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Pavlik Harness Treatment May Not Be Necessary for All Newborns With Ultrasonic Hip Dysplasia
CI 2.14-2.48) reported suicidal ideation, and 9.3% (N=416; AOR 3.24, 95% CI 2.91-3.60) reported at least one suicide attempt within the last 12 months. Developmental assets decreased the odds of these outcomes for all youth, but were less protective for homeless youth than non-homeless youth. Conclusion: Youth who have been homeless with their families during the past year are at significantly higher risk of suicidality than their non-homeless peers. Internal and external factors that protect against suicidality are somewhat less impactful among youth who have experienced family homelessness, implicating family homelessness as a marker of extreme risk during adolescence. Future research among this group should take broader ecological factors into account, ideally in a longitudinal manner. Preventive interventions among homeless youth may need to not only promote developmental assets but also address the need for stable housing and the mitigation of extreme psychosocial risk.
Pavlik Harness Treatment May Not Be Necessary for All Newborns With Ultrasonic Hip Dysplasia Erica Flores, MSN, RN, CPNP-PC, AC, Harry K. W. Kim, MD, MS, Terri Beckwith, MPH, CPH, Augusta Lloyd, MS, Adriana De La Rocha, MS, Lauren Paraison, BA, ChanHee Jo, PhD, & Daniel J. Sucato, MD, MS Category/Date: Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Health Promotion and Disease Prevention, Presented at NAPNAPÕs 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA Purpose: Currently, there is no clear practice guideline for management of newborns with ultrasonic hip dysplasia (UHD), defined as having a normal hip exam and an alpha angle <55 degrees. As a result, some physicians routinely treat with Pavlik harness (PH) while others observe. The purpose of this study was to assess the treatment patterns of 8 pediatric orthopedic surgeons for UHD at a tertiary referral center and to determine the outcomes of 304
Volume 30 Number 4
patients managed with a PH or observation (OB) at a 2 year follow-up. Background: Developmental dysplasia of the hip (DDH) represents a spectrum of hip instability ranging from stable hip with UHD to unstable, dislocatable or dislocated hip. In infants less than 6 months of age with dislocatable or dislocated hip, PH treatment has become one of the treatment choices for this age group of patients. PH treatment has been shown to improve hip stability and acetabular development with a low risk of complications. While there is evidence in the literature that supports the initiation of PH treatment for hips with clinical instability, the optimal treatment for infants with a clinically stable hip with UHD remains unclear. Methods: This is a prospective study of 1,152 babies referred for DDH. Infants # 6 weeks of age at presentation were included. Diagnostic criteria for stable UHD were normal hip exam with alpha angle <55 and head coverage $10%. Acetabular indices were determined by 2 observers at 2 year follow-up. Statistical analyses included intraclass correlation coefficient, t-test, and logistic regression. Results: 79 patients (114 hips) met the inclusion criteria. The mean age at presentation was 2.61.3 weeks. The mean age at first ultrasound was 5.5 1.6 weeks. Fifty-four hips were treated with PH while 60 hips were observed. Of the 8 surgeons, 3 treated almost all patients with PH. Five surgeons treated some patients with PH and some by observation. The mean alpha angle and the mean head coverage were significantly lower in the PH compared to the OB group (p=0.014 and p<0.001). Logistic regression analysis revealed that a lower head coverage had a significant influence on the treatment decision for PH vs. OB (OR=0.91, 95% CI: 0.86-0.96) whereas the alpha angle did not. At 2 year follow-up, no significant difference in the rate of acetabular dysplasia was observed between the 2 groups by observer 1 (OB 9% vs PH 9%) and observer 2 (OB 9% vs PH 3%, p=0.61). The PH group had significantly greater numbers of sonograms (p=0.002) and clinic visits (p<0.001) compared to the OB group. Conclusions: Even in one center, treatment patterns for stable UHD varied considerably. Ninety-one percent of the OB group had a good outcome at 2 year follow-up, suggesting that not all patients with stable UHD need PH treatment. Clinical Implications: Results suggest that not all patients with UHD need to be treated. Longer follow-up Journal of Pediatric Health Care
and further studies are needed to develop specific treatment guideline and criteria for UHD.
The Development and Validation of a Tool to Assess the Acuity of Children Receiving Home-Based/ Community Palliative Care Linda Del Vecchio-Gilbert, DNP, CPNP-PC, ACHPN, CPON Category/Date: Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Health Promotion and Disease Prevention, Presented at NAPNAPÕs 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA Purpose: To develop and validate a tool to assess the acuity of children receiving home-based/community palliative care. Background: Each year in the United States, there are more than 500,000 children living every day with a chronic, life-threatening condition who require compassionate, comprehensive, consistent, and coordinated palliative care, supporting both curative and comfort measures. However, many of these children do not receive palliative care services. If they do, there is a paucity of data and information guiding the clinicians with the development of a plan of care (POC) to meet the level of acuity for patientÕs and familyÕs needs. Methods: The authors conducted a literature review on acuity tools in pediatric palliative care as well as the domains of pediatric palliative care. The authors developed the instructions, which included the three levels of acuity, prompting questions for each domain, and the tool. The tool addressed each domain needs– emotional, social, and physiological. Within each domain, specific categories were scored according to a Likert Scale a score of 1-5 (1 = Strongly Disagree to 5 = Strongly Agree).
www.jpedhc.org
To assess content validity of the tool, both the instructions and tool were reviewed by a panel of nine experts in pediatrics and pediatric palliative care (e.g., social work, child life therapy, and nursing), as well as two parents whose children have died. The experts reviewed the tool specifications and the selection of items to ensure the content validity of the survey. Both instructions and tool were sent to each expert reviewer with a content validity index (CVI) score sheet. The content validity reviewers evaluated all items on each survey, rating each item a score on a Likert Scale of 15 (1 = Strongly Disagree to 5 = Strongly Agree). Based on the expert reviewersÕ feedback regarding the content, the surveys were modified. To assess face validity, six reviewers from various disciplines (e.g., social work, child life therapy, and nursing) provided feedback on the readability and clarity of the instructions and tool and ensured that the items are a good measure of assessing acuity of children receiving home-based/community palliative care Results: The face validity indicated that the instructions and tool appeared to measure what it is supposed to be measuring and to be valid to the participants who would be completing the survey. The survey was determined to be 100% clear and readable. The content validity indicated that the items in the instructions and tool adequately reflected the content domain being measured. The overall content validity index (CVI) score for the instructions and tool was 93% (0.928). Six items were revised since the CVI for each item was < 0.8. All other items were rated strongly agree to agree and with no significant discrepancies among reviewers. Conclusion: The tool was validated with overall significant content and face validity. Practice Implications: The purpose of the Pedi Pals Acuity Tool is to assist the team (i.e. Social Worker, Child Life Therapist, Registered Nurse) in the development of a plan of care (POC) to meet the level of acuity for patientÕs and familyÕs needs. Members of the interdisciplinary team - social workers, child life specialists, nurses, nurse practitioners, and physicians, can utilize this tool.
July/August 2016
305
Pavlik Harness Treatment May Not Be Necessary for All Newborns With Ultrasonic Hip Dysplasia Erica Flores, MSN, RN, CPNP-PC, AC, Harry K. W. Kim, MD, MS, Terri Beckwith, MPH, CPH, Augusta Lloyd, MS, Adriana De La Rocha, MS, Lauren Paraison, BA, ChanHee Jo, PhD, & Daniel J. Sucato, MD, MS Category/Date: Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Health Promotion and Disease Prevention, Presented at NAPNAPÕs 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA Purpose: Currently, there is no clear practice guideline for management of newborns with ultrasonic hip dysplasia (UHD), defined as having a normal hip exam and an alpha angle <55 degrees. As a result, some physicians routinely treat with Pavlik harness (PH) while others observe. The purpose of this study was to assess the treatment patterns of 8 pediatric orthopedic surgeons for UHD at a tertiary referral center and to determine the outcomes of 304
Volume 30 Number 4
patients managed with a PH or observation (OB) at a 2 year follow-up. Background: Developmental dysplasia of the hip (DDH) represents a spectrum of hip instability ranging from stable hip with UHD to unstable, dislocatable or dislocated hip. In infants less than 6 months of age with dislocatable or dislocated hip, PH treatment has become one of the treatment choices for this age group of patients. PH treatment has been shown to improve hip stability and acetabular development with a low risk of complications. While there is evidence in the literature that supports the initiation of PH treatment for hips with clinical instability, the optimal treatment for infants with a clinically stable hip with UHD remains unclear. Methods: This is a prospective study of 1,152 babies referred for DDH. Infants # 6 weeks of age at presentation were included. Diagnostic criteria for stable UHD were normal hip exam with alpha angle <55 and head coverage $10%. Acetabular indices were determined by 2 observers at 2 year follow-up. Statistical analyses included intraclass correlation coefficient, t-test, and logistic regression. Results: 79 patients (114 hips) met the inclusion criteria. The mean age at presentation was 2.61.3 weeks. The mean age at first ultrasound was 5.5 1.6 weeks. Fifty-four hips were treated with PH while 60 hips were observed. Of the 8 surgeons, 3 treated almost all patients with PH. Five surgeons treated some patients with PH and some by observation. The mean alpha angle and the mean head coverage were significantly lower in the PH compared to the OB group (p=0.014 and p<0.001). Logistic regression analysis revealed that a lower head coverage had a significant influence on the treatment decision for PH vs. OB (OR=0.91, 95% CI: 0.86-0.96) whereas the alpha angle did not. At 2 year follow-up, no significant difference in the rate of acetabular dysplasia was observed between the 2 groups by observer 1 (OB 9% vs PH 9%) and observer 2 (OB 9% vs PH 3%, p=0.61). The PH group had significantly greater numbers of sonograms (p=0.002) and clinic visits (p<0.001) compared to the OB group. Conclusions: Even in one center, treatment patterns for stable UHD varied considerably. Ninety-one percent of the OB group had a good outcome at 2 year follow-up, suggesting that not all patients with stable UHD need PH treatment. Clinical Implications: Results suggest that not all patients with UHD need to be treated. Longer follow-up Journal of Pediatric Health Care
and further studies are needed to develop specific treatment guideline and criteria for UHD.
The Development and Validation of a Tool to Assess the Acuity of Children Receiving Home-Based/ Community Palliative Care Linda Del Vecchio-Gilbert, DNP, CPNP-PC, ACHPN, CPON Category/Date: Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Health Promotion and Disease Prevention, Presented at NAPNAPÕs 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA Purpose: To develop and validate a tool to assess the acuity of children receiving home-based/community palliative care. Background: Each year in the United States, there are more than 500,000 children living every day with a chronic, life-threatening condition who require compassionate, comprehensive, consistent, and coordinated palliative care, supporting both curative and comfort measures. However, many of these children do not receive palliative care services. If they do, there is a paucity of data and information guiding the clinicians with the development of a plan of care (POC) to meet the level of acuity for patientÕs and familyÕs needs. Methods: The authors conducted a literature review on acuity tools in pediatric palliative care as well as the domains of pediatric palliative care. The authors developed the instructions, which included the three levels of acuity, prompting questions for each domain, and the tool. The tool addressed each domain needs– emotional, social, and physiological. Within each domain, specific categories were scored according to a Likert Scale a score of 1-5 (1 = Strongly Disagree to 5 = Strongly Agree).
www.jpedhc.org
To assess content validity of the tool, both the instructions and tool were reviewed by a panel of nine experts in pediatrics and pediatric palliative care (e.g., social work, child life therapy, and nursing), as well as two parents whose children have died. The experts reviewed the tool specifications and the selection of items to ensure the content validity of the survey. Both instructions and tool were sent to each expert reviewer with a content validity index (CVI) score sheet. The content validity reviewers evaluated all items on each survey, rating each item a score on a Likert Scale of 15 (1 = Strongly Disagree to 5 = Strongly Agree). Based on the expert reviewersÕ feedback regarding the content, the surveys were modified. To assess face validity, six reviewers from various disciplines (e.g., social work, child life therapy, and nursing) provided feedback on the readability and clarity of the instructions and tool and ensured that the items are a good measure of assessing acuity of children receiving home-based/community palliative care Results: The face validity indicated that the instructions and tool appeared to measure what it is supposed to be measuring and to be valid to the participants who would be completing the survey. The survey was determined to be 100% clear and readable. The content validity indicated that the items in the instructions and tool adequately reflected the content domain being measured. The overall content validity index (CVI) score for the instructions and tool was 93% (0.928). Six items were revised since the CVI for each item was < 0.8. All other items were rated strongly agree to agree and with no significant discrepancies among reviewers. Conclusion: The tool was validated with overall significant content and face validity. Practice Implications: The purpose of the Pedi Pals Acuity Tool is to assist the team (i.e. Social Worker, Child Life Therapist, Registered Nurse) in the development of a plan of care (POC) to meet the level of acuity for patientÕs and familyÕs needs. Members of the interdisciplinary team - social workers, child life specialists, nurses, nurse practitioners, and physicians, can utilize this tool.
July/August 2016
305