Survey to child/adolescent psychiatry and developmental/behavioral pediatric training directors to expand psychiatric-mental health training to nurse practitioners.

BACKGROUND: There is an ongoing shortage of child mental health professionals. Nurse practitioners (NPs) who completed behavioral and mental health training have proven that they can diagnose and manage many pediatric problems. PURPOSE: To ask the training directors of both child/adolescent psychiatry (CAP) and developmental/behavioral pediatric (DBP) programs about their receptivity and willingness to give additional training for NPs who provide care to children with behavioral and mental health issues and examine the main obstacles to the development of such programs. METHODS: A survey was sent to 151 CAP and DBP training directors in the United States. RESULTS: The return rate was 67% (N = 101). Only 12% expressed objection to the concept of additional NP training in CAP or DBP, but only 53% of training directors currently reported having sufficient faculty to do so. Some training directors reported already having advanced behavioral and mental health training programs for NPs (31%) and most (82%) would consider expanding, if funded. CONCLUSIONS: There is support for advanced training for NPs, but funding is needed to make this a reality. IMPLICATIONS FOR PRACTICE: Expansion of such programs might rapidly improve accessibility and reduce waiting time of mental health providers for children and adolescents.

A Health-Related Quality of Life Measure for Older Adolescents With Asthma: Child Health Survey for Asthma-T (Teen Version).

BACKGROUND: Although adolescent substance use can have direct effects on asthma symptoms and interact with medications used to treat asthma, no validated health-related quality of life (HRQL) instrument exists for adolescents 17 to 19 years of age with asthma. PURPOSE: The American Academy of Pediatric's HRQL instrument, the Child Health Survey for Asthma (CHSA)-Child version, was modified with a substance use subscale to address outcomes specific to adolescents ages 17 to 19 years with asthma. METHODS: Two cohorts (N = 70) were recruited for instrument testing at pediatric primary care practices and two university clinics. A small methodological study with 24 adolescents was conducted to obtain initial support of the psychometric properties for the CHSA-Teen version at baseline, day 14, and day 16. A follow-up study included 46 teens to provide further support. RESULTS: The psychometric properties of the CHSA-Teen version were good and comparable with the CHSA-Child version for feasibility, reliability, and validity. CONCLUSIONS: Health care providers need to be aware of each adolescent's substance use to personalize counseling related to asthma medications.

Managing asthma during pregnancy.

PURPOSE: Pregnant women with asthma have many concerns about their respiratory health, as well as the health of their baby. A woman's respiratory system experiences many physiological changes during pregnancy and when a diagnosis of asthma is present, the clinical effect of pregnancy on asthma is variable. Regardless of disease years, when asthma patients become pregnant, both patients and healthcare providers want to know how pregnancy affects asthma and how asthma may affect pregnancy outcomes. This article will review how to optimally manage asthma during pregnancy using an evidence-based approach that recognizes the patient's changing needs. DATA SOURCES: Literature collected from sources identified through searches of PubMed and CINAHL covering the periods from 1996 to 2012. CONCLUSION: With the implementation of evidence-based management and treatment, pregnant patients who have asthma can be positioned to better control their symptoms and avoid unwanted complications that may affect the health of their baby. IMPLICATIONS FOR PRACTICE: Pregnant patients with asthma may be cared for in a variety of healthcare settings ranging from primary care to specialty care to the emergency department. Consequently, it is imperative that healthcare providers across the array of clinical venues be proficient on how to optimize the asthma outcomes of their pregnant patients.

National Asthma Education Prevention Program: survey of nurse practitioners' knowledge, attitudes, and behaviors.

INTRODUCTION: Much has been written regarding poor physician adherence to the National Asthma Education, Prevention Program (NAEPP) guidelines, but no data are available regarding nurse practitioners (NP) adherence. This descriptive study compared NP adherence to figures reported for medical doctors (MDs) in the 2001 and 2007 analyses by Cabana and colleagues. METHOD: A national, cross-sectional survey approach was used to assess NP knowledge, attitudes, and behaviors regarding the NAEPP guidelines. The survey was adapted from Cabana's 48-item questionnaire. RESULTS: NPs provided more prescriptions of inhaled corticosteroids (ICSs) to patients with daily symptoms than did physicians (NPs, 79%; MDs, 54%). Overall, compared with MDs, NPs reported higher adherence on three of the four NAEPP guideline components surveyed, two of which were statistically significant. DISCUSSION: This survey suggests that NPs have greater adherence to prescribing ICSs than do MDs. However, improved adherence still needs to be a goal for all providers because prescription of ICSs is the cornerstone of management of persistent asthma.

A substance use decision aid for medically at-risk adolescents: results of a randomized controlled trial for cancer-surviving adolescents.

BACKGROUND: Adolescent survivors of childhood cancer engage in risky behaviors. OBJECTIVE: This study tested a decision aid for cancer-surviving adolescents aimed at difficult decisions related to engaging in substance use behaviors. METHODS: This randomized controlled trial recruited 243 teen survivors at 3 cancer centers. The cognitive-behavioral skills program focused on decision making and substance use within the context of past treatment. Effects at 6 and 12 months were examined for decision making, risk motivation, and substance use behaviors using linear regression models. RESULTS: The majority of the teen cancer survivors (90%) rated the program as positive. There was an intermediate effect at 6 months for change in risk motivation for low riskers, but this effect was not sustained at 12 months. For quality decision making, there was no significant effect between treatment groups for either time point. CONCLUSIONS: The overall program effects were modest. Once teen survivors are in the program and learn what quality decision making is, their written reports indicated adjustment in their perception of their decision-making ability; thus, a more diagnostic baseline decision-making measure and a more intensive intervention are needed in the last 6 months. With 2 of 3 teen participants dealing with cognitive difficulties, the data suggest that this type of intervention will continue to be challenging, especially when 90% of their household members and 56% of their close friends model substance use. IMPLICATIONS FOR PRACTICE: This effectiveness trial using late-effects clinics provides recommendations for further program development for medically at-risk adolescents, particularly ones with cognitive difficulties.

An intervention to change clinician behavior: Conceptual framework for the multicolored simplified asthma guideline reminder (MSAGR).

Clinical practice guidelines decrease variation in health care because they standardize the care offered by healthcare providers. Seventeen years after publication, the National Asthma Education and Prevention Program (NAEPP) guidelines are considered the "gold standard" in asthma care, yet they remain underutilized despite three revisions with the latest in July 2007. Multiple factors are presented for lack of adherence to the guidelines. This article discusses the Multicolored, Simplified Asthma Guideline Reminder (MSAGR), an algorithm chart intervention for helping change clinicians' behavior for better adherence to the NAEPP guidelines, and describes the conceptual framework underpinning this intervention as a means of predicting better outcomes for providers and children.