Emily Shaffer-Hudkins

Long-Term Outcomes of Infants with Neonatal Abstinence Syndrome

Abstract Parents of infants with neonatal abstinence syndrome (NAS) in the NICU may have questions about the long-term consequences of prenatal exposure to methadone, both asked and unasked. Although the signs of withdrawal will abate relatively quickly, parents should be aware of potential vision, motor, and behavioral/cognitive problems, as well as sleeping disturbances and ear infections so their infants can be followed closely and monitored by their pediatrician with appropriate referrals made. Furthermore, this knowledge may inspire parents to enroll their infants in an early intervention program to help optimize their outcomes. There are still many unanswered questions about epigenetic consequences, risk for child abuse/neglect, and risk of future substance abuse in this population.

Student and resident perspectives on professionalism: beliefs, challenges, and suggested teaching strategies

Objectives The purpose of this study was to investigate the views of medical students and residents regarding the practice of professionalism, their perceived challenges, and ideas for the development of a new curriculum in medical professionalism. Methods Data were collected from four focus groups comprised of 27 residents and medical students recruited from the University of South Florida Morsani School of Medicine and Residency Programs between January and March 2012. A questioning protocol was used to guide the focus group discussion. Data were transcribed for thematic analysis. Results Learners expressed beliefs regarding key attributes of professional behaviors, factors perceived to be associated with lapses of professional behavior, skills that need to be taught, and strategies to teach professionalism from the learners’ perspective. Learners perceived that the values of professionalism are often disconnected from the reality evidenced in clinical training due to a myriad of personal and contextual challenges. Conclusions Residents and students need help in negotiating some of the challenges to medical professionalism that are encountered in clinical settings. We recommend a learner’s centered model of curriculum development in medical professionalism that takes into consideration perceived challenges and strategies for modeling and reinforcing medical professionalism.

Cultivating Healthy Eating, Exercise, and Relaxation (CHEER): A Case Study of a Family-Centered and Mindfulness-Based Cognitive-Behavioral Intervention for Obese Adolescents at Risk for Diabetes and Cardiovascular Disease

Attrition from weight management programs and difficulty maintaining success are of significant concern for pediatric overweight patients. Patient and family variables associated with completing and maintaining outcomes from a healthy weight program include understanding and buy-in for treatment, parental motivation, and valuing of weight loss to quality of life. Such findings highlight the need for comprehensive intervention that involves family members and addresses motivation and relapse prevention. The present study describes a family-centered and mindfulness-based cognitive-behavioral intervention implemented with a 15-year old, clinically obese male with associated symptoms including elevated blood pressure and sleep apnea. This pilot implementation resulted in improved pre–post outcomes in regard to weight, blood pressure, and health-promoting behaviors. Improvements in healthy lifestyle were maintained 1-year post-treatment. These results add to the growing literature on ecologically relevant intervention for obese adolescents at risk for future health complications. Technical issues and clinical implications related to recruitment and retention are discussed.

Initial development of the Health Literacy and Resiliency Scale: Youth version

Background: Health literacy and resiliency are empirically linked to better adaptation and the ability to thrive in the face of living with a chronic disease. To date, there are limited tools to assess these constructs among youth. The purpose of this study was to develop and validate the Health Literacy and Resiliency Scale: Youth Version (HLRS-Y), a questionnaire designed to tap the current health knowledge and resiliency factors for youth and young adults with chronic health conditions. Method: A multi-step process was used to create and validate the scale. A thorough review of the literature along with findings from focus groups guided initial item development. Items were refined through an expert review process and a pilot study (n = 25). All remaining items were administered to a national sample (n = 204) and responses were analyzed using exploratory factor analysis (EFA). Results: The EFA revealed a three-factor structure: Knowledge, Self-Advocacy/Support, and Resiliency. The finalized scale contained 37 items; 10 items loaded on Knowledge (α = 0.88), 14 items on Self Advocacy/Support (α = 0.94), and 13 items on Resiliency (α = 0.93). Conclusions: The HLRS-Y is the first general measure of health literacy and resiliency for youth and young adults with chronic health conditions. The information gleaned from the scale can be used to empower these individuals to develop health literacy skills, promote social connectedness and optimism, and adapt to living with their condition.

Characteristics of Maternal-Infant Interaction During Treatment for Opioid Withdrawal.

Abstract Purpose: The purpose of this study was to describe the interactions between mothers in a methadone treatment program and their infants during a bottle feeding and compare the findings with normed data. Design: A comparative-descriptive design was used. Sample: Data from 12 opiate-exposed mother–infant dyads were compared with normed data. Main outcome variable: Nursing Child Assessment Satellite-Training Scale scores. Results: The opiate-exposed dyads scored significantly lower than the normed dyads in the infant subscales of clarity of cues (p < .001, 95% confidence interval [CI], 1.56–4.08) and responsiveness to caregiver (p < .01, 95% CI, 0.27–2.5), as well as the total score (p < .001, 95% CI, 2.42–6.15). Parent sensitivity to infant cues subscale (p < .01, 95% CI, 0.42–2.37) and parent contingency score (p < .01, 95% CI, 0.55–3.81) were also significantly lower. The cognitive growth fostering subscale scores were significantly higher in the neonatal abstinence syndrome (NAS) group (p < .01, 95% CI, −2.94 to −0.7).

Attendance and implementation of strategies in a behavioral parent-training program: comparisons between English and Español programs.

Low levels of attendance and implementation of strategies in behavioral parent-training programs may limit their impact. The purpose of this study was to examine attendance and implementation across a behavioral parent-training program delivered in English and Español. Participants included parents (n = 739) of young children who attended a behavioral parent-training program. The mean number of sessions attended for the entire sample was 4.46 (SD = 1.66, range = 1-6) of six sessions, and the mean number of strategies implemented was 17.66 (SD = 11.43, range = 0-35) of a possible 35. There were no significant differences across the number of sessions attended among the participants in the English (M = 4.45) and Español versions (M = 4.48) of the course, t(737) = -0.20, p = .85. There also were no significant differences between the English (M = 17.97) and Español (M = 16.87) versions for the number of Tip Trackers completed, t(737) = 1.18, p = .24. Only child diagnosis predicted parent attendance in the English group. Implications for research and practice are discussed.

Student perceptions of a patient- centered medical training curriculum.

Objectives To evaluate a patient-centered medical training curriculum, the SELECT program, through perceptions of the inaugural student cohort. Methods Data were collected from two focus groups conducted in the university setting, comprised of fifteen first-year medical students who participated in the SELECT program during its inaugural year. A questioning protocol was used to guide the focus group discussion, which was transcribed and hand-coded through thematic analyses. Results Various themes related to patient-centered care were identified. Students noted changes in their attitudes towards interacting with patients in an empowering and educative manner as a result of communication and motivational interviewing exercises. Additionally, they recognized certain external, structural barriers as well as internal conflict between pragmatism and emotional intelligence that could potentially hinder patient-centered care. The impact of family dynamics and social support on quality of life and health outcomes was acknowledged. Students also emphasized the value of collaborating with multiple health professionals. Lastly, students provided suggestions for program improvement, namely additional simulations, more education regarding other healthcare professionals’ roles, more standardized experiences, and application of principles to acute and primary care. Conclusions Upon completion of the first year of the SELECT program, students gained an appreciation for patient-centered care and various factors and skills that facilitate such care. Additionally, they experienced a dissonance between didactic concepts from the curriculum and observed medical practices. This study highlights the educational benefits of a patient-centered medical curriculum and provides suggestions for future improvement.

Feeding Infants with Neonatal Abstinence Syndrome: Finding the Sweet Spot

The purpose of this study is to learn how caregivers who are expert in feeding infants with neonatal abstinence syndrome (NAS) successfully feed these infants during withdrawal. Focus group methodology was used to gather information from self-identified experts from three large regional NICUs. Twelve NICU nurses and speech therapists participated in open-ended, recorded discussions. Detailed flip chart notes were taken, reviewed, and verified by the participants before the group ended. Four major themes emerged verified by the participants: (1) optimal medication management, (2) follow the baby’s cues, (3) calm and comfortable, and (4) nurture the relationship. Participants reported using both common and creative techniques. Keeping the infant calm was crucial to being successful, as well as maintaining good control of withdrawal signs. Feeding the infant facing away from them to avoid eye contact was used, as well as vertical rocking, continuous butt patting, bundling, “shhing” sound, and a novel feeding position.