The Peds NP: Pearls of Pediatric Evidence-Based Practice

Practical tips for the APRN student on selecting the article, reading it, then writing a literature review for discussion with classmates or colleagues.

When a global pandemic threatens my NP students' ability to complete clinical hours in person, faculty all over the country scrambled to figure out how to reach the academic goals for their students. Join me as I journey through an attempt at conveying my finest clinical pearls using a novel medium. A podcast!

Vaccine hesitancy has become a controversial and highly politicized topic in healthcare today.  Join us as we discuss the history on how we got here, the current literature and obstacles facing the perpetuation of the issue, and how to talk with vaccine hesitant parents.

References:

AAP Committee on Community Health Services. (2006). Periodic survey #6: Pediatricians’ attitudes and practices surrounding the delivery of immunizations. Retrieved online from https://www.aap.org/en-us/professional-resources/Research/Pages/PS66_Executive_Summary_PediatriciansAttitudesandPracticesSurroundingtheDeliveryofImmunizationsPart2.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:+No+local+token.

AAP Committee on Practice and Ambulatory Medicine, Committee on Infectious Diseases, Committee on State Government Affairs, Council on School Health and Section on Administration and Practice Management. (2016). Medical versus nonmedical immunization exemptions for child care and school attendance. Pediatrics, e20162145. DOI: https://doi.org/10.1542/peds.2016-2145

Edwards, K.M., Hackell, J.M., The Committee on Infectious Diseases, & The Committee on Practice and Ambulatory Medicine. (2016). Countering vaccine hesitancy. Pediatrics, 138 (3), e20162146. DOI: https://doi.org/10.1542/peds.2016-214.

McCauley, M.M., Kennedy, A., Basket, M., & Sheedy, K. (2012). Exploring the choice to refuse or delay vaccines: A national survey of parents of 6- through 23-month-olds. Academic Pediatrics, 12(5),375–383.

Meissner, H.C. (2020). Ask the Expert: Why is vaccine development against COVID-19 disease so difficult? AAP News. Retrieved from https://www.aappublications.org/news/2020/06/17/covid19vaccines061720

Opel, D.J., Heritage, J., Taylor, J.A., Mangione-Smith, R., Salas, H.S., DeVere, V.,… & Robinson, J.D. (2013) The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), p. 1037-1046. Doi: DOI: https://doi.org/10.1542/peds.2013-2037

Reiland, R. (2018). Searching for a vaccine against mistrust. Johns Hopkins Magazine, online. Retrieved from https://hub.jhu.edu/magazine/2018/winter/vaccines-mistrust-and-misinformation/.

CDC. (2020). Africa kicks out wild polio. Retrieved from https://www.cdc.gov/polio/why-it-matters/africa-kicks-out-wild-polio.htm#:~:text=On%20August%2025%2C%202020%2C%20the,certified%20as%20wild%20poliovirus%2Dfree.

When a marital argument seeks to justify the use of a seemingly antiquated healthcare learning exercise, we find ourselves at the center of an existential question: Is the keyboard mightier than the mouse click?  

Rabies is one of those scary words associated with animal bites.  But not every situation requires post-exposure prophylaxis.  Join us today as we talk about rabies exposure, risk, and post-exposure management in the pediatric patient.  

References:

American Academy of Pediatrics. (2018). Red Book: 31st Ed. American Academy of Pediatrics: Itasca, IL.

Bula-Rusas, F.J., & Olcott, J.L. (2018). Human and animal bites. Pediatrics in Review, 39(10), p. 490-500.

Centers for Disease Control and Prevention. (2019). Wildlife reservoirs for rabies. Retrieved online at https://www.cdc.gov/rabies/exposure/animals/wildlife_reservoirs.html

Mani, C.S., & Murray, D.L. (2006). Rabies. Pediatrics in Review, 27(4), 129-136.

Today we talk through the tough decision on what to do when a patient presents at the most inconvenient time with Fever Without Source.  Why is this a hard decision?  What are the things that you should be thinking about?  We review the literature, the rationale, and the options of how to manage these patients using evidence-based practice to guide us. 

References:

AAP. (2011). Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics, 128(3), 595-610.

Baraff, L.J. (2000). Management of fever without source in infants and children. Annals of Emergency Medicine, 36(6), 602-614.

Simon, A.E., Lukacs, S.L., & Mendola, P. (2011). Emergency department laboratory evaluations of fever without source in children aged 3 to 36 months. Pediatrics, 128(6), e1368-e1375.

 

When constipation enters the acute care setting or is difficult to manage in primary care, use this podcast to consider the evidence-based practice guidelines and a few pearls of wisdom to assess a child’s presentation, diagnose constipation, and manage the cleanout at home with two essential medications.

References:

Chumpitazi, C.E., Rees, C.A., Camp, E.A., Henkel, E.B, Valdez, K.L., & Chumpitazi, B.P. (2017). Diagnostic approach to constipation impacts pediatric emergency department disposition. American Journal of Emergency Medicine, 35(10), 1490-1493.

Drossman, D.A., Hasler, W.L. (2016) Rome IV-functional GI disorders: disorders of gut-brain interaction. Gastroenterology, 150(6):1257–1261. doi: 10.1053/j.gastro.2016.03.035.

Ferguson, C.C., Gray, M.P., Diaz, M., & Boyd, K.P. (2017). Reducing unnecessary imaging for patients with constipation in the pediatric emergency department. Pediatrics, 140(1), e1-e7.

Freedman SB, Thull-Freedman J, Manson D, et al. Pediatric abdominal radiograph use, constipation, and significant misdiagnoses. The Journal of pediatrics. 2014;164(1):83-88.e82.

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. (2014). Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 58(2), 258-274.

Varni, J.W., Burwinkle, T.M., Katz, E.R., Meeske, K., & Dickinson, P. (2002). The PedsQL™ in pediatric cancer. Cancer, 94(7), 2090-2106.

Youssef, N.N., Langseder, A.L., Verga, B.J., Mones, R.L., & Rosh, J.R. (2005). Chronic childhood constipation is associated with impaired quality of life: A case-controlled study. Journal of Pediatric Gastroenterology and Nutrition, 41(1), 56-60.