Utility of the Frontal Lobe Epilepsy Parasomnia Scale in Evaluation of Children With Nocturnal Events.

ABSTRACT: BACKGROUND: Sleep-related hypermotor epilepsy (SHE) and nocturnal non-rapid eye movement parasomnias are difficult to differentiate. Neurologists and sleep medicine clinicians largely rely on clinical history when evaluating nocturnal spells. When the diagnosis is in question, referral for video electroencephalogram monitoring is the standard. However, there are no guidelines as to when this evaluation is needed. The Frontal Lobe Epilepsy Parasomnia (FLEP) scale was developed to assist clinicians in differentiating the two among adults. The aim of this study was to provide a preliminary evaluation of the FLEP for use with children. METHODS: This was a retrospective pilot instrument validation study with a convenience sample of 17 children seen in neurology or sleep medicine clinics. To determine concurrent validity, FLEP scores were compared with clinical diagnoses by neurology providers confirmed by electroencephalography. RESULTS: With a cutoff score of 2, the modified FLEP distinguished between children with and without SHE. The FLEP tool had a specificity of 0.58, implying that 7 of the 12 children without SHE would have been accurately recommended to follow up for parasomnia management rather than more urgent evaluation of potential frontal lobe epilepsy. CONCLUSIONS: With some minor adaptations for children, the FLEP satisfactorily distinguished between SHE and non-SHE patients.

Parent Perspective on Care Coordination Services for Their Child with Medical Complexity.

The overarching goal of care coordination is communication and co-management across settings. Children with medical complexity require care from multiple services and providers, and the many benefits of care coordination on health and patient experience outcomes have been documented. Despite these findings, parents still report their greatest challenge is communication gaps. When this occurs, parents assume responsibility for aggregating and sharing health information across providers and settings. A new primary-specialty care coordination partnership model for children with medical complexity works to address these challenges and bridge communication gaps. During the first year of the new partnership, parents participated in focus groups to better understand how they perceive communication and collaboration between the providers and services delivering care for their medically complex child. Our findings from these sessions reflect the current literature and highlight additional challenges of rural families, as seen from the perspective of the parents. We found that parents appreciate when professional care coordination is provided, but this is often the exception and not the norm. Additionally, parents feel that the local health system's inability to care for their medically complex child results in unnecessary trips to urban-based specialty care. These gaps require a system-level approach to care coordination and, consequently, new paradigms for delivery are urgently needed.

Reducing OR Traffic Using Education, Policy Development, and Communication Technology.

A bundled approach to surgical site infection (SSI) prevention strategies includes reducing OR traffic. A nurse-led quality improvement (QI) team sought to reduce OR traffic through education and a process change that included wireless communication technology and policy development. The team measured OR traffic by counting the frequency of door openings per hour in seven surgical suites during 305 surgical procedures conducted during similar 22-week periods before and after the QI project intervention. Door openings decreased significantly (P < 0.05) from an average of 37.8 per hour to 32.8 per hour after the QI project intervention. This suggests that our multifaceted approach reduces OR traffic. The next steps of this project include analyzing automatically captured video to understand OR traffic patterns and expanding education to departments and external personnel frequently present in our surgical suites. Future research evaluating the effectiveness of this OR traffic initiative on SSI incidence is recommended.

Implementation of a Phase I Caregiver Visitation Program for a Specialized Pediatric Population.

Phase I caregiver visitation practice has been endorsed and encouraged by the American Society of PeriAnesthesia Nurses, yet implementation has not been widespread. Literature has described benefits of visitation for patients and their caregivers. This article reports on a Phase I caregiver visitation program at a specialty care hospital. The steps of implementation and guidelines for both the health care team and the patient's caregivers are outlined. Visitation is recognized as promoting patient safety during Phase I recovery. A discussion of additional benefits and obstacles is addressed.

Prewarming in a pediatric hospital: process improvement through interprofessional collaboration.

A quality improvement project intended to promote maintenance of normothermia through active prewarming was carried out at a pediatric specialty hospital. An alternative active, forced-air warming product (Bair Paws warming gowns) was trialed in place of the existing active warming product (Bair Hugger blankets). Converting to the new product was intended to improve patient and staff compliance with prewarming recommendations. The alternative forced air active warming product was favored by both staff and patients, and the rate of compliance with this practice nearly doubled following the change in product. Extensive interprofessional collaboration and problem solving were required to go from an idea to a fully implemented change. The project demonstrated the importance of collaboration among various disciplines and the positive impact interprofessional collaboration can have on compliance with practice changes.

Motor function predicts parent-reported musculoskeletal pain in children with cerebral palsy.

BACKGROUND: The relationship between pain and motor function is not well understood, especially for children and adolescents with communication and motor impairments associated with cerebral palsy (CP). OBJECTIVES: To determine whether a predictive relationship between motor function and musculoskeletal pain exists in children with CP. METHODS: Following informed consent, caregivers of 34 pediatric patients with CP (mean [± SD] age 9.37±4.49 years; 80.0% male) completed pain- and function-related measures. Parents completed the Dalhousie Pain Interview and the Brief Pain Inventory based on a one-week recall to determine whether pain had been experienced in the past week, its general description, possible cause, duration, frequency, intensity and interference with daily function. The Gross Motor Function Classification System (GMFCS) was used to classify the motor involvement of the child based on their functional ability and their need for assistive devices for mobility. RESULTS: GMFCS level significantly predicted parent-reported musculoskeletal pain frequency (P<0.02), duration (P=0.05) and intensity (P<0.01). Duration of pain was significantly related to interference with activities of daily living (P<0.05). CONCLUSIONS: Children with CP with greater motor involvement, as indexed by GMFCS level, may be at risk for increased pain (intensity, frequency and duration) that interfers with activities of daily living. The clinical index of suspicion should be raised accordingly when evaluating children with developmental disability who cannot self-report reliably.

Qualitative evaluation of a pain intensity screen for children with severe neurodevelopmental disabilities.

The population of individuals with severe and profound intellectual disabilities (ID) is extremely heterogeneous, and the unique pain-related behaviors of each individual might not be satisfactorily captured using a standardized checklist such as the Noncommunicating Children's Pain Checklist or the Revised Faces, Legs, Arms, Cry, and Consolability tools. There has been increasing appreciation of the importance of recognizing the idiosyncratic pain behaviors of these individuals. The investigators developed a tool, the Tailored Observational Pain Screen (TOPS), to facilitate recognition of pain in the individual who lacks verbal communication, based on caregivers' descriptions of the individual's unique pain-related behaviors. The aim of this study was to elicit caregivers' evaluations of this personalized pain screen, using qualitative analysis of semi-structured interviews. The participants were the primary caregivers of 13 children with severe or profound ID and ongoing pain issues who were interviewed after they had used the TOPS for 6 weeks. The investigators identified themes from the interviews, including: using the TOPS to recognize and evaluate pain; using the TOPS to facilitate communication; limitations of the TOPS; and recommendations for its improvement. For clinical purposes, the TOPS shows promise as a tool for helping caregivers to share with others the ways that pain of these children can be detected.

Innovative use of perianesthesia nurses in imaging services: meeting the needs of children with disabilities.

A new imaging center was established within a children's specialty hospital that provides services for children and adults with childhood-onset disabilities. New services in this advanced imaging center include computed tomography, magnetic resonance imaging, fluoroscopy, and ultrasound. Individuals with disabilities are particularly at risk for complications during procedures requiring sedation and anesthesia. The perianesthesia nurses' role was developed to support the sedation needs of this population during imaging services. Perianesthesia nurses developed an advanced imaging screening process to prepare patients for sedation during imaging services. With these processes, the new Advanced Imaging Center is providing timelier and better coordinated imaging services.

Effectiveness of the essential oils lavender and ginger in promoting children's comfort in a perianesthesia setting.

This randomized, controlled, blinded study examined the effectiveness of an aromatherapy intervention on the reduction of children's distress in a perianesthesia setting. The sample included children with and without developmental disabilities (n = 94). Subjects in the intervention group received an aromatherapy intervention of lavender and ginger essential oils. The control group received a placebo intervention of jojoba oil. Distress was measured at two times: before induction and in the PACU, using the Faces, Legs, Arms, Cry and Consolability (FLACC) scale. The mean distress level was lower for the children in the essential oil group, but the effect was not statistically significant (P = .055). Parents' responses to survey questions about satisfaction with aromatherapy did not differ between groups, although open-ended comments indicated a more positive opinion of the benefits of the intervention in the aromatherapy group.