Prevalence of Acute-Onset Subtypes in Pediatric Obsessive-Compulsive Disorder.

BACKGROUND: Pediatric obsessive-compulsive disorder (OCD) is a common, debilitating illness. When childhood OCD symptom onset is described as acute and severe, diagnostic criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) should be considered. However, the frequency and differentiating features of these putative syndromes within pediatric OCD remain poorly understood. OBJECTIVES: To determine the prevalence and characteristics of those meeting PANDAS and/or PANS criteria within pediatric OCD, as determined by parent report and clinician interview. METHODS: Consecutive youth presenting to a subspecialty pediatric OCD clinic were rigorously assessed through the Anxiety Disorders Interview Schedule for DSM-IV, the Children's Yale-Brown Obsessive-Compulsive Scale, and through self- and parent-report measures, including a medical questionnaire. Strict diagnostic criteria for PANDAS and PANS were applied to determine prevalence rates, and comparative analyses were performed between subgroups. RESULTS: Among 136 youth with a lifetime OCD diagnosis, 5% (n = 7; 95% adjusted Wald interval: 1%-10%) met proposed criteria for PANDAS and/or PANS, of whom two met PANDAS criteria, four met PANS criteria, and one met criteria for both. Those in the PANDAS/PANS subgroup were more likely to have autoimmune illness, less likely to report symmetry factor symptoms, and had greater OCD-related family impairment during their worst OCD episode. CONCLUSION: A small yet significant percentage of pediatric OCD outpatients met criteria for PANDAS and/or PANS, justifying routine screening and attention to related characteristics during assessment and management. Longitudinal studies of these putative subtypes are warranted.

Staying Connected: Computer-Mediated and Face-to-Face Communication in College Students' Dating Relationships.

Little is known about the features, depth, and quality of communication in heterosexual dating relationships that include computer-mediated communication (CMC). This study examined these features as well as CMC's potential to facilitate self-disclosure and information-seeking. It also evaluated whether partner CMC interactions play a role in partner intimacy and communication quality. Young adults (N = 359; 18-24) attending postsecondary education institutions completed an online survey about their CMC use. To be included in the study, all participants were in established dating relationships at the time of the study and reported daily communication with their partner. CMC was linked to partners' disclosure of nonintimate information. This personal self-disclosure was linked positively to relationship intimacy and communication quality, beyond contributions from face-to-face interactions. Breadth (not depth) of self-disclosure and positively valenced interactions, in particular, proved key to understanding greater levels of intimacy in dating relationships and better communication quality as a function of CMC. CMC provides opportunities for partners to stay connected and to improve the overall quality of their intimacy and communication.

Geriatric rehabilitation and resilience from a cultural perspective.

Resiliency is a key aspect to aging successfully. Promoting healthy lifestyles, strong social bonds, enhancements to one's environment, accessibility to quality care and rehabilitation are critical in a positive aging experience. Issues of personal, social, medical, and rehabilitative care are addressed in the context of resiliency from a cultural perspective. Various research studies explore resiliency through the progression of aging within changing environments, medical needs, and social conditions. Findings suggest that a strong connection to culture, accessibility to medical attention, and comprehensive assessment of a patient's background can effectively improve the rehabilitation for an aging individual. This article addresses aspects of caregiving that are essential in raising cultural sensitivity and resiliency, discussing three case studies (i.e. fall risk; stroke; congestive heart failure) in the geriatric patient. Resiliency in culture and rehabilitation has a connection needed to advance the quality of care and quality of life for an aging patient population.

Development of learning objectives and a validated testing tool for management of pediatric mechanical ventilation*.

OBJECTIVES: Graduate medical education is shifting toward an outcome-based paradigm, where physicians are evaluated for competency using well-defined criteria. Our aim was to learning objectives and a testing tool to assess competency in the management of mechanical ventilation for infants, children, and adolescents and to verify that the test was reliable and valid. DESIGN: Prospective reliability and validity study. SETTING: Large, university-affiliated academic hospital. SUBJECTS: Sixty-one total subjects from five different academic centers divided into three groups of varying experience. The groups were second- and third-year pediatric residents (Novice), second- and third-year pediatric critical care fellows (Advanced), and pediatric critical care faculty (Expert). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Ten learning objectives considered important for the management of pediatric mechanical ventilation were developed from expert opinion and current evidence. Based on these objectives, a 35-question multiple choice, knowledge- and case-based test was created. Content validity was achieved by consensus of three experts in pediatric critical care medicine evaluating whether the questions reflected the learning objectives and the responses were consistent with current practice and evidence-based medicine. The test was then administered to the three groups to establish construct validity. The "Novice" group scored a mean of 34.6% (95% CI, 28-41%), the "Advanced" group a mean of 59.4% (95% CI, 53-65%), and the "Expert" group a mean of 74.8% (95% CI, 69-80%), with p less than 0.01 for all comparisons. As determined by Hoyt's analysis, the reliability coefficient was 0.89, reflecting excellent reliability. CONCLUSIONS: This is the first description of specific learning objectives for management of pediatric mechanical ventilation and the first validated and reliable testing tool for assessing knowledge. This tool could be used by fellowship programs to assess fellow competency and identify knowledge gaps in this area prior to completion of training. Further work must be done to determine the criteria for determination of competency.

Responding to demands to change nursing education: use of curriculum mapping to assess curricular content.

Nurse educators are endeavoring to assess and revise their undergraduate curriculum for a variety of reasons. Legislation passed in California mandates that universities must offer more seamless associate degree-to-baccalaureate of science in nursing degree programs and must ensure that course content in their programs is not redundant across program types. A nursing education consortium, including a university, two community colleges, and four hospital partners, formed a working group to assess all undergraduate curricula. This working group included faculty from all three academic institutions and nurse educators from area service provider partners. This article describes the use of curriculum mapping using a tool formed based on the American Association of Colleges of Nursing's Essentials of Baccalaureate Education for Professional Nursing Practice to assess the three curricula and the outcomes and implications of the assessment.

Predicting NCLEX-RN success in a diverse student population.

Many schools of nursing have implemented standardized testing using platforms such as those developed by Assessment Technologies Institute (ATI) to better prepare students for success on the National Council Licensure Examination for Registered Nurses® (NCLEX-RN). This study extends and replicates the research on standardized testing to predict first-time pass success in a diverse student population and across two prelicensure program types. The final sample consisted of 589 students who graduated between 2003 and 2009. Demographic data, as well as academic performance and scores on the ATI RN Comprehensive Predictor, were analyzed. The findings in this study indicate that scores on the ATI RN Comprehensive Predictor were positively, significantly associated with first-time pass success. Students in jeopardy of failing the NCLEX-RN on their first attempt can be identified prior to graduation and remediation efforts can be strengthened to improve their success.

Predictors of NCLEX-RN success across 3 prelicensure program types.

Nursing faculty are concerned about the ability of recent graduates to successfully pass NCLEX-RN on their first-attempt. To facilitate student first-time success on the examination, nurse educators need to understand what student characteristics are predictive of success. The purpose of this study was to explore student characteristics across 3 different programs types (university-based BSN, master's entry, and satellite BSN) and in each of the 3 program types to identify predicators of first-time NCLEX-RN success.

Partnership in action: a satellite program to expand an existing bachelor of science in nursing education program.

The nursing shortage affects communities at many levels, from community hospitals to schools of nursing. The authors describe an innovative 4-way partnership involving a community healthcare district, a community hospital, a community college, and a state university. Working together, these partners established a new baccalaureate nursing program based at a community college and also functioning as a satellite of an existing university-based program, which increased the enrollment of baccalaureate nursing students by 50%. Their work could serve as a model for other collaborative efforts to expand nursing education and reduce the shortage of nurses.