Stephen R. Gillaspy

An Intervention to Decrease Uncertainty and Distress Among Parents of Children Newly Diagnosed With Diabetes: A Pilot Study

This pilot study reports findings from a randomized clinical trial of a novel intervention for parents of children newly diagnosed with Type 1 diabetes. The intervention was designed to decrease parental uncertainty and distress as well as child behavioral problems by teaching parents skills to manage uncertainty. Thirty-four families were randomly assigned to either an intervention (IG) or a treatment as usual (TAU) group. Parents completed measures of distress, uncertainty, and child behavior problems at baseline, 1 month, and 6 months postintervention. In the IG, significant reductions were observed for maternal and paternal distress as well as maternal ratings of child behavior problems. No changes were observed for the TAU, except for father-reported reductions in child internalizing symptoms at 1 month postintervention. Preliminary data suggest that, with further development and testing, the intervention has potential to be an effective tool to reduce paternal distress and possibly child behavior problems.

Psychological effects of dance‐based group exergaming in obese adolescents

In order to attract obese adolescents who are often reluctant to engage in traditional exercise, new forms of physical activity are needed.

Encouraging physicians to respond to surveys through the use of fax technology.

High response rates to surveys of physicians are difficult to achieve. One possible strategy to improve physicians’ survey participation is to offer the option of receiving and returning the survey by fax. This study describes the success of the option of fax communication in a survey of general practitioners, family physicians, and pediatricians in Arkansas with regard to pediatric asthma. Eligible physicians were given the choice of receiving the survey by telephone, mail, or fax. In this observational study, physicians’ preferences, response rates, and biases for surveys administered by fax were compared with mail and telephone surveys. The overall survey response rate was 59%. For the 96 physicians completing an eligibility screener survey, the largest percentage requested to be surveyed by fax (47%) rather than by telephone (28%) or mail (25%). Faxing may be one strategy to add to the arsenal of tools to increase response rates in surveying physicians.

Parental Emotional and Time Costs Predict Compliance With Respiratory Syncytial Virus Prophylaxis

BACKGROUND Two agents are effective in preventing respiratory syncytial virus (RSV) hospitalization in premature infants: RSV immune globulin (RSV-IG) and palivizumab. RSV-IG is associated with greater parental emotional and time costs, which may account for the more limited adherence to recommended monthly treatment with this agent. OBJECTIVES To compare the emotional distress and time costs associated with RSV-IG and palivizumab treatments and to determine the influence of these costs on treatment adherence. METHODS We surveyed parents of 82 infants who received RSV-IG (90% of eligible) and parents of 61 infants who received palivizumab (87% of eligible) at Arkansas Childrens Hospital by telephone. We measured infant distress during treatment, parental distress, parental time costs, and adherence with recommended monthly prophylaxis. RESULTS Half of parents of RSV-IG recipients witnessed their infant in distress during infusion, over half (61%) were upset by observing the needle stick, and 22% observed infusion in the scalp. Fewer than 5% of parents of palivizumab recipients observed their infant in distress or were themselves distressed during treatment. A quarter of parents took time off from work for RSV-IG or palivizumab treatment. RSV-IG recipients completed 62% of recommended monthly treatments compared with 86% completed by palivizumab recipients. Increased parental distress and time costs largely accounted for the reduction in adherence to monthly treatment among RSV-IG recipients. CONCLUSIONS The emotional and time costs of RSV-IG treatment far exceed those of palivizumab and predict substantial differences in treatment adherence between the 2 agents. The impact of hidden costs on treatment adherence should be included in economic evaluations of medical procedures.

Parent Perceptions of Illness Uncertainty and Child Depressive Symptoms in Juvenile Rheumatic Diseases: Examining Caregiver Demand and Parent Distress as Mediators

OBJECTIVE Examine caregiver demand and general parent distress as mediators in the parent illness uncertainty-child depressive symptom association in youth with juvenile rheumatic diseases. METHODS Children and adolescents completed the Child Depression Inventory; caregivers completed the Parent Perceptions of Uncertainty Scale, the Care for My Child with Rheumatic Disease Scale, and the Brief Symptom Inventory. The pediatric rheumatologist provided ratings of clinical disease status. RESULTS Analyses revealed significant direct associations between illness uncertainty and caregiver demand, and between caregiver demand and both parent distress and child depressive symptoms. Results also revealed significant parent uncertainty → caregiver demand → parent distress and parent uncertainty → caregiver demand → child depressive symptom indirect paths. CONCLUSIONS Results highlight the role of illness appraisals in adjustment to juvenile rheumatic diseases, and provide preliminary evidence that parent appraisals of illness uncertainty impact parent distress and child depressive symptoms indirectly through increased perceptions of caregiver demand.

Reliability of the postpartum depression screening scale in the neonatal intensive care unit.

Background:Rates of postpartum depression have been found to be significantly higher in mothers of infants in the neonatal intensive care unit (NICU) than the general population estimate of 10%–15%, making routine screening for these mothers essential. Objectives:The aim of this study was to examine the reliability (internal consistency) and construct validity of the Postpartum Depression Screening Scale with a sample of mothers of infants in the NICU. Methods:A total of 111 (40% of eligible) mothers participated in the study. Mothers completed a brief demographic questionnaire and the screening scale at 14 or greater days postpartum. Estimates of internal consistency were evaluated using Cronbach’s coefficient alpha. Results:On the basis of the scale total score, 52% of mothers had a positive screen and an additional 30% received a score indicating that they were at-risk. Reliability estimates were consistent with previous research and indicate excellent internal consistency for the total score and adequate to good internal reliability for subscales scores. The coefficient alpha for total score equaled .95, and alpha for subscale scores ranged from .72 (Anxiety/Insecurity) to .89 (Suicidal Thoughts). Interscale correlations were consistently lower than subscale reliability estimates (coefficient alpha) and were lower than subscale-to-total score correlations, suggesting initial support for the proposed structure of the scale for mothers in the NICU. Discussion:Most of this sample of mothers experienced significant symptoms of postpartum depression. The Postpartum Depression Screening Scale is a promising tool for screening mothers with infants in the NICU. Additional research is necessary to better understand the construct and predictive validity of scores among these mothers. Current and future research will contribute to the routine use of scale as a screening tool in this environment.

Postpartum depression screening in the Neonatal Intensive Care Unit: program development, implementation, and lessons learned

Objective The aims of this project were to describe the development of a postpartum depression screening program for mothers of infants in the Neonatal Intensive Care Unit and assess the implementation of the screening program. Methods Screening began at 14 days postpartum and was implemented as part of routine medical care. A nurse coordinator facilitated communication with mothers for increasing screen completion, review of critical self-harm items, and making mental health referrals. During the 18-month study period, 385 out of 793 eligible mothers completed the screen. Results Approximately 36% of mothers had a positive screen that resulted in a mental health referral and an additional 30% of mothers had screening results indicating significant symptoms. Conclusion Several barriers were identified, leading to adjustments in the screening process, and ultimately recommendations for future screening programs and research. Development of a postpartum depression screening process in the Neonatal Intensive Care Unit involves support, training, implementation, and coordination from administrators, medical staff, new mothers, and mental health specialists. Several predictable challenges to program development require ongoing assessment and response to these challenges. Relevance This study highlights the expanding role of the psychologist and behavioral health providers in health care to intervene as early as possible in the life of a child and family with medical complications through multidisciplinary program development and implementation, as well as key considerations for institutions initiating such a program.

Influence of a Systems-Based Approach to Prescribing Errors in a Pediatric Resident Clinic

OBJECTIVE To measure the difference in prescribing error rates between 2 clinics, 1 with a system in place to reduce errors and 1 with no such system; to determine variables that affect the likelihood of prescription errors. METHODS This was a retrospective study at 2 university-based general pediatric clinics utilizing the same electronic medical record (EMR) system. Clinic 1 employed pharmacists who provided daily prescription review, provider feedback and education, and EMR customization to decrease errors. Clinic 2 had no systems in place for reducing prescribing errors. Prescriptions written by resident physicians over 2 months were identified and reviewed. RESULTS A total of 1361 prescriptions were reviewed, 40.7% from clinic 1 and 59.3% from clinic 2. Errors were found in 201 prescriptions (14.8%). Clinics 1 and 2 had error rates of 11% and 17.5%, respectively (P = .0012). The odds of a prescription error at clinic 2 were 1.7 times the odds of a prescription error at clinic 1. Logistic regression identified clinic, nonpediatric resident, liquid dose forms, and younger patient age as significant predictors of prescription errors. Half of the errors could have been prevented with consistent use of a custom medication list within the EMR. CONCLUSIONS We found 37% fewer prescribing errors in a clinic with systems in place for prescribing error detection and prevention. Pediatric clinics should explore systematic procedures for identifying, resolving, and providing education about prescribing errors to reduce patient risk.

Barriers to Care, Illness Intrusiveness, and Depressive Symptoms in Youth with Juvenile Rheumatic Diseases

The role of illness intrusiveness in the barriers to care → depressive symptom association in youth with juvenile rheumatic diseases (JRDs) was examined. Sixty-six youth completed the Child Depression Inventory and the Illness Intrusiveness Scale-Child; parents completed the Barriers to Care Questionnaire and the Illness Intrusiveness Scale-Parent. Healthcare barriers and parent illness intrusiveness had direct effects on child illness intrusiveness, which was subsequently associated with youth depressive symptoms. Child illness intrusiveness mediated the barriers to care → depressive symptom association, particularly under conditions of low parent illness intrusiveness. Findings suggest that parent appraisals directly influence child illness appraisals related to adjustment outcomes. Healthcare barriers contribute to youth outcomes in the absence of maladaptive parent illness perceptions.

Patient referrals to a multispecialty asthma clinic

A total of 656 patients with asthma have been referred to a multispecialty pediatric asthma clinic for evaluation; 52 (7.9%): mild; 406 (61.9%): moderate; 177 (27%): severe; and 21 (3.2%): incomplete data. No significant differences in demographics or payer source were observed across disease severity levels. Only 25% of the patients with primary care providers were referred by these practitioners. Over 20% of the mild asthmatics were using inhaled bronchodilators regularly. Only 40% and 50% of the moderate and severe asthmatics, respectively, were using inhaled bronchodilators regularly, and only 19% and 36%, respectively, were on maintenance inhaled corticosteroids. Pressures to reduce subspecialty services may place some of these asthma patients at increased risk for complications from this chronic lung disease.