Amoxicillin and penicillin G dosing in pediatric community-acquired pneumococcal pneumonia in the era of conjugate pneumococcal vaccines.

Background: Parenteral penicillin G (PENG) and oral amoxicillin (AMOX) are recommended as treatment for pediatric community-acquired pneumonia (CAP). With recent epidemiologic penicillin susceptibility data for Streptococcus pneumoniae, the most common etiology of CAP, the objective of this study was to evaluate optimal dosing regimens of PENG and AMOX based on population pharmacokinetics linked to current susceptibility data.

Methods: Using NONMEM v7.

A Nuclear Stress Pathway that Parallels Cytoplasmic Stress Granule Formation.

Stress adaptation is exploited by cancer cells to survive and proliferate under adverse conditions. Survival pathways induced by stress are thus highly promising therapeutic targets. One key pathway involves formation of cytoplasmic stress granules, which regulate the location, stability, and translation of specific mRNAs.

The value of faculty during student on-site evaluations.

The American Academy of Nurse Practitioners Certification Board recognizes the value of nurse practitioner faculty in evaluating students at the clinical site. The Board of Commissioners recently approved the awarding of clinical hours to nurse practitioner faculty for clinical site visits. This article outlines the rationale and procedure for conducting and documenting student visits that can be applied to recertification.

Emergency nurse practitioner practice analysis: Report and implications of the findings.

Background And Purpose: A practice analysis of nurse practitioners (NPs) working in emergency care was undertaken to define their job tasks and develop a specialty certification by examination.

Method: In phase I, clinical experts created a qualitative description of domains of practice, tasks performed, knowledge required, and procedures performed by NPs in emergency care. Phase II involved validating the qualitative description through a national survey (N = 474) of emergency nurse practitioners (ENPs).

Precepting nurse practitioner students: A new view-Results of two national surveys of nurse practitioner preceptors.

Purpose: The aim of two national studies was to identify characteristics of nurse practitioners (NPs) who precept and the benefits, incentives, and barriers associated with the NP preceptor role.

Methods: Stratified randomized sampling was used to invite a representative number of NPs from each state to participate in a 2015 survey and a follow-up survey in 2016. These descriptive, exploratory studies distributed electronic questionnaires to 5000 randomly selected NPs in the 2015 survey and 40,000 NPs in the 2016 survey.

A primary care intervention to improve weight in obese children: A feasibility study.

Purpose: Examine the effects of a primary care weight management program, which used a parent-child-provider collaborative negotiation intervention, among rural-dwelling families with obese children.

Data Sources: Health histories, physical examinations, fasting blood samples, interviews, and questionnaires.

Conclusions: Feasibility of implementing a family weight management intervention in a rural primary care setting was demonstrated.

Maternal health needs and interest in screening for depression and health behaviors during pediatric visits.

Introduction: Our aims were to assess postpartum health care barriers; health status (including depression and health behaviors); missed opportunities to discuss maternal health at health visits; acceptability of maternal screening in pediatric settings; and association of these variables with income level and race/ethnicity.

Method: A mail survey was used with names randomly drawn from birth files and balanced for race/ethnicity and income level.

Results: The adjusted response rate was 27.

Collaborating with low-income families and their overweight children to improve weight-related behaviors: an intervention process evaluation.

Purpose: This paper aims to examine the collaborative negotiation process, an interventional approach being tested at a primary-care school-based clinic to help low-income families improve lifestyle and weight-related health indicators in their overweight children.

Design And Methods: Process evaluation of the intervention employed in an ongoing longitudinal pilot study. Descriptive analysis is from structured field notes and audiotapes of parent-child-provider interactions during intervention visits (n=111).

Family-centered collaborative negotiation: a model for facilitating behavior change in primary care.

Purpose: To describe a parent-child-based model that melds a family-centered interaction approach, Touchpoints, with brief negotiation strategies (an adaptation of motivational interviewing) to address health risks in children. An application of the model for addressing childhood overweight in the primary care setting is presented.

Data Sources: Selected research, theoretical, and clinical articles; national recommendations and guidelines; and a clinical case.

Integrating evidence-based practice in nurse practitioner education.

This column normally focuses on a specific clinical practice guideline (CPG). This month's column deviates from that practice to demonstrate how evidence-based practice (EBP) was integrated into the nurse practitioner (NP) curriculum at the University of Texas at Austin School of Nursing. Processes of EBP were linked to student clinical assignments across core NP clinical courses, culminating in a student-published CPG.

Overweight and perceived health in Mexican American children: a pilot study in a central Texas community.

This study assessed actual and perceived health status of overweight Mexican American clients at a central Texas school-based health center in a predominantly Hispanic school district. It also explored the participants' interest in making lifestyle changes to promote a healthy weight. A medical records review indicated that of the Hispanic children between the ages of 7 and 12 years, 38% had a weight status at or above the 85th percentile.

Put Prevention into Practice implementation model: translating practice into theory.

Put Prevention into Practice (PPIP), a national initiative promoting evidence-based clinical preventive services, was atheoretical in its approach to change. In 1994, the Texas Department of Health began demonstration projects to implement PPIP in grantee primary care sites across the state. They funded implementation and evaluation projects that resulted in eight years of experience with the process.

Utilizing "PPIP Texas style!" in a medically underserved population.

Implementation models, such as the national Put Prevention Into Practice program, have produced small to moderate changes in the delivery of preventive services in primary care. More recently, researchers concluded that guides and tools, such as the PPIP toolkit, are helpful, but are not sufficient to facilitate substantive change in clinical preventive practice. Successful implementation of clinical preventive services, according to the Texas Department of Health-PPIP (TDH-PPIP) initiative, involves creating or altering systems to produce change in service delivery for a specific setting.

Ensuring quality preventive care: the Texas Department of Health's Put Prevention into Practice initiative.

In the current public health arena, assurance of quality clinical preventive services to all populations will be possible only if collaborations are nurtured between public health and the private sector health care delivery systems. This article explores key preventive health programs that serve as the historical context for the evolution of the Texas Department of Health-Put Prevention Into Practice (TDH-PPIP) initiative, outlines documented barriers to implementation of preventive services in primary care, and reviews national public health programs launched to reduce these barriers. Lastly, a discussion regarding the joint responsibilities of the public health and the private sector professionals in assuring quality preventive services to all populations is initiated.

Effects of 17alpha-ethinylestradiol on immune parameters in the lizard Sceloporus occidentalis.

We examined the effect of 17alpha-ethinylestradiol on immunity of the Western fence lizard, Sceloporus occidentalis. Injection of 17alpha-ethinylestradiol resulted in dose-dependent suppression of peripheral blood leukocyte levels as determined by cell counts, whereas total spleen cell levels were decreased only at higher doses of 17alpha-ethinylestradiol. In contrast, spleen cell proliferation was enhanced by 17alpha-ethinylestradiol as measured by reduction of MTT to formazan following a two-way mixed lymphocyte reaction.

Weight loss methods used by African American and Euro-American women.

In this naturalistic study employing intensive interviews and anthropometric measures, an educationally and economically diverse community-based sample of 40 African American and 40 Euro-American women described their lifetime experiences with weight management. Twenty types of weight loss methods were identified and grouped into one of three categories: lifestyle work, head work, and professional services. The most frequently used weight loss methods were from the lifestyle work category, with the leading methods identified as exercise on own and reduce high calorie and/or increase low calorie foods.

Activity progression in acute cardiac patients.

Progressive advancement of activity in cardiac patients is well documented in the literature. However, the concern in today's practice centers on balancing prudent progression of activity with a cost-effective delivery of care. This article presents a review of the literature, comparing the state of knowledge with current clinical pathway suggestions for activity therapy in various cardiac populations.

Developing a standard for endotracheal tube cuff care.

Potential complications from the use of cuffed endotracheal tubes are well documented and have generated a large body of research focusing on cuff design and interventions to decrease tracheal damage caused by the cuffs. The authors conducted a state-wide survey to determine the extent to which these procedures were incorporated into practice and to develop a current standard of care for patients with cuffed endotracheal tubes.

Effects of a 1-minute back rub on mixed venous oxygen saturation and heart rate in critically ill patients.

In this study we evaluated mixed venous oxygen saturation (SvO2) and heart rate responses after a 1-minute back rub in 173 critically ill patients. The back rub was the third and last intervention in a study conducted in intensive care units at four hospitals. For this multiple-intervention study all patients were placed in a supine position to obtain baseline SvO2 and heart rate, then underwent suctioning via endotracheal tube, and were turned to a lateral position.

Effects of a lateral turn on mixed venous oxygen saturation and heart rate in critically ill adults.

The purpose of this study was to determine the effects of a lateral turn on mixed venous oxygen saturation (SvO2) and heart rate in 183 critically ill adults. Mean SvO2 decreased from a baseline of 67% to 61% saturation (p less than 0.0001) immediately after turning and gradually returned to 66% saturation (p less than 0.

Effects of endotracheal suctioning on mixed venous oxygen saturation and heart rate in critically ill adults.

The purpose of this multisite study was to determine the effects of endotracheal suctioning on mixed venous oxygen saturation (SvO2) and heart rate in 189 critically ill adults. One-pass, intermittent suction was applied for 10 or fewer seconds, with three prehyperoxygenation and three posthyperoxygenation breaths of 100% oxygen. Subjects at three hospitals (n = 127) underwent suctioning using hyperoxygenation with anesthesia bags and traditional suction catheters (open suction method).

The physiologic basis for continuous mixed venous oxygen saturation monitoring.

Critically ill patients often have conditions that reduce oxygen delivery and increase oxygen demand. Routine nursing care, such as suctioning, positioning, and bathing, also increases the patient's oxygen demand. If the patient's oxygen demand exceeds the supply, dysrhythmias, hypotension, altered level of consciousness, and other adverse responses can occur.