Tina Haney

Twenty-One Years of Experience With Minimally Invasive Repair of Pectus Excavatum by the Nuss Procedure in 1215 Patients

Objective: To review the technical improvements and changes in management that have occurred over 21 years, which have made the minimally invasive repair of pectus excavatum safer and more successful. Summary Background Data: In 1997, we reported our 10-year experience with a new minimally invasive technique for surgical correction of pectus excavatum in 42 children. Since then, we have treated an additional 1173 patients, and in this report, we summarize the technical modifications which have made the repair safer and more successful. Methods: From January 1987 to December 2008, we evaluated 2378 pectus excavatum patients. We established criteria for surgical intervention, and patients with a clinically and objectively severe deformity were offered surgical correction. The objective criteria used for surgical correction included computed tomography (CT) scans of the chest, resting pulmonary function studies (spirometry and/or plethysmography), and a cardiology evaluation which included echocardiogram and electrocardiogram. Surgery was indicated if the patients were symptomatic, had a severe pectus excavatum on a clinical basis and fulfilled two or more of the following: CT index greater than 3.25, evidence of cardiac or pulmonary compression on CT or echocardiogram, mitral valve prolapse, arrhythmia, or restrictive lung disease. Data regarding evaluation, treatment, and follow up have been prospectively recorded since 1994. Surgical repair was performed in 1215 (51%) of 2378 patients evaluated. Of these, 1123 were primary repairs, and 92 were redo operations. Bars have been removed from 854 patients; 790 after primary repair operations, and 64 after redo operations. Results: The mean Haller CT index was 5.15 ± 2.32 (mean ±SD). Pulmonary function studies performed in 739 patients showed that FVC, FEV1, and FEF25–75 values were decreased by a mean of 15% below predicted value. Mitral valve prolapse was present in 18% (216) of 1215 patients and arrhythmias in 16% (194). Of patients who underwent surgery, 2.8% (35 patients) had genetically confirmed Marfan syndrome and an additional 17.8% (232 patients) had physical features suggestive of Marfan syndrome. Scoliosis was noted in 28% (340). At primary operation, 1 bar was placed in 69% (775 patients), 2 bars in 30% (338), and 3 bars in 0.4% (4). Complications decreased markedly over 21 years. In primary operation patients, the bar displacement rate requiring surgical repositioning decreased from 12% in the first decade to 1% in the second decade. Allergy to nickel was identified in 2.8% (35 patients) of whom 22 identified preoperatively received a titanium bar, 10 patients were treated successfully with prednisone and 3 required bar removal: 2 were switched to a titanium bar, and 1 required no further treatment. Wound infection occurred in 1.4% (17 patients), of whom 4 required surgical drainage (0.4% of the total). Hemothorax occurred in 0.6% (8 patients); 4 during the postoperative period and four occurred late. Postoperative pulmonary function testing has shown significant improvement. A good or excellent anatomic surgical outcome was achieved in 95.8% of patients at the time of bar removal. A fair result occurred in 1.4%, poor in 0.8%, and recurrence of sufficient severity to require reoperation occurred in 11 primary surgical patients (1.4%). Five patients (0.6%) had their bars removed elsewhere. In the 752 patients, more than 1 year post bar removal, the mean time from initial operation to last follow up was 1341 ± 28 days (SEM), and time from bar removal to last follow-up is 854 ± 51 days. Age at operation has shifted from a median age of 6 years (range 1–15) in the original report to 14 years (range 1–31). The minimally invasive procedure has been successfully performed in 253 adult patients aged 18 to 31 years of age. Conclusions: The minimally invasive repair of pectus excavatum has been performed safely and effectively in 1215 patients with a 95.8% good to excellent anatomic result in the primary repairs at our institution.

Telehealth: preparing advanced practice nurses to address healthcare needs in rural and underserved populations.

Abstract Healthcare is being confronted with questions on how to deliver quality, affordable, and timely care to patients, especially those in rural areas, in systems already burdened by the lack of providers. Advanced Practice Registered Nurses (APRNs) have been challenged to lead this movement in providing care to these populations through the use of technologies, specifically telehealth. Unfortunately, APRNs have limited exposure to telehealth during their educational experience, thereby limiting their understanding and comfort with telehealth. To address this problem, a telehealth program was developed at a large university that prepares Doctor of Nursing Practice (DNP) APRN students. The telehealth program, embedded into the DNP curriculum, consisted of a simulation workshop, practice immersion, and written project. This program was well received by students, making them aware of the benefits and barriers to the implementation of telehealth as a care delivery modality. Telehealth was embraced as students implemented the program in their own practices.

Educating Advanced Practice Nurses in Using Social Media in Rural Health Care

Health care in the United States is facing a crisis in providing access to quality care for those in underserved and rural regions. Advanced practice nurses are at the forefront of addressing such issues, through modalities such as health care technology. Many nursing education programs are seeking strategies for better educating students on technology utilization. Health care technology includes electronic health records, telemedicine, and clinical decision support systems. However, little focus has been placed on the role of social media in health care. This paper describes an educational workshop using standardized patients and hands-on experiences to introduce advanced practice nurses in a Doctor of Nursing Practice program to the role of social media in addressing issues inherent in the delivery of rural health care. The students explore innovative approaches for utilizing social media for patient and caregiver support as well as identify online resources that assist providers in a rural setting.

A pilot study using electronic communication in home healthcare: implications on parental well-being and satisfaction caring for medically fragile children.

The aim of this study was to explore the impact of a nurse-established and nurse-managed electronic communication in the form of e-mail on the self-reported well-being and satisfaction of parents caring for medically fragile and technologically dependent children. This study was conducted in a pediatric home care agency located in the southeastern region of the United States. Nineteen parents and caregivers participated in a 3-month intervention. A quasiexperimental pre- and posttest design was used. There were no significant differences in pre- and postintervention parental self-reported well-being (p < .227) or satisfaction (p < .528). Parental qualitative comments suggest positive outcomes related to well-being and satisfaction. Further investigation into the utility of e-mail communication with parents of medically fragile and technologically dependent children cared for at home is warranted.

Telehealth and eHealth in Nurse Practitioner Training: Current Perspectives

Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care.

How to Prepare Interprofessional Teams in Two Weeks: An Innovative Education Program Nested in Telehealth

Abstract Problem: Preparing health professional students for interprofessional collaborative practice, especially at a distance where provider shortages prevail remains difficult. Approach: A two-week interprofessional education (IPE) immersion experience preparing students from 11 disciplines and four universities was implemented. Week-one, using online technology, students develop/present an interprofessional careplan for a complex patient. Students then meet face-to-face to conduct group interviews with two standardized patient dyads. Week-two, students develop a website for use of the patient dyads. Websites are presented to faculty and fellow students via an online virtual meeting space. Outcomes: To date, 594 students have participated demonstrating capacity to: 1.effectively engage in interprofessional care,  2. utilize Telehealth to impact care and break down barriers of isolation, and 3. implement skills to advance healthcare. Conclusion: IPE combined with Telehealth technology provides future providers with knowledge and skills for interprofessional care regardless of geographic barriers. Next Step: Integrate more technology using mobile devices and enhance the evaluation process.

Helping Dementia Caregivers Through Technology.

It is estimated there are between 43.5 and 65.7 million caregivers in the United States who provide unpaid care for older adults. Although the number of informal caregivers is expected to continue to increase, few programs have been established in home healthcare agencies to support these caregivers. This article describes a project that used a unique Web site to connect caregivers of people with dementia in a geographic region with an interprofessional group of healthcare providers and caregiver peers. Virtual Healthcare Neighborhood (VHN) was developed and maintained by an interprofessional group of healthcare providers from nursing, physical therapy, clinical counseling, and dental hygiene. The VHN provided weekly information on topics relevant to caring for a loved one with dementia at home as well as Question and Answer and Social Support Blogging sections for use by participants. This project was viewed as a positive and helpful method to provide support for caregivers of homebound older adults that could be easily replicated by home healthcare agencies.

Telehealth etiquette in home healthcare: the key to a successful visit.

The use of telehealth by home healthcare agencies is growing. It has been shown to reduce rehospitalizations by up to 62%, reduce costs, and increase efficiency. Due to the use of telehealth technology, new and unique rules of etiquette must be followed to make both the patient and clinician comfortable and satisfied with the process. Little literature exists regarding telehealth etiquette. This article explores the techniques and methods that home care clinicians should utilize to assure that the telehealth experience is positive and effective. After providing a less successful scenario, steps for success are outlined and a suggested successful conclusion is provided for the scenario. Home care agencies will benefit greatly from expanding their ability to visit patients in different ways. Simple steps need to be taken to assure successful visits that follow the rules for assuring patient comfort, autonomy, and protection.

Sleep problems in children: an overlooked factor in evaluating behavior.

Sleep disturbance is a problem for many children; however, it remains an underevaluated factor when assessing behavior. The purpose of the current article is to explore sleep problems in children, as well as the effects that disrupted sleep patterns have on child behavior. The authors recommend strategies to guide the assessment of sleep and improve childrens sleep quality.

The APN-PLACE Telehealth Education Network: Legal and Regulatory Considerations

Telehealth technology can enhance nursing clinical education by allowing for virtual site visits, preceptor support, preceptor education, and student oversight. The Advance Practice Nurse-Preceptor Link and Clinical Education (APN-PLACE) Telehealth Education Network is a new and innovative video communication system that connects schools of nursing to preceptors and clinical practice sites. Specific areas of focus include preceptor education and support, student assessment, and clinical experiences when implementing a telehealth education network. As with in-person, or traditional, clinical education, it is important to consider the legal and regulatory issues related to the use of telehealth programs in clinical education. This article presents a telehealth preceptor support network and provides an overview of the associated legal and regulatory issues surrounding its use in advanced practice registered nurse clinical education.