ABSTRACT
Introduction: Latinx children are the fastest-growing ethnic minority of children under the age of 5 years in a tri-county area in the Southeastern United States (US Census, 2018). There are limited culturally and linguistically appropriate school preparedness initiatives in this geographic region. Methods: A cultural and linguistic appropriate program was developed in coordination with the state's largest Latinx advocacy organization and two patient-centered pediatric medical homes (PCPMHs) after securing extramural grant funding for an evidenced-based home visitation program using skilled community health workers (CHWs) aimed at Latinx children at the age of 0-5 years and their caregivers. The program includes developmental screenings using the Ages & Stages Questionnaires®, Third Edition (ASQ®-3), CHW role modeling of developmentally appropriate play, early literacy, connection to resources, oral health, nutrition, and physical activity. Results: Of the 103 unique children represented in this programmatic evaluation that received an initial and follow-up ASQ®-3 developmental screening, paired t-tests indicate statistically significant improvement in mean scores from the first to second ASQ®-3 in all five major developmental domains with the largest gains represented in the communication and fine motor skill domains. Conclusion: This evaluation suggests that low-frequency home visits from skilled CHWs can have a beneficial effect on development in early childhood. PPCMHs can serve as a hub for these community-based programs.
Subject(s)
Ethnicity , Minority Groups , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Mass Screening , Schools , Surveys and QuestionnairesABSTRACT
BACKGROUND: The COVID-19 pandemic created new challenges in controlling the transmission of sexually transmitted diseases (STDs), forcing the Centers for Disease Control and Prevention (CDC) to temporarily modify recommendations. As rapid COVID-19 testing emerged, supplies for similar testing platforms, specifically Chlamydia trachomatis and Neisseria gonorrhoeae, became compromised. LOCAL PROBLEM: The local community was identified as having the highest rate of chlamydia infections in North Carolina. Concerns regarding disease transmission within the community were amplified as the project site began experiencing a critical shortage of chlamydia and gonorrhea testing kits. METHODS: This quality improvement (QI) project, conducted in an emergency department, located in an underserved area with high STD infection rates, offered a prioritized approach to STD testing and treatment during a critical time with limited testing capabilities. INTERVENTIONS: Program analysis evaluated the management of 227 patients preintervention and 218 patients postintervention with confirmed or suspected infection, using a testing and treatment algorithm to identify and treat those most likely to be infected while preserving testing supplies for those at higher risk for complications from infections. RESULTS: Test utilization decreased by 25% (p-value = .003 via t-test), whereas a significant improvement in empiric treatment, increasing from 59% (133/227) to 73% (158/218), was also observed (p-value = .002 via chi-square analysis). CONCLUSIONS: Results suggest that a testing and treatment algorithm for providers can successfully guide testing and treatment decisions, reducing onward transmission and preserving supplies for those more likely to experience complications from chlamydia and gonorrhea infections.
Subject(s)
COVID-19 , Gonorrhea , Sexually Transmitted Diseases , COVID-19 Testing , Centers for Disease Control and Prevention, U.S. , Chlamydia trachomatis , Gonorrhea/diagnosis , Gonorrhea/drug therapy , Gonorrhea/epidemiology , Humans , Pandemics , Prevalence , SARS-CoV-2 , Sexually Transmitted Diseases/epidemiology , United StatesABSTRACT
Early recognition of developmental delay is critical to providing comprehensive pediatric primary care. Advanced practice nurses must be aware of the guidelines for surveillance and developmental screening in children. This article discusses guidelines for screening, examples of screening tools, information for follow up, and referral for positive screenings.
Subject(s)
Developmental Disabilities/nursing , Mass Screening/nursing , Population Surveillance/methods , Practice Guidelines as Topic , Primary Care Nursing/methods , Advanced Practice Nursing , Child , Child, Preschool , Early Diagnosis , Humans , Infant , Infant, Newborn , Mass Screening/methods , Nursing Diagnosis , Nursing Methodology Research , Pediatric Nurse PractitionersABSTRACT
Pediatric fractures sometimes are complicated by growth disturbances. Most reported growth disturbances are in the lower extremity and can entail growth arrest or overgrowth. We report a case of overgrowth and angular deformity after an extraphyseal distal radius fracture that resulted in clinically significant pain and functional impairment because of palmar instability of the distal ulna. A dome osteotomy was successful in treating the patient's wrist pain, distal radioulnar instability, and multiplanar deformity of the distal radius.
