Julee Waldrop

Pharmacologic Treatment for the Core Deficits and Associated Symptoms of Autism in Children

Autism is a neurodevelopmental condition affecting 1 out of 160 children in the United States today. Only risperidone has Food and Drug Administration approval for the pharmacologic management of autism in children. However, health care providers may prescribe other drugs used off-label to assist autistic children and their families with the core deficits and associated behaviors of this condition. Evidence for the use of these medications will be discussed in this continuing education offering. Meta analyses, randomized clinical trials, and other prospective experimental studies of pharmacotherapy conducted in the United States in the past 10 years in children between the ages of 5 and 15 years were reviewed. The results support moderate success in treating the associated behaviors of autism and minimal success in treating core deficits across all drug classes. Preliminary evidence demonstrates possible uses for atypical antipsychotic agents, selective-serotonin reuptake inhibitors, stimulants, and N-methyl-D-aspirate receptor antagonists in decreasing the core behaviors and associated symptoms of autism. More studies and longer periods of follow-up are needed before definitive guidelines can be suggested.

Review of the Evidence for Treatment of Children with Autism with Selective Serotonin Reuptake Inhibitors

PURPOSE To review the potential role of serotonin dysregulation in autism and the efficacy of selective serotonin reuptake inhibitors (SSRIs) in treating core deficits and associated symptoms of autism in children. The literature was searched for reports of SSRI use in children with autism. Data are presented from prospective clinical trials that evaluated treatment outcomes. CONCLUSIONS Some SSRIs show moderate success in managing specific behaviors. Only fluoxetine shows evidence of decreasing global autism severity. PRACTICE IMPLICATION Definitive conclusions concerning selection criteria, dosage, safety, and efficacy cannot be drawn given the current state of evidence.

Exploration of reasons for feeding choices in Hispanic mothers.

Purpose:To explore factors that contribute to feeding choices Hispanic women make for their newborn infants in the immediate postpartum period, with a focus on the phenomenon of “los dos,” breastfeeding with formula supplementation. Study Design and Methods:A descriptive qualitative design that utilized a semistructured interview guide with open-ended questions was used. Qualitative data preparation and analysis methods were used to identify themes surrounding feeding choices. The sample included 19 women within 48 hours of giving birth who self-identified as Spanish speakers. Results:Reasons included 1) previous experience; 2) “no llora con hambre” (no crying for hunger); 3) “para salud” (for health); and 4) to prevent suffering that might occur when the mother and infant were separated while the mother worked “no quiero que sufra mientras trabajo.” Clinical Implications:Discussion of infant feeding choices should occur prior to birth since many mothers decide on feeding method while still pregnant. At the first prenatal visit identification of preference should occur to include not just breast or formula, but also asking about “los dos.” Educational interventions that directly address the “los dos” feeding practice should be culturally appropriate, evaluated and disseminated for use in the prenatal period. Influential family members should be included in prenatal visits and educational sessions to help assure that the woman is not receiving mixed messages at home. Assessment of the workplace environment should also occur during the prenatal period with an exploration of how pumping and storing of breast milk might be possible once women return to work after the babys birth.

Guideline-Based Educational Intervention to Decrease the Risk for Readmission of Newborns With Severe Hyperbilirubinemia

INTRODUCTION The purpose of this study was to determine if educational intervention with medical providers in combination with a management tool to facilitate clinical guideline usage would (a) increase quality of care, (b) increase compliance with published guidelines, and (c) decrease hospital readmissions as a result of hyperbilirubinemia in the first week of life. METHOD A quality improvement initiative was undertaken with a preintervention/postintervention design. INTERVENTION An educational intervention was offered to persons who provide medical care to newborns. The charts of newborns were reviewed before and after the intervention in three samples: a care quality sample (N = 244), a compliance sample (N = 240), and a readmission sample. RESULTS In the quality care sample, documentation of three quality care indicators improved significantly and one worsened significantly. In the compliance sample, the percentage of infants who were given appropriate follow-up appointments in primary care based on their hyperbilirubinemia risk at discharge improved (p = .03), and the readmission rate of newborns within the first week of life as a result of hyperbilirubinemia decreased by 50%. DISCUSSION An educational intervention with a clinical tool may help change provider practice. Longer follow-up is needed to determine if the impact is sustainable.

Twitter: An Application to Encourage Information Seeking Among Nursing Students.

Twitter is a social networking application that has seen limited evaluation in nursing education. The aim of this study was to determine if Twitter could be used to stimulate further exploration about current clinical and professional topics with nurse practitioner students. The students used Twitter to receive tweets on clinical and professional topics from the instructor throughout the semester: 75% demonstrated willingness to follow the links in the tweets to seek more information, and 87% expressed a desire to receive the tweets even after the semester was over.

People Live Here: Maternal and Child Health on Isla Isabela, Galapagos

There has been little written about the health of the people who live in the Galapagos Islands. The goal of this study was to better understand the health concerns of women with children less than 5 years of age on Isabela Island, one of the populated islands. Multiple sources of data were collected for this study including in-depth interviews with 20 mothers. Health-related concerns included limited access to specialty care and emergency medical services, which necessitated leaving the island for many healthcare needs including childbirth; lack of a variety and sometimes a scarcity of fresh produce and therefore increased reliance on processed foods with a long shelf life; and concerns about infections caused by contaminated water and the lack of fresh drinking water. Overweight and obesity were common among the women, many of whom preferred a smaller body size. In contrast, many of their children were also at risk for or were already overweight or obese, yet their mothers still preferred a larger body size for them. Despite these concerns, most of the women appreciated the positives of living on Isabela Island, such as its tranquility, its perceived safety for their children and the opportunity for employment and higher income.

Pediatric overweight or obesity: Does the label really matter?

PurposeTo discuss the issue of early identification of overweight and obesity in infants and young children and provide some clinical recommendations based on the current evidence and the World Health Organizations (WHO) newly released guidelines for growth and development. Data sourcesComparison of the growth charts from the WHO and the Centers for Disease Control as well as current literature. ConclusionsAlthough healthcare providers and the general public recognize overweight and obesity as serious problems, there is still disagreement on what constitutes obesity in infants and young children and when and how to intervene. More research on interventions and outcomes is particularly needed. Implications for practiceThe primary care provider deals with the sequelae of obesity on a daily basis. Some recommendations are provided for nurse practitioners who care for infants and children based on current evidence and expert opinion.

Developing a Postpartum Depression Screening and Referral Procedure in Pediatric Primary Care

INTRODUCTION Postpartum depression affects approximately 10% to 20% of mothers and impairs a mothers ability to engage with her child at an emotional and cognitive level, placing the child at greater risk for impaired development. Early diagnosis and management can reduce its negative impacts. Despite mothers being receptive to screening, screening rates are less than 50%. METHODS This article provides an appraisal of the current state of the evidence on implementing screening for postpartum depression in pediatric primary care. It describes how to use a clinical decision support algorithm for screening and follow-up and the process of developing an accompanying referral/resource list. RESULTS Evidence supports the use of clinical decision support algorithm and the need for having local resources and referrals available at the point of care. DISCUSSION Screening for postpartum depression in the pediatric primary care setting is feasible and can be adapted to the local setting.

Fit living in progress--fighting lifelong obesity patterns (FLIP-FLOP): A nurse practitioner delivered intervention.

PURPOSE To evaluate the feasibility and outcomes of a nurse practitioner (NP) delivered program, which targets obesity, in a real-world primary care setting. METHOD A small, descriptive study was conducted in a clinic for low-income patients. Sixteen adult participants, who are obese, attended 5 individual primary care office visits, occurring every 2 weeks over 12-weeks. The NP healthcare provider delivered pre-planned behavioral interventions at each visit. Data comprised the Health Promoting Lifestyle Profile II (HPLP II), additional surveys and physical measures. RESULTS Participants reported improvement in health responsibility, physical activity, nutrition, spiritual growth, stress management and motivation for healthy living (p<0.05). Diastolic blood pressure declined (p<0.05). Systolic blood pressure and body mass index declined non-significantly. CONCLUSION Additional research is necessary to determine success of the program over time with larger numbers of diverse participants, healthcare providers and primary care practice sites.

The safety advantages of pentavalent vaccines.

AbstractThe ever-growing vaccination schedule can cause patients, parents, and nurse practitioners undue concern. Combination vaccines may provide an answer. This integrative review demonstrates that pentavalent vaccines offer adequate immunity, are well tolerated, and safe when compared to vaccines administered separately.