Pediatric Resident Knowledge, Confidence, and Experience in Transitioning Youth with Special Healthcare Needs

Background. The transition from pediatric to adult healthcare is vital to the 17% of adolescents with special healthcare needs (SHCN). Barriers to successful transition exist. The purpose of this study was to assess the baseline knowledge, confidence, and experience of pediatric residents in our state on transitioning adolescents with SHCN from pediatric to adult-oriented health care. Methods. An anonymous, voluntary, self-report survey was distributed electronically via Survey Monkey® to 2011-2012 pediatric residents in the state of Kansas (n = 39). Results. Of 39 pediatric residents, 21 (54%) completed the survey. Most (71%) had two or fewer adolescents with SHCN on their patient panel. Overall, the majority categorized their knowledge (71%) and experience (81%) transitioning adolescents with SHCN as minimal or very minimal. Conclusions. Pediatric residents report a general lack of knowledge, confidence, and experience in transitioning youth with SHCN. Additional training opportunities are needed to overcome the barriers in successful transition planning

Nursing Students in Clinical Placements Learning in Dyads: A Feasibility Study Using a Non-Randomized Pilot Trial

Purpose: To develop a protocol for a clinical education intervention using dyads and to assess the feasibility of implementing the approach with second year nursing students in their first clinical placement. The objectives were: 1) to evaluate and refine data collection procedures and outcome measures, 2) to evaluate the acceptability and sustainability of the intervention, and 3) to identify weaknesses of the intervention or threats to future implementation. Methods: A feasibility study was designed as a non-randomized pilot trial. The setting was the university site of a collaborative Bachelor of Science in Nursing program in Ottawa, Ontario. Three clinical groups consisting of 24 second-year students enrolled in both the French and English undergraduate programs comprised the sample. The intervention protocol was developed based on guiding principles reflective of the needs of our institution, as well as pedagogical priorities. Data were collected from clinical instructors and other stakeholders pre- and post-intervention through multiple means and analyzed descriptively. We followed the CONSORT extension to randomized pilot and feasibility trials to guide reporting of the study. Results: The intervention was deemed acceptable by the clinical instructors, as well as the managers and educators of the units. We received no negative feedback regarding the intervention, or the workload required to implement the intervention properly. For data collection instruments, the NSSES was completed more often and with greater ease than the VSI-NS. In all cases, the responses to the instruments were congruent with our expectations and student scores shifted in the anticipated direction. Clinical instructors were able to consistently observe patient care and reported having more time for teaching and mentorship. Conclusions: Using a dyad approach to clinical education appears to be a viable strategy, and our feasibility study supports the appropriateness of further research into the use of dyads for nursing clinical education. From a sustainability perspective, the intervention allowed for the safe implementation of larger group sizes without negatively affecting the learning environment or the integrity of the course objectives. Résumé Objectif : Élaborer un protocole d’intervention en formation clinique qui utilise des dyades et évaluer la faisabilité de mettre en place l’approche avec des étudiantes en sciences infirmières de deuxième année lors de leur premier stage clinique. Les objectifs étaient : 1) d’évaluer et de peaufiner les procédures de collecte de données et les mesures de résultats; 2) d’évaluer l’acceptabilité et la viabilité de l’intervention; et, 3) d’identifier les faiblesses de l’intervention ou les risques pour une future mise en place. Méthodologie : Une étude de faisabilité, a été menée sous forme d’un essai pilote non randomisé. Cette étude fut effectuée sur le site universitaire d’un programme collaboratif de baccalauréat en sciences infirmières à Ottawa, en Ontario. Les trois groupes cliniques étaient composés de 24 étudiantes de deuxième année inscrites aux programmes de premier cycle en français et en anglais. Le protocole d’intervention a été élaboré en se basant sur des principes directeurs reflétant les besoins de notre établissement et nos priorités pédagogiques. Les données ont été recueillies par plusieurs méthodes auprès des enseignantes cliniques et d’autres intervenantes avant et après l’intervention et elles ont été analysées de façon descriptive. Nous avons suivi la structure CONSORT des essais pilotes randomisés et des études de faisabilité pour guider la présentation de l’étude. Résultats : L’intervention fut jugée acceptable par les enseignantes cliniques ainsi que par les gestionnaires et les conseillères des unités. Nous n’avons reçu aucun commentaire négatif par rapport à l’intervention ou à la charge de travail requise pour la mettre en place adéquatement. Concernant les instruments de collecte de données, la NSSES (échelle d’auto-efficacité des étudiantes en sciences infirmières) a été remplie plus souvent et plus facilement que le VSI-NS (questionnaire sur les interactions verbales et sociales des étudiantes en sciences infirmières). Dans tous les cas, les réactions par rapport aux instruments correspondaient à nos attentes et les résultats des étudiantes changeaient dans la direction prévue. Les enseignantes cliniques ont pu observer systématiquement les soins aux patients et ont rapporté avoir eu plus de temps pour enseigner et faire du mentorat. Conclusions : L’utilisation d’une approche de dyade en formation clinique semble être une stratégie viable et notre étude de faisabilité appuie la pertinence de recherches plus poussées sur l’utilisation de dyades en formation clinique en sciences infirmières. Du point de vue de la viabilité, l’intervention permettait une mise en place sécuritaire de plus grands groupes sans conséquence négative sur l’environnement d’apprentissage ou l’intégrité des objectifs de cours

The Vehicle, Spring 1983

Vol. 24, No. 2 Table of Contents A-B-C-D-E-F-G-H....Beth Kennypage 1 Contemporary IssuesBrook Wilsonpage 1 BlackJohn Stockmanpage 2 BeatGraham Lewispage 2 Catholic DazeSuzanne Hornpage 4 AfricaGraham Lewispage 5 The Friendly SkiesRajendra Sinhanpage 5 BreadKen Kempckepage 7 PhotographLinda Fraembspage 8 SnapshotMaggie Kennedypage 9 PoemAnne Smithpage 9 Activities on IceKerri Mahatpage 11 Beecham\u27s Orchard And VineyardBecky Lawsonpage 11 PoemKarri Mahatpage 12 Sneak PreviewsMaggie Kennedypage 12 ZooKen Kempckepage 12 PhotographNick Haskettpage 13 The Slave HouseCraig Barnespage 13 The Nomad Preacher\u27s SermonStacey Flanniganpage 16 Owl Creek RevisitedScott Graypage 16 Thought On CopperGraham Lewispage 20 OutfielderKen Kempckepage 20 HoneymoonJohn Stockmanpage 21 Candy Wrapper Dream GirlStacey Flanniganpage 21 PhotographLinda Fraembspage 22 October DreamMarlene Weekspage 23 IndistinctionStacey Flanniganpage 24 Taking InventorySara Farrispage 24 Flying In From K-Mart, NebraskaMichelle Mitchellpage 25 PhotographNick Haskettpage 26 Bone ChinaMichelle Mitchellpage 27 She Was A DollNick Haskettpage 30 The Seventh DayGeoffrey Andrespage 31 Blade Of Grass (On A Golf Course)Ken Kempckepage 31 PoemKen Kempckepage 32 Cigarette SmokeJean M. Davispage 33 Future LoveR. Lawsonpage 34 PhotographNick Haskettpage 35 Dancing In The StreetBetsy Acklinpage 35 PhotographLinda Fraembspage 38 CleoMarlene Weekspage 39 Teddy BearKen Kempckepage 39 PreludeBecky Lawsonpage 40https://thekeep.eiu.edu/vehicle/1043/thumbnail.jp

Genetic determinants of telomere length from 109,122 ancestrally diverse whole-genome sequences in TOPMed

Genetic studies on telomere length are important for understanding age-related diseases. Prior GWAS for leukocyte TL have been limited to European and Asian populations. Here, we report the first sequencing-based association study for TL across ancestrally-diverse individuals (European, African, Asian and Hispanic/Latino) from the NHLBI Trans-Omics for Precision Medicine (TOPMed) program. We used whole genome sequencing (WGS) of whole blood for variant genotype calling and the bioinformatic estimation of telomere length in n=109,122 individuals. We identified 59 sentinel variants (p-value OBFC1indicated the independent signals colocalized with cell-type specific eQTLs for OBFC1 (STN1). Using a multi-variant gene-based approach, we identified two genes newly implicated in telomere length, DCLRE1B (SNM1B) and PARN. In PheWAS, we demonstrated our TL polygenic trait scores (PTS) were associated with increased risk of cancer-related phenotypes

Young Mothers Lack Plans to Receive Preventive Health Care

Background: Despite their health vulnerability, multiple barriers to health care exist for adolescent mothers. This pilot study aimed to gain information regarding preventive health care intentions of young mothers following pregnancy. Methods: We administered institutional review board–approved surveys to mothers aged 15 to 21 years at a local hospital where 75% of infants are born. Participants were questioned regarding current and intended use of health care. Results: Results showed that only half of the young mothers identified a primary care provider (PCP) but more had seen some type of doctor in the 3 years preceding their pregnancy. White mothers were significantly more likely than Hispanic to have seen a physician prior to pregnancy; family physicians (FPs) were referenced most. Additionally, white and black mothers were significantly more likely than Hispanic mothers or mothers of other ethnicity to have received minor emergency care during pregnancy. While FPs were referenced most frequently, few mothers planned to see one for preventive care. Nearly half of participants planned to see their obstetrician/gynecologist (OBGYN) for routine yearly checkups. Conclusions: This research indicates a gap in health care for young mothers. Only half enter parenthood with a PCP, and once mothers, few plan to see a physician for preventive care. In this study, OBGYNs were identified most often for preventive health care. Therefore OBGYNs should provide comprehensive care to this population, or connect them with other PCPs. Furthermore, young mothers do plan on seeing FPs for acute health care, supporting previous recommendations that physicians use all visits to provide comprehensive care to adolescents

In-Person Education During the Early COVID-19 Pandemic at Wichita Collegiate School : In person learning at WCS during COVID

Introduction. The COVID-19 pandemic forced most schools in Kansas in 2020-2021 to adopt remote or hybrid learning. Wichita Collegiate School proceeded with an in-person teaching model. The purpose of this study was to determine if in-person learning can be done safely during the COVID-19 pandemic prior to vaccine use. Methods. Wichita Collegiate is a private school located in Sedgwick County, Kansas. The study population included 671 students (grades 1-12) and 130 staff.  The procedures implemented during the school year (8/19/20- 5/21/21) included: mandatory face coverings, six feet physical distancing, and daily temperature checks. A registered nurse performed contact tracing and executed quarantine requirements per the Center for Disease Control and Prevention (CDC) guidelines.  Results. Over the study period, 487 students and staff were tested for COVID-19, and 18.5% (n=90) were positive. Overall, students and staff rate of COVID 19 infection was lower than the expected rate when compared to the surrounding community of Sedgwick County. Thorough contract tracing of positive cases revealed that 2.2% (n=2) individuals were likely exposed to COVID-19 at school.  Conclusions. This study suggests that transmission of COVID-19 was infrequent in a school setting with in-person attendance, even before widespread vaccine availability. By following public health guidelines and utilizing contact tracing, this study suggests that it is possible to limit the spread of COVID-19 during in-person learning. This has immediate implications for how schools safely returned to in-person learning in the post vaccine era.   

Internet-Based Information on Long-Acting Reversible Contraception for Adolescents

Background: Long-acting reversible contraception (LARC) is safe, effective, and recommended as first-line contraception for adolescents. Despite clear medical recommendations, the type and quality of Internet information regarding LARC for teenagers is unknown. Methods: Data were collected through web queries. Resulting websites were assessed for quality criteria and a priori content themes based on the leading medical societies’ recommendations for adolescent LARC. Results: Of the 238 websites evaluated, 77% made no recommendation of LARC for adolescent females. Of the 55 websites that did recommend LARC, only 40% specifically discussed its use in the adolescent population. Of note, 16% of websites recommending LARC discouraged their use in adolescents. Quality varied among LARC-discussing websites, ranging from 3 to 13 of the 15 criteria assessed. Discussion: Few websites offer up-to-date information regarding the use of LARC, and most fail to discuss LARC use at all. As LARC is highly effective in preventing unplanned pregnancies in adolescents, incomplete or inaccurate information on the Internet present a barrier to promoting its utilization in this at-risk population

The impact of systematically repairing multiple choice questions with low discrimination on assessment reliability: an interrupted time series analysis

At our centre, we introduced a continuous quality improvement (CQI) initiative during academic year 2018-19 targeting for repair multiple choice question (MCQ) items with discrimination index (D) < 0.1. The purpose of this study was to assess the impact of this initiative on reliability/internal consistency of our assessments. Our participants were medical students during academic years 2015-16 to 2020-21 and our data were summative MCQ assessments during this time. Since the goal was to systematically review and improve summative assessments in our undergraduate program on an ongoing basis, we used interrupted time series analysis to assess the impact on reliability. Between 2015-16 and 2017-18 there was a significant negative trend in the mean alpha coefficient for MCQ exams (regression coefficient -0.027 [-0.008, -0.047], p = 0.024). In the academic year following the introduction of our initiative (2018-19) there was a significant increase in the mean alpha coefficient (regression coefficient 0.113 [0.063, 0.163], p = 0.010) which was then followed by a significant positive post-intervention trend (regression coefficient 0.056 [0.037, 0.075], p = 0.006). In conclusion, our CQI intervention resulted in an immediate and progressive improvement reliability of our MCQ assessments

Identifying maltreatment in infants and young children presenting with fractures: does age matter?

Objectives Child abuse is a significant cause of morbidity and mortality in preverbal children who cannot explain their injuries. Fractures are among the most common injuries associated with abuse but of themselves fractures may not be recognized as abusive until a comprehensive child abuse evaluation is completed, often prompted by other signs or subjective features. We sought to determine which children presenting with rib or long-bone fractures should undergo a routine abuse evaluation based on age. Methods A systematic review searching Ovid, PubMed/Medline, Scopus, and CINAHL from 1980 to 2020 was performed. An evidence-based framework was generated by a consensus panel and applied to the results of the systematic review to form recommendations. Fifteen articles were suitable for final analysis. Results Studies with comparable age ranges of subjects and sufficient evidence to meet the determination of abuse standard for pediatric patients with rib, humeral, and femoral fractures were identified. Seventy-seven percent of children presenting with rib fractures aged less than 3 years were abused; when those involved in motor vehicle collisions were excluded, 96% were abused. Abuse was identified in 48% of children less than 18 months with humeral fractures. Among those with femoral fractures, abuse was diagnosed in 34% and 25% of children aged less than 12 and 18 months, respectively. Conclusion Among children who were not in an independently verified incident, the authors strongly recommend routine evaluation for child abuse, including specialty child abuse consultation, for: 1) children aged less than 3 years old presenting with rib fractures and 2) children aged less than 18 months presenting with humeral or femoral fractures (Level of Evidence: III Review)