Printed Health Information Materials: Evaluation of Readability and Suitability

Interdisciplinary collaboration and coordination of services are receiving new emphasis in Birth to Three Early Intervention programs under Part H of Public Law (PL) 102-119 (Individuals with Disabilities Education Act, formerly PL 99-457, the Education for All Handicapped Children Act). Public Health Nurses (PHNs) have historically provided health promotion services in the home to families of infants and children with special health and developmental needs, whereas other community programs have provided specific developmental and related services. Now, as the number of professional specialties involved with children with special needs increases, overlap also increases. Nursing is frequently questioned as to its unique contribution. The holistic health perspective of nursing, which integrates all aspects of the health and well-being of individuals and families, can provide especially valuable insight to the assessment, planning, and service delivery processes. Nurses need to not only participate in the planning process during the interdisciplinary planning meetings, but also to contribute their own assessment and recommendations from a nursing perspective. Under PL 102-119, the Individual Family Service Plan (IFSP) provides the framework for family-centered planning of services for the infant or young child with special needs. Developed in partnership with the family, this plan identifies strengths, resources, concerns, and priorities based on the family's determination of relevancy (Sokoly &; Dokecki, 1992). IFSP development includes formal and informal assessments by qualified professionals who provide their special expertise as shaped by the family's priorities. The health assessment and services called for within PL 102-119 are consistent with public health nursing's focus on prevention and early intervention. Health issues are basic to the definition of children with special health needs and often must be addressed before developmental goals can be...     

Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms

BACKGROUND: Surgical repair of thoracoabdominal aneurysms may be associated with a significant risk of perioperative morbidity including spinal cord ischemia, which occurs at a rate of between 5% and 21%. Spinal cord ischemia after endovascular repair of thoracic aortic aneurysms (TAAs) has also been reported. This investigation reviews the occurrence of spinal cord ischemia after endovascular repair of descending TAAs at the Mount Sinai Medical Center. PATIENTS AND METHODS: Between May 1997 and April 2001, 53 patients underwent endovascular exclusion of their TAA. Preprocedure computed tomography scanning and angiography were performed on all patients. All were performed in the operating room using C-arm fluoroscopy. Physical examinations and computed tomography scans were performed at discharge and at 1, 3, 6, and 12 months postoperatively and then annually thereafter. Spinal cord ischemia developed in three of the 53 patients (5.7%) postoperatively. In one patient, cord ischemia developed that manifested as early postoperative left leg weakness occurring after concomitant open infrarenal abdominal and endovascular TAA repair. The neurologic deficit resolved 12 hours after spinal drainage, steroid bolus, and the maintenance of hemodynamic stability. The remaining two patients developed delayed onset paralysis, one patient on the second postoperative day and the other patient 1 month postrepair. Both of these patients had previous abdominal aortic aneurysm repair, and both required long grafts to exclude an extensive area of their thoracic aortas. Irreversible cord ischemia and paralysis occurred in both of these patients. CONCLUSIONS: Endovascular repair of TAA has shown a promising reduction in operative morbidity; however, the risk of spinal cord ischemia remains. Concomitant or previous abdominal aortic aneurysm repair and long segment thoracic aortic exclusion appear to be important risk factors. Spinal cord protective measures (ie, cerebrospinal fluid drainage, steroids, prevention of hypotension) should be used for patients with the aforementioned risk factors undergoing endovascular TAA repair.     

Pediatric patients who receive antibiotics for fever and neutropenia in less than 60 min have decreased intensive care needs

Background

Antibiotic delivery to patients with fever and neutropenia (F&N) in <60 min is an increasingly important quality measure for oncology centers, but several published reports indicate that a time to antibiotic delivery (TTA) of <60 min is quite difficult to achieve. Here we report a quality improvement (QI) effort that sought to decrease TTA and assess associated clinical outcomes in pediatric patients with cancer and F&N.

Procedure

We used Lean‐Methodology and a Plan‐Do‐Study‐Act approach to direct QI efforts and prospectively tracked TTA measures and associated clinical outcomes (length of stay, duration of fever, use of imaging studies to search for occult infection, bacteremia, intensive care unit (ICU) consultation or admission, and mortality). We then performed statistical analysis to determine the impact of our QI interventions on total TTA, sub‐process times, and clinical outcomes.

Results

Our QI interventions significantly improved TTA such that we are now able to deliver antibiotics in <60 min nearly 100% of the time. All TTA sub‐process times also improved. Moreover, achieving TTA <60 min significantly reduced the need for ICU consultation or admission (P = 0.003) in this population.

Conclusion

Here we describe our QI effort along with a detailed assessment of several associated clinical outcomes. These data indicate that decreasing TTA to <60 min is achievable and associated with improved outcomes in pediatric patients with cancer and F&N. Pediatr Blood Cancer 2015;62:807–815. © 2015 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc.