Pediatric Contact Dermatitis Registry Inaugural Case Data.

BACKGROUND: Little is known about the epidemiology of allergic contact dermatitis (ACD) in US children. More widespread diagnostic confirmation through epicutaneous patch testing is needed. OBJECTIVE: The aim was to quantify patch test results from providers evaluating US children. METHODS: The study is a retrospective analysis of deidentified patch test results of children aged 18 years or younger, entered by participating providers in the Pediatric Contact Dermatitis Registry, during the first year of data collection (2015-2016). RESULTS: One thousand one hundred forty-two cases from 34 US states, entered by 84 providers, were analyzed. Sixty-five percent of cases had one or more positive patch test (PPT), with 48% of cases having 1 or more relevant positive patch test (RPPT). The most common PPT allergens were nickel (22%), fragrance mix I (11%), cobalt (9.1%), balsam of Peru (8.4%), neomycin (7.2%), propylene glycol (6.8%), cocamidopropyl betaine (6.4%), bacitracin (6.2%), formaldehyde (5.7%), and gold (5.7%). CONCLUSIONS: This US database provides multidisciplinary information on pediatric ACD, rates of PPT, and relevant RPPT reactions, validating the high rates of pediatric ACD previously reported in the literature. The registry database is the largest comprehensive collection of US-only pediatric patch test cases on which future research can be built. Continued collaboration between patients, health care providers, manufacturers, and policy makers is needed to decrease the most common allergens in pediatric consumer products.

A comparative effectiveness study of continuous positive airway pressure-related skin breakdown when using different nasal interfaces in the extremely low birth weight neonate.

A three group prospective randomized experimental design was conducted to identify differences in frequency and severity of nasal injuries when comparing various interfaces used during continuous positive airway pressure (CPAP) and identified risk factors associated with injury. Seventy-eight neonates <1500 g were randomized into three groups: continuous nasal prongs; continuous nasal mask; or alternating mask/prongs. Repeated measures ANOVA with Bonferroni correction demonstrated that significantly less skin injury was detected in the rotation interface group when compared to both mask and prong groups. In the final stepwise regression model (F = 11.51; R(2) = 0.221; p = 0.006) significant predictors of skin injury included number of days on nasal CPAP (p < 0.001) and current mean post menstrual age (p = 0. 006). Reduced nasal injury was demonstrated using rotating mask/prong nasal interfaces. Future best practices must include precise selection of device size, developmental and CPAP device positioning with focused skin assessment including rapid intervention for skin injury.

An evidence-based quality improvement perspective for a chronic obstructive pulmonary disease case-finding program.

Chronic obstructive pulmonary disease (COPD) is a persistent progressive respiratory disease that is increasing in prevalence and cost in the United States health care system. Delays in recognition, diagnosis, and treatment are associated with poorer clinical outcomes. These delays are seen more often in populations experiencing economic hardship, lack of access to care, and lack of insurance, such as those seen in an indigent care clinic. The COPD case-finding program was planned as an evidence-based quality improvement project with a prospective, descriptive design generating a convenience sample of patients meeting modified screening criteria (i.e. patients 40 years of age with a smoking history and no pulmonary disease history) in a community-based indigent care clinic which was not screening for COPD. Practice change recommendations were guided by the Diffusion of Innovations Model. Descriptive statistics were used to describe the sample (i.e. age, ethnicity, race, gender, income, and selected comorbidities). Sensitivity, specificity, positive predictive value, negative predictive value, prevalence, and receiver operator characteristics curve COPD Questionnaire were calculated for this sample.

An integrative review of skin breakdown in the preterm infant associated with nasal continuous positive airway pressure.

OBJECTIVE: To identify factors associated with skin injury during nasal continuous positive airway pressure (NCPAP) and describe differences in frequency, severity, and type of skin injuries when comparing nasal interfaces used during NCPAP in the preterm infant. DATA SOURCES: Scientific databases were searched using provided key terms and yielded 113 articles. STUDY SELECTION: Forty-six articles were included in this integrative review: six case studies, 22 with identified aim of examining skin and nasal injury during NCPAP; 18 included skin care considerations during NCPAP. DATA EXTRACTION: Studies were categorized into four themes: types of nasal injuries; associated risk factors that increase incidence of injury; differences between NCPAP devices and/or nasal interface and corresponding rate and severity of nasal injury; and recommended prevention strategies to reduce iatrogenic cutaneous injury. DATA SYNTHESIS: Skin injury was a common theme during neonatal NCPAP with skin breakdown rates of 20% to 60%. Increased skin injury risk was associated with smaller infant size, gestational age, and duration of therapy. Nursing care strategies to improve skin integrity during NCPAP had little supportive evidence. Nursing practice is varied with reportedly little standardized care during NCPAP therapy. Recommendations for specific care strategies to reduce skin injury during NCPAP were supported by limited experimental studies. CONCLUSIONS: Risk factors during NCPAP include nasal injury and trauma secondary to tight-fitting nasal interfaces necessary to provide continuous distending pressure for respiratory stability. Identifying strategies to reduce skin breakdown will support noninvasive treatment success, reduce reintubation rates, reduce sepsis, reduce patient discomfort, and improve developmental outcomes during NCPAP use.

Developing and testing the nurse educator scale: a robust measure of students' intentions to pursue an educator role.

No instrument exists that measures student perceptions of the faculty role. Such a measure is necessary to evaluate the efficacy of interventions aimed at attracting students to the faculty career path. We developed the Nurse Educator Scale (NES). The initial scale items were generated using the social cognitive career theory (SCCT) constructs and were reviewed by an expert panel to ensure content validity. Exploratory factor analysis was used. The optimized 25-item, 7-point Likert scale has a Cronbach's alpha reliability coefficient of 0.85, with a total variance of 42%. The underlying factor structure supported three defining characteristics congruent with SCCT: outcome expectations (alpha = 0.79), relevant knowledge (alpha = 0.67), and social influence (alpha = 0.80). A stand-alone, item-measuring goal setting was also supported. The NES provides a valid and reliable measure of students' intentions and motivations to pursue a future career as a nurse educator or scientist.

Moving towards effective chronic illness management: asthma as an exemplar.

The United States health care system is at a pivotal point in its ability to manage chronic illness. The demands and philosophical differences between the management of acute and chronic illnesses suggest the need for different strategies for effective and efficient management of chronic illness. The purpose of this article is to discuss the Chronic Care Model and the collaborative approach to managing chronic illnesses. Asthma, as an exemplar, will be used to illustrate the need for the development of new models of collaborative care for the treatment of chronic illnesses.