG Press and Baishideng. All rights reserved.

doi:10.3748/wjg.15.27

The Need for Evidence Based Nutritional Guidelines for Pediatric Acute Lymphoblastic Leukemia Patients: Acute and Long-Term Following Treatment

High survival rates for pediatric leukemia are very promising. With regard to treatment, children tend to be able to withstand a more aggressive treatment protocol than adults. The differences in both treatment modalities and outcomes between children and adults make extrapolation of adult studies to children inappropriate. The higher success is associated with a significant number of children experiencing nutrition-related adverse effects both in the short and long term after treatment. Specific treatment protocols have been shown to deplete nutrient levels, in particular antioxidants. The optimal nutrition prescription during, after and long-term following cancer treatment is unknown. This review article will provide an overview of the known physiologic processes of pediatric leukemia and how they contribute to the complexity of performing nutritional assessment in this population. It will also discuss known nutrition-related consequences, both short and long term in pediatric leukemia patients. Since specific antioxidants have been shown to be depleted as a consequence of therapy, the role of oxidative stress in the pediatric leukemia population will also be explored. More pediatric studies are needed to develop evidence based therapeutic interventions for nutritional complications of leukemia and its treatment

Estimation of the number of women of reproductive age in need of preventive chemotherapy for soil-transmitted helminth infections.

BACKGROUND:Soil-transmitted helminth infections are among the most common infections in developing countries. Globally, as many as 2 billion people are considered to be at risk for soil-transmitted-helminth (STH) infections. Preschool children (PSAC), school-age children (SAC) and women of reproductive age (WRA) are at high risk of STH-attributable morbidity and preventive chemotherapy (PC) for STH is recommended by the World health Organization (WHO). METHODOLOGY/PRINCIPAL FINDINGS:Over the last five years, PC coverage in PSAC and SAC has gradually increased, while coverage in WRA has lagged. Estimating the numbers of WRA in each endemic country would inform scale-up in this group. A two-step process was used: 1) total numbers of girls and women between 15 and 49 years of age were obtained from the United Nations World Population Prospects 2015 database; and 2) the proportion in need of PC was obtained primarily from extrapolation from the WHO PC Databank. WRA were divided into four sub-groups reflecting different reproductive life stages, each having a potentially different interface with the health care system and, consequently, presenting different opportunities for intervention strategies. Worldwide, we estimated that 688 million WRA in 102 countries were in need of PC for STH in 2015. The South-East Asia (49%) and Africa regions (26%) had the highest numbers. Adolescent girls accounted for 16%, while pregnant and lactating women each represented 10%. Over 25 million pregnant women alone were estimated living in areas where the prevalence of hookworm and T. trichiura infection was ≥ 20%. Approximately 20% of at-risk WRA had received deworming with albendazole through the Global Programme to Eliminate Filariasis. CONCLUSIONS/SIGNIFICANCE:To close current gaps in coverage, numbers of WRA in need of PC for STH are essential for operational strategies to control STH infection

Skin Integrity in Critically Ill and Injured Children

Background Skin breakdown increases the cost of care, may lead to increased morbidity, and has negative psychosocial implications because of secondary scarring or alopecia. The scope of this problem has not been widely studied in critically ill and injured children. Objectives To determine the incidence of skin breakdown in critically ill and injured children and to compare the characteristics of patients who experience skin breakdown with those of patients who do not. Methods Admission and follow-up data for a 15-week period were collected retrospectively on children admitted to a large pediatric intensive care unit. The incidence of skin breakdown was calculated. The risk for skin breakdown associated with potential risk factors (relative risk) and 95% confidence intervals were determined. Results The sample consisted of 401 distinct stays in the intensive care unit for 373 patients. During the 401 stays, skin breakdown occurred in 34 (8.5%), redness in 25 (6.2%), and breakdown and redness in 13 (3.2%); the overall incidence was 18%. Patients who had skin breakdown or redness were younger, had longer stays, and were more likely to have respiratory illnesses and require mechanical ventilatory support than those who did not. Patients who had skin breakdown or redness had a higher risk of mortality than those who did not. Conclusions Risk factors for skin breakdown were similar to those previously reported. Compared with children of other ages, children 2 years or younger are at higher risk for skin breakdown

Protecting Fragile Skin: Nursing Interventions to Decrease Development of Pressure Ulcers in Pediatric Intensive Care

Background The reported incidence of pressure ulcers in critically ill infants and children is 18% to 27%. Patients at risk for pressure ulcers and nursing interventions to prevent the development of the ulcers have not been established. Objectives To determine the incidence of pressure ulcers in critically ill children, to compare the characteristics of patients in whom pressure ulcers do and do not develop, and to identify prevention strategies associated with less frequent development of pressure ulcers. Methods Characteristics of 5346 patients in pediatric intensive care units in whom pressure ulcers did and did not develop were compared. Multiple logistic regression was used to determine which prevention strategies were associated with less frequent development of pressure ulcers. Results The overall incidence of pressure ulcers was 10.2%. Patients at greatest risk were those who were more than 2 years old; who were in the intensive care unit 4 days or longer; or who required mechanical ventilation, noninvasive ventilation, or extracorporeal membrane oxygenation. Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable under-pads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets. Conclusions The overall incidence of pressure ulcers among critically ill infants and children is greater than 10%. Nursing interventions play an important role in the prevention of pressure ulcers

Early enteral nutrition is associated with lower mortality in critically ill children

The purpose of this study was to examine the association of early enteral nutrition (EEN), defined as the provision of 25% of goal calories enterally over the first 48 hours of admission, with mortality and morbidity in critically ill children. : We conducted a multicenter retrospective study of patients in 12 pediatric intensive care units (PICUs). We included patients aged 1 month to 18 years who had a PICU length of stay (LOS) of ≥96 hours for the years 2007–2008. We obtained patients’ demographics, weight, Pediatric Index of Mortality–2 (PIM2) score, LOS, duration of mechanical ventilation (MV), mortality data, and nutrition intake data in the first 4 days after admission. : We identified 5105 patients (53.8% male median age, 2.4 years). Mortality was 5.3%. EEN was achieved by 27.1% of patients. Children receiving EEN were less likely to die than those who did not (odds ratio, 0.51 95% confidence interval, 0.34–0.76 = .001 [adjusted for propensity score, PIM2 score, age, and center]). Comparing those who received EEN to those who did not, adjusted for PIM2 score, age, and center, LOS did not differ ( = .59), and the duration of MV for those receiving EEN tended to be longer than for those who did not, but the difference was not significant ( = .058). : EEN is strongly associated with lower mortality in patients with PICU LOS of ≥96 hours. LOS and duration of MV are slightly longer in patients receiving EEN, but the differences are not statistically significant

Estimated number of women of reproductive age in need of preventive chemotherapy who had been treated through GPELF, by WHO region, 2015.

<p>Estimated number of women of reproductive age in need of preventive chemotherapy who had been treated through GPELF, by WHO region, 2015.</p