Rachel Difazio - Academia.edu (original) (raw)
Papers by Rachel Difazio
Tools used to measure the impact of comorbidities on surgical outcomes in children with complex chronic conditions: A scoping review
Developmental medicine and child neurology/Developmental medicine & child neurology, Apr 28, 2024
Reflections [Complete issue : Third Quarter 2002]
Journal of Pediatric Orthopaedics, Jul 29, 2020
Background: The purpose of this study is to examine the relationship between preoperative comorbi... more Background: The purpose of this study is to examine the relationship between preoperative comorbidities, surgical complications, and length of stay (LOS) after hip reconstruction in nonambulatory children with cerebral palsy (CP). Methods: This single-center retrospective cohort study included 127 patients undergoing hip surgery between 2007 and 2016 who were diagnosed with CP (GMFCS IV/V). The cohort was 54% Gross Motor Function Classification System (GMFCS) V with an average age at surgery of 9 years (range, 3-19 y). Preoperative comorbidities included: presence of a gastrostomy tube, respiratory difficulty requiring positive-pressure ventilation or tracheostomy, history of seizures, and nonverbal status. Complications were dichotomized into major and minor complications according to severity. Multivariable general linear modeling was used to identify factors associated with complications and prolonged LOS. Results: The median LOS in the hospital was 6 days (intequartile range, 5-9 d). The majority of procedures (72%) involved both the femur and acetabulum and 82% of surgeries were performed bilaterally. Patients who experienced a major complication were mostly GMFCS level V and were more likely to spend time in intensive care unit than postanesthetic care unit (P = 0.001). Multivariable analysis for a major complication determined that the addition of each comorbid risk fact increased the odds of developing a major complication by 2.6 times (odds ratio, 2.64; 95% confidence interval, 1.56-4.47; P < 0.001) regardless of GMFCS level. Multivariable analysis for prolonged LOS determined that major complications (P < 0.001), bilaterality (P = 0.01), age (P = 0.02), female sex (P = 0.01), and GMFCS V (P < 0.001) were all factors that increased LOS. Migration percentage, acetabular index odds ratio, and pelvic obliquity were not associated with prolonged LOS or the presence of a major complication. Conclusions: From our analysis, the authors found that a patient's premorbid comorbidities were more predictive of the likelihood of sustaining a major complication than their GMFCS level. Identifying high-risk patients preoperatively may help reduce complications and LOS, which ultimately will improve the quality of care the authors deliver to nonambulatory children with CP undergoing hip reconstruction surgery. Level of Evidence: Level III-retrospective cohort study.
Spine, Jun 15, 2017
Study Design: Prospective longitudinal cohort Objective:Evaluate changes in caregivers' perceptio... more Study Design: Prospective longitudinal cohort Objective:Evaluate changes in caregivers' perceptions of health related quality of life (HRQOL) and caregiver burden in children with severe cerebral palsy (CP) following spinal fusion. Summary of Background Data: Progressive scoliosis is common in non-ambulatory children with CP;the utility of spine fusion has been long debated and prospective evaluations of patient reported outcomes are limited. Methods:Children3-21 years old, GMFCS IV-V CP, scheduled for spine fusion were enrolled consecutively from September 2011-March 2014. Caregivers completed the CPCHILD ™ and ACEND pre-operatively and at 6 weeks, 3, 6, 12, and 24 months post-operatively.Changes in CPCHILD™ and ACEND scores from pre-operativeto 1 and 2 years after surgery were assessed using paired t-tests. Correlationsbetween pre-operative Cobb angle and CPCHILD™ and ACEND scores wereevaluated using Pearson's correlation analysis. Results:Twenty-six GMFCS IV-V CP patients with severe scoliosis treated with spine fusionwere included. Mean age was 14 years, 50% male, 46% had instrumentation to the pelvis. Average preoperative Cobb angle was 68.9° (SD 25.68) with an average improvement of 76%. The CPCHILD™ score increased by 9.8 points above baseline (95% CI: 3.4 to 16.2) at 1 year post-operatively (p=0.005). However, at 2 years, the CPCHILD™ score regressed to baseline (p=0.40).ACEND scores did not change from baseline scores at 1 year (p=0.09) and 2 year (0.72) follow-up; reflecting that caregiver burden is little changed by spine fusion. While there was no correlation between pre-operative Cobb angle and CPCHILD™ score (p=0.52) or ACEND score (p=0.56) at 1 year or 2 year follow-up (p=0.69, p=0.90). Children with Cob ≤ 75° experienced more improvement 1 year after surgery than children with Cobb >75°.
Identifying Bullied Youth: Re-engineering the Child-Adolescent Bullying Scale into a Brief Screen
PubMed, 2019
While youth bullying is a critical public health problem, standardized exposure screening is not ... more While youth bullying is a critical public health problem, standardized exposure screening is not routinely practiced. The Child-Adolescent Bullying Scale, (CABS), a psychometrically robust 22-item tool, was designed and evaluated for this purpose using classical test theory. The goals of the present study were to examine and optimize the measurement properties of the CABS using a Rasch psychometric analysis to develop a brief screening tool appropriate for clinical use. A methodologic design and the Rasch rating scale model were employed. Three hundred and fifty-two youths from two clinical sites participated. Rasch-based analyses included evaluation of response category functioning, measurement precision, dimensionality, targeting, differential item functioning and guidance in item reduction. After iterative revisions, the resulting screening instrument consists of 9 items. Cut-scores and interpretive guidance are provided to aid clinical identification of bullying-related risk. Findings suggest the CABS-9 holds promise as a useful screening tool for identifying bullying exposure.
Pneumonia after hip surgery in children with neurological complex chronic conditions
Developmental Medicine & Child Neurology, Jul 10, 2022
AimIn children with neurological complex chronic conditions (CCC) undergoing hip surgery we aimed... more AimIn children with neurological complex chronic conditions (CCC) undergoing hip surgery we aimed to: estimate the rate of postoperative pneumonia, determine the effect of pneumonia on postoperative hospital resource use, and identify predictors of postoperative pneumonia.MethodA retrospective cohort study was conducted utilizing the Pediatric Health Information System database for 2609 children (1081 females, 1528 males) aged 4 years and older with a neurological CCC who underwent hip surgery (i.e. reconstruction surgery or salvage procedure) between 2016 and 2018 in 41 US children's hospitals. Multivariable, mixed‐effects logistic regression was used to assess patient characteristics and risk of pneumonia.ResultsMean age at hip surgery was 10 years 1 month (SD 4y 8mo). The postoperative pneumonia rate was 1.6% (n=42). Median length of stay (LOS) was longer for children with pneumonia and the 30‐day all‐cause unplanned readmission rate and costs were higher. Variability in rates of pneumonia ranged from 1.1% to 2.8% across hospitals. Significant predictors of postoperative pneumonia were osteotomy type (p=0.005) and number of chronic conditions (p≤0.001).InterpretationPostoperative pneumonia after hip surgery in children with a neurological CCC is associated with longer LOS, readmissions, and higher costs. Children undergoing pelvic osteotomies and who have multimorbidity need additional clinical support to prevent postoperative pneumonia and decrease resource utilization.What this paper adds Pneumonia is a major postoperative complication in children with neurological complex chronic conditions (CCC). Forty‐two (1.6%) children with neurological CCC developed pneumonia after hip surgery. Length of stay, readmissions, and costs were significantly higher in the group with pneumonia. Variability in pneumonia rates existed across hospitals. Predictors of developing pneumonia include osteotomy type and number of CCC.
Journal of Pediatric Nursing, Nov 1, 2017
Limited research has been conducted on the non-medical out-of-pocket expenses (NOOPEs) incurred b... more Limited research has been conducted on the non-medical out-of-pocket expenses (NOOPEs) incurred by families of children with chronic health conditions. The study objectives were to: 1) calculate the estimated NOOPEs incurred by families during hospitalization of their child, 2) identify predictors of high NOOPEs, and 3) assess the impact of the child's chronic health condition on the family's finances. Design and Methods: Prospective observational study. Parents were included if their child was 3-20 years old, had severe, non-ambulatory cerebral palsy (CP), and scheduled for hip or spine surgery. Parents reported all NOOPEs incurred during their child's hospitalization using the Family Expense Diary. Families completed the subscales of the Impact on Family Scale and the Assessment of Caregivers Experience with Neuromuscular Disease. Descriptive and univariate and multiple hierarchical regression models were used in the analysis. Results: Fifty two parents participated. The total NOOPEs ranged from 193.00to193.00 to 193.00to7192.71 (M = $2001.92) per hospitalization representing an average of 4% of the family's annual earned income. Caregiver age (F = 8.393, p b 0.001), income (F = 7.535, p b 0.001), and distance traveled to the hospital (F = 4.497, p = 0.039) were significant predictors of high NOOPEs. The subscale scores indicated that a child's chronic health condition had a significant impact on family finances. Conclusions and Practice Implications: Hospitalization is associated with numerous NOOPEs that create additional financial demands for families caring for a child with severe CP. NOOPEs should be addressed when preparing families for their children's planned hospital admissions, especially those families of CSHCN who experience significant financial impacts secondary to their children's care.
Non-medical out-of-pocket expenses incurred by families during their child’s hospitalization
Journal of Child Health Care, May 27, 2013
Little is known about the nonmedical out of pocket expenses (NOOPEs) incurred by families of hosp... more Little is known about the nonmedical out of pocket expenses (NOOPEs) incurred by families of hospitalized children. The purpose of this study is to help nurses, other healthcare providers, hospital administrators, and policymakers better understand the NOOPEs incurred by families during their child’s hospitalization. Parents of children (n = 50) who underwent orthopedic surgery at a major tertiary-care children’s hospital reported all NOOPEs incurred during their child’s hospitalization. Descriptive statistics and univariate and multiple logistic regression analyses were used to analyze the data. The total NOOPEs ranged from 17.00to17.00 to 17.00to4745.00 (M = $736.21) per hospitalization, with 2096 missed hours from work. Length of stay, gross family income, distance from the hospital, and Hollingshead score are significant predictors of expenses (F-ratio = 732.88, p < 0.001). Hospitalization is associated with numerous NOOPEs. Future research needs to investigate the total array of expenses to families.
Journal of Bone and Joint Surgery, American Volume, Jul 20, 2016
Background: The primary aim of this study was to evaluate the relationship of the migration perce... more Background: The primary aim of this study was to evaluate the relationship of the migration percentage (a radiographic metric quantifying hip displacement) in children with Gross Motor Function Classification System (GMFCS) level-IV or V cerebral palsy and spastic hip dysplasia to the acetabular index and the health-related quality of life (HRQOL) as measured with the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) before and after reconstructive hip surgery. Methods: In a prospective cohort study (n = 38), the migration percentage, acetabular index, and CPCHILD scores were analyzed using the Pearson correlation analysis immediately before reconstructive hip surgery and at 6 weeks and 3, 6, 12, and 24 months after the surgery. Subgroup analysis was used to compare patients who had a preoperative migration percentage of ‡50% with those who had a preoperative migration percentage of <50% and to compare the acetabular index between patients who had a pelvic osteotomy and those who had not. Linear mixed models were used to analyze changes in the migration percentage, acetabular index, and CPCHILD scores over time. Results: The preoperative migration percentage negatively correlated with the preoperative CPCHILD score (r = 20.50; p = 0.002). This relationship continued throughout the follow-up period such that, for each additional 1% correction in migration percentage, the CPCHILD total score increased by 0.2 point (p < 0.001). There was no correlation between the acetabular index and CPCHILD total score before or after surgery (p = 0.09 to 0.71). The preoperative CPCHILD total scores differed between the migration-percentile groups (mean difference = 13 points; 95% confidence interval = 3.3 to 22.8; p = 0.01). However, after hip surgery, the CPCHILD score improved similarly for both groups. Conclusions: These data support the effectiveness of reconstructive hip surgery for the treatment of spastic hip dysplasia to improve the HRQOL of non-ambulatory children with severe cerebral palsy.
Annual review of nursing research, Dec 1, 2010
In the complex health care workplace of nurses, intra/interprofessional ideals intersect with the... more In the complex health care workplace of nurses, intra/interprofessional ideals intersect with the expectations of patients, families, students, and coworkers in a context of managed care environments, academia, and other health care enterprises. Integral to quality assessment, management, and assurance is collegial and respectful communication. Decades of reported descriptive and anecdotal data on intra/inter professional and on client communication, describe the antithesis of these ideals. Specifi cally, increasing frequency and rates of persistent bullying, harassment, or horizontal violence (BHHV) have shown to yield detrimental effects on workplace satisfaction, workforce retention, and the psychological and physical health of nurses as well as implied effects on quality of patient care and risk of poor health outcomes. Persistent BHHV among nurses is a serious concern. In advancing the science of description and explanation to a level of prevention intervention, explanatory models from biology, developmental psychology, intra/interpersonal interactionism are described along with theoretical explanations for the prevalence of BHHV in nurse workplaces. Making
Revista Horizonte de Enfermería, Oct 7, 2016
42nd Biennial Convention (16 November - 20 November 2013), Dec 19, 2013
The purpose of this study was to elucidate changes in parents' perceptions of health related qual... more The purpose of this study was to elucidate changes in parents' perceptions of health related quality of life (HRQOL), functional status, and caregiver burden in children with severe cerebral palsy (CP) following extensive orthopedic surgery and to determine the amount of nonmedical out-of-pocket expenses (NOOPEs) incurred during hospitalization. Background: CP is the most common cause of childhood physical disability. Children with severe non-ambulatory CP have multiple complex medical problems and frequently develop hip dislocations and neuromuscular scoliosis; these require extensive orthopaedic surgical interventions to prevent progression. The surgical trajectory is costly, resource intensive, and complications are common. Decision-making needs to extend beyond anticipated physical and radiographic improvements to include patient-centered outcomes including HRQOL, functional status, caregiver impact, and financial burden. Currently, research on this second group of outcomes does not exist. DiFazio, Dissertation Methods: A single group prospective cohort study (N=48) design was used to measure changes pre-and post-surgery. NOOPEs were collected on a daily basis from parents during their child's hospitalization. A linear mixed-model regression analysis for longitudinal data, incorporating serial patient measurements over one year, was used to assess changes in HRQOL, functional status, and caregiver impact using measures normed for this population (i.e., CPCHILD, ACEND). NOOPEs were calculated using descriptive statistics. Results: Significant declines in HRQOL and functional status were noted at six weeks post-operative with return to baseline at three months. Long-term significant (p = .005) improvements, however, were noted beginning at six months. Caregiver impact did not change significantly over time.
Pediatric Research, Nov 1, 2010
Purpose: Document the incidence of skin related complications in children treated with a spica ca... more Purpose: Document the incidence of skin related complications in children treated with a spica cast for femur fractures and determine associated cast change charges.
Journal of Pediatric Nursing, Apr 1, 2003
This article describes a clinically based project that used evidence-based practice (EBP). It fol... more This article describes a clinically based project that used evidence-based practice (EBP). It follows the EBP process of: (1) identifying a clinical problem and stating a clinical question that focuses the process; (2) doing a literature search for best research evidence; (3) using query techniques, such as phone calls and e-mails, to determine best clinical practice among similar institutions; and (4) drawing a practice conclusion-to accept the status quo, to instigate change of practice, or to do more research. This project was an interdisciplinary effort orchestrated by the surgical programs nurses at Boston Children's Hospital.
Research in Nursing & Health, Mar 5, 2018
While youth bullying is a significant public health problem, healthcare providers have been limit... more While youth bullying is a significant public health problem, healthcare providers have been limited in their ability to identify bullied youths due to the lack of a reliable, and valid instrument appropriate for use in clinical settings. We conducted a multisite study to evaluate the psychometric properties of a new 22-item instrument for assessing youths' experiences of being bullied, the Child Adolescent Bullying Scale (CABS). The 20 items summed to produce the measure's score were evaluated here. Diagnostic performance was assessed through evaluation of sensitivity, specificity, predictive values, and area under receiver operating characteristic (AUROC) curve. A sample of 352 youths from diverse racial, ethnic, and geographic backgrounds (188 female, 159 male, 5 transgender, sample mean age 13.5 years) were recruited from two clinical sites. Participants completed the CABS and existing youth bullying measures. Analyses grounded in classical test theory, including assessments of reliability and validity, item analyses, and principal components analysis, were conducted. The diagnostic performance and test characteristics of the CABS were also evaluated. The CABS is comprised of one component, accounting for 67% of observed variance. Analyses established evidence of internal consistency reliability (Cronbach's α = 0.97), construct and convergent validity. Sensitivity was 84%, specificity was 65%, and the AUROC curve was 0.74 (95% CI: 0.69-0.80). Findings suggest that the CABS holds promise as a reliable, valid tool for healthcare provider use in screening for bullying exposure in the clinical setting. K E Y W O R D S bullying, classical test theory, instrument development, psychometrics, youths 1 | INTRODUCTION Youth bullying is a critical public health problem experienced by approximately 20% of American middle school youths each year (Kann, 2016; US Department of Education, 2016). The current federal definition for bullying is "Any unwanted aggressive behavior(s) by another youth or group of youths who are not siblings or current dating partners that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated" (Gladden, Vivolo-Kantor, Hamburger, & Lumpkin, 2014). In meta-analyses and systematic reviews, exposure to bullying has been linked to numerous psychosocial, and academic problems (
International Nursing Review, Sep 7, 2018
Aim: The aim of this study was to describe bullying experienced by professional nurses working in... more Aim: The aim of this study was to describe bullying experienced by professional nurses working in the Russian Federation. The frequency and type of bullying behaviours experienced, the personal and professional consequences of bullying and the actions taken to address bullying were all examined. Background/Introduction: Workplace bullying negatively affects nurses, patients and healthcare organizations. To date, no research has been conducted on workplace bullying among nurses in the Russian Federation. Methods: This was a descriptive study using survey methodology. Members of the Russian Nurses Association were invited to participate via email and social media. Participants completed the 26-item, webbased Bullying in the Workplace Survey. Data were analysed using descriptive statistics. Results: Of the 438 participants, 63% reported being bullied at some point during their career. The majority were female and worked fulltime for an average of 20 years. Over half the nurses were working in staff positions when bullying occurred, and administrators were most commonly identified as the bully. Bullying caused moderate to severe distress in 73.5%. Half of the nurses reported that bullying affected their work, and 83.3% reported that it affected their health. Just over 70% took action to address the bullying situation; 59% of those who did were dissatisfied with the outcome. Conclusion: Bullying is prevalent in the nursing workplace in the Russian Federation. The perpetrators were most frequently the nurse administrator or physician administrator. Workplace bullying negatively affects nurses' ability to function and subsequently impacts nursing teamwork and patient care.
Nursing Outlook, Sep 1, 2013
Discharge Readiness for Transition from Hospital to Home for Children with Cerebral Palsy Undergoing Orthopedic Surgery
Social Science Research Network, 2022
What makes a good reviewer?
Journal of Pediatric Nursing, Mar 1, 2022
Horizonte de enfermería, May 5, 2016
Tools used to measure the impact of comorbidities on surgical outcomes in children with complex chronic conditions: A scoping review
Developmental medicine and child neurology/Developmental medicine & child neurology, Apr 28, 2024
Reflections [Complete issue : Third Quarter 2002]
Journal of Pediatric Orthopaedics, Jul 29, 2020
Background: The purpose of this study is to examine the relationship between preoperative comorbi... more Background: The purpose of this study is to examine the relationship between preoperative comorbidities, surgical complications, and length of stay (LOS) after hip reconstruction in nonambulatory children with cerebral palsy (CP). Methods: This single-center retrospective cohort study included 127 patients undergoing hip surgery between 2007 and 2016 who were diagnosed with CP (GMFCS IV/V). The cohort was 54% Gross Motor Function Classification System (GMFCS) V with an average age at surgery of 9 years (range, 3-19 y). Preoperative comorbidities included: presence of a gastrostomy tube, respiratory difficulty requiring positive-pressure ventilation or tracheostomy, history of seizures, and nonverbal status. Complications were dichotomized into major and minor complications according to severity. Multivariable general linear modeling was used to identify factors associated with complications and prolonged LOS. Results: The median LOS in the hospital was 6 days (intequartile range, 5-9 d). The majority of procedures (72%) involved both the femur and acetabulum and 82% of surgeries were performed bilaterally. Patients who experienced a major complication were mostly GMFCS level V and were more likely to spend time in intensive care unit than postanesthetic care unit (P = 0.001). Multivariable analysis for a major complication determined that the addition of each comorbid risk fact increased the odds of developing a major complication by 2.6 times (odds ratio, 2.64; 95% confidence interval, 1.56-4.47; P < 0.001) regardless of GMFCS level. Multivariable analysis for prolonged LOS determined that major complications (P < 0.001), bilaterality (P = 0.01), age (P = 0.02), female sex (P = 0.01), and GMFCS V (P < 0.001) were all factors that increased LOS. Migration percentage, acetabular index odds ratio, and pelvic obliquity were not associated with prolonged LOS or the presence of a major complication. Conclusions: From our analysis, the authors found that a patient's premorbid comorbidities were more predictive of the likelihood of sustaining a major complication than their GMFCS level. Identifying high-risk patients preoperatively may help reduce complications and LOS, which ultimately will improve the quality of care the authors deliver to nonambulatory children with CP undergoing hip reconstruction surgery. Level of Evidence: Level III-retrospective cohort study.
Spine, Jun 15, 2017
Study Design: Prospective longitudinal cohort Objective:Evaluate changes in caregivers' perceptio... more Study Design: Prospective longitudinal cohort Objective:Evaluate changes in caregivers' perceptions of health related quality of life (HRQOL) and caregiver burden in children with severe cerebral palsy (CP) following spinal fusion. Summary of Background Data: Progressive scoliosis is common in non-ambulatory children with CP;the utility of spine fusion has been long debated and prospective evaluations of patient reported outcomes are limited. Methods:Children3-21 years old, GMFCS IV-V CP, scheduled for spine fusion were enrolled consecutively from September 2011-March 2014. Caregivers completed the CPCHILD ™ and ACEND pre-operatively and at 6 weeks, 3, 6, 12, and 24 months post-operatively.Changes in CPCHILD™ and ACEND scores from pre-operativeto 1 and 2 years after surgery were assessed using paired t-tests. Correlationsbetween pre-operative Cobb angle and CPCHILD™ and ACEND scores wereevaluated using Pearson's correlation analysis. Results:Twenty-six GMFCS IV-V CP patients with severe scoliosis treated with spine fusionwere included. Mean age was 14 years, 50% male, 46% had instrumentation to the pelvis. Average preoperative Cobb angle was 68.9° (SD 25.68) with an average improvement of 76%. The CPCHILD™ score increased by 9.8 points above baseline (95% CI: 3.4 to 16.2) at 1 year post-operatively (p=0.005). However, at 2 years, the CPCHILD™ score regressed to baseline (p=0.40).ACEND scores did not change from baseline scores at 1 year (p=0.09) and 2 year (0.72) follow-up; reflecting that caregiver burden is little changed by spine fusion. While there was no correlation between pre-operative Cobb angle and CPCHILD™ score (p=0.52) or ACEND score (p=0.56) at 1 year or 2 year follow-up (p=0.69, p=0.90). Children with Cob ≤ 75° experienced more improvement 1 year after surgery than children with Cobb >75°.
Identifying Bullied Youth: Re-engineering the Child-Adolescent Bullying Scale into a Brief Screen
PubMed, 2019
While youth bullying is a critical public health problem, standardized exposure screening is not ... more While youth bullying is a critical public health problem, standardized exposure screening is not routinely practiced. The Child-Adolescent Bullying Scale, (CABS), a psychometrically robust 22-item tool, was designed and evaluated for this purpose using classical test theory. The goals of the present study were to examine and optimize the measurement properties of the CABS using a Rasch psychometric analysis to develop a brief screening tool appropriate for clinical use. A methodologic design and the Rasch rating scale model were employed. Three hundred and fifty-two youths from two clinical sites participated. Rasch-based analyses included evaluation of response category functioning, measurement precision, dimensionality, targeting, differential item functioning and guidance in item reduction. After iterative revisions, the resulting screening instrument consists of 9 items. Cut-scores and interpretive guidance are provided to aid clinical identification of bullying-related risk. Findings suggest the CABS-9 holds promise as a useful screening tool for identifying bullying exposure.
Pneumonia after hip surgery in children with neurological complex chronic conditions
Developmental Medicine & Child Neurology, Jul 10, 2022
AimIn children with neurological complex chronic conditions (CCC) undergoing hip surgery we aimed... more AimIn children with neurological complex chronic conditions (CCC) undergoing hip surgery we aimed to: estimate the rate of postoperative pneumonia, determine the effect of pneumonia on postoperative hospital resource use, and identify predictors of postoperative pneumonia.MethodA retrospective cohort study was conducted utilizing the Pediatric Health Information System database for 2609 children (1081 females, 1528 males) aged 4 years and older with a neurological CCC who underwent hip surgery (i.e. reconstruction surgery or salvage procedure) between 2016 and 2018 in 41 US children's hospitals. Multivariable, mixed‐effects logistic regression was used to assess patient characteristics and risk of pneumonia.ResultsMean age at hip surgery was 10 years 1 month (SD 4y 8mo). The postoperative pneumonia rate was 1.6% (n=42). Median length of stay (LOS) was longer for children with pneumonia and the 30‐day all‐cause unplanned readmission rate and costs were higher. Variability in rates of pneumonia ranged from 1.1% to 2.8% across hospitals. Significant predictors of postoperative pneumonia were osteotomy type (p=0.005) and number of chronic conditions (p≤0.001).InterpretationPostoperative pneumonia after hip surgery in children with a neurological CCC is associated with longer LOS, readmissions, and higher costs. Children undergoing pelvic osteotomies and who have multimorbidity need additional clinical support to prevent postoperative pneumonia and decrease resource utilization.What this paper adds Pneumonia is a major postoperative complication in children with neurological complex chronic conditions (CCC). Forty‐two (1.6%) children with neurological CCC developed pneumonia after hip surgery. Length of stay, readmissions, and costs were significantly higher in the group with pneumonia. Variability in pneumonia rates existed across hospitals. Predictors of developing pneumonia include osteotomy type and number of CCC.
Journal of Pediatric Nursing, Nov 1, 2017
Limited research has been conducted on the non-medical out-of-pocket expenses (NOOPEs) incurred b... more Limited research has been conducted on the non-medical out-of-pocket expenses (NOOPEs) incurred by families of children with chronic health conditions. The study objectives were to: 1) calculate the estimated NOOPEs incurred by families during hospitalization of their child, 2) identify predictors of high NOOPEs, and 3) assess the impact of the child's chronic health condition on the family's finances. Design and Methods: Prospective observational study. Parents were included if their child was 3-20 years old, had severe, non-ambulatory cerebral palsy (CP), and scheduled for hip or spine surgery. Parents reported all NOOPEs incurred during their child's hospitalization using the Family Expense Diary. Families completed the subscales of the Impact on Family Scale and the Assessment of Caregivers Experience with Neuromuscular Disease. Descriptive and univariate and multiple hierarchical regression models were used in the analysis. Results: Fifty two parents participated. The total NOOPEs ranged from 193.00to193.00 to 193.00to7192.71 (M = $2001.92) per hospitalization representing an average of 4% of the family's annual earned income. Caregiver age (F = 8.393, p b 0.001), income (F = 7.535, p b 0.001), and distance traveled to the hospital (F = 4.497, p = 0.039) were significant predictors of high NOOPEs. The subscale scores indicated that a child's chronic health condition had a significant impact on family finances. Conclusions and Practice Implications: Hospitalization is associated with numerous NOOPEs that create additional financial demands for families caring for a child with severe CP. NOOPEs should be addressed when preparing families for their children's planned hospital admissions, especially those families of CSHCN who experience significant financial impacts secondary to their children's care.
Non-medical out-of-pocket expenses incurred by families during their child’s hospitalization
Journal of Child Health Care, May 27, 2013
Little is known about the nonmedical out of pocket expenses (NOOPEs) incurred by families of hosp... more Little is known about the nonmedical out of pocket expenses (NOOPEs) incurred by families of hospitalized children. The purpose of this study is to help nurses, other healthcare providers, hospital administrators, and policymakers better understand the NOOPEs incurred by families during their child’s hospitalization. Parents of children (n = 50) who underwent orthopedic surgery at a major tertiary-care children’s hospital reported all NOOPEs incurred during their child’s hospitalization. Descriptive statistics and univariate and multiple logistic regression analyses were used to analyze the data. The total NOOPEs ranged from 17.00to17.00 to 17.00to4745.00 (M = $736.21) per hospitalization, with 2096 missed hours from work. Length of stay, gross family income, distance from the hospital, and Hollingshead score are significant predictors of expenses (F-ratio = 732.88, p < 0.001). Hospitalization is associated with numerous NOOPEs. Future research needs to investigate the total array of expenses to families.
Journal of Bone and Joint Surgery, American Volume, Jul 20, 2016
Background: The primary aim of this study was to evaluate the relationship of the migration perce... more Background: The primary aim of this study was to evaluate the relationship of the migration percentage (a radiographic metric quantifying hip displacement) in children with Gross Motor Function Classification System (GMFCS) level-IV or V cerebral palsy and spastic hip dysplasia to the acetabular index and the health-related quality of life (HRQOL) as measured with the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) before and after reconstructive hip surgery. Methods: In a prospective cohort study (n = 38), the migration percentage, acetabular index, and CPCHILD scores were analyzed using the Pearson correlation analysis immediately before reconstructive hip surgery and at 6 weeks and 3, 6, 12, and 24 months after the surgery. Subgroup analysis was used to compare patients who had a preoperative migration percentage of ‡50% with those who had a preoperative migration percentage of <50% and to compare the acetabular index between patients who had a pelvic osteotomy and those who had not. Linear mixed models were used to analyze changes in the migration percentage, acetabular index, and CPCHILD scores over time. Results: The preoperative migration percentage negatively correlated with the preoperative CPCHILD score (r = 20.50; p = 0.002). This relationship continued throughout the follow-up period such that, for each additional 1% correction in migration percentage, the CPCHILD total score increased by 0.2 point (p < 0.001). There was no correlation between the acetabular index and CPCHILD total score before or after surgery (p = 0.09 to 0.71). The preoperative CPCHILD total scores differed between the migration-percentile groups (mean difference = 13 points; 95% confidence interval = 3.3 to 22.8; p = 0.01). However, after hip surgery, the CPCHILD score improved similarly for both groups. Conclusions: These data support the effectiveness of reconstructive hip surgery for the treatment of spastic hip dysplasia to improve the HRQOL of non-ambulatory children with severe cerebral palsy.
Annual review of nursing research, Dec 1, 2010
In the complex health care workplace of nurses, intra/interprofessional ideals intersect with the... more In the complex health care workplace of nurses, intra/interprofessional ideals intersect with the expectations of patients, families, students, and coworkers in a context of managed care environments, academia, and other health care enterprises. Integral to quality assessment, management, and assurance is collegial and respectful communication. Decades of reported descriptive and anecdotal data on intra/inter professional and on client communication, describe the antithesis of these ideals. Specifi cally, increasing frequency and rates of persistent bullying, harassment, or horizontal violence (BHHV) have shown to yield detrimental effects on workplace satisfaction, workforce retention, and the psychological and physical health of nurses as well as implied effects on quality of patient care and risk of poor health outcomes. Persistent BHHV among nurses is a serious concern. In advancing the science of description and explanation to a level of prevention intervention, explanatory models from biology, developmental psychology, intra/interpersonal interactionism are described along with theoretical explanations for the prevalence of BHHV in nurse workplaces. Making
Revista Horizonte de Enfermería, Oct 7, 2016
42nd Biennial Convention (16 November - 20 November 2013), Dec 19, 2013
The purpose of this study was to elucidate changes in parents' perceptions of health related qual... more The purpose of this study was to elucidate changes in parents' perceptions of health related quality of life (HRQOL), functional status, and caregiver burden in children with severe cerebral palsy (CP) following extensive orthopedic surgery and to determine the amount of nonmedical out-of-pocket expenses (NOOPEs) incurred during hospitalization. Background: CP is the most common cause of childhood physical disability. Children with severe non-ambulatory CP have multiple complex medical problems and frequently develop hip dislocations and neuromuscular scoliosis; these require extensive orthopaedic surgical interventions to prevent progression. The surgical trajectory is costly, resource intensive, and complications are common. Decision-making needs to extend beyond anticipated physical and radiographic improvements to include patient-centered outcomes including HRQOL, functional status, caregiver impact, and financial burden. Currently, research on this second group of outcomes does not exist. DiFazio, Dissertation Methods: A single group prospective cohort study (N=48) design was used to measure changes pre-and post-surgery. NOOPEs were collected on a daily basis from parents during their child's hospitalization. A linear mixed-model regression analysis for longitudinal data, incorporating serial patient measurements over one year, was used to assess changes in HRQOL, functional status, and caregiver impact using measures normed for this population (i.e., CPCHILD, ACEND). NOOPEs were calculated using descriptive statistics. Results: Significant declines in HRQOL and functional status were noted at six weeks post-operative with return to baseline at three months. Long-term significant (p = .005) improvements, however, were noted beginning at six months. Caregiver impact did not change significantly over time.
Pediatric Research, Nov 1, 2010
Purpose: Document the incidence of skin related complications in children treated with a spica ca... more Purpose: Document the incidence of skin related complications in children treated with a spica cast for femur fractures and determine associated cast change charges.
Journal of Pediatric Nursing, Apr 1, 2003
This article describes a clinically based project that used evidence-based practice (EBP). It fol... more This article describes a clinically based project that used evidence-based practice (EBP). It follows the EBP process of: (1) identifying a clinical problem and stating a clinical question that focuses the process; (2) doing a literature search for best research evidence; (3) using query techniques, such as phone calls and e-mails, to determine best clinical practice among similar institutions; and (4) drawing a practice conclusion-to accept the status quo, to instigate change of practice, or to do more research. This project was an interdisciplinary effort orchestrated by the surgical programs nurses at Boston Children's Hospital.
Research in Nursing & Health, Mar 5, 2018
While youth bullying is a significant public health problem, healthcare providers have been limit... more While youth bullying is a significant public health problem, healthcare providers have been limited in their ability to identify bullied youths due to the lack of a reliable, and valid instrument appropriate for use in clinical settings. We conducted a multisite study to evaluate the psychometric properties of a new 22-item instrument for assessing youths' experiences of being bullied, the Child Adolescent Bullying Scale (CABS). The 20 items summed to produce the measure's score were evaluated here. Diagnostic performance was assessed through evaluation of sensitivity, specificity, predictive values, and area under receiver operating characteristic (AUROC) curve. A sample of 352 youths from diverse racial, ethnic, and geographic backgrounds (188 female, 159 male, 5 transgender, sample mean age 13.5 years) were recruited from two clinical sites. Participants completed the CABS and existing youth bullying measures. Analyses grounded in classical test theory, including assessments of reliability and validity, item analyses, and principal components analysis, were conducted. The diagnostic performance and test characteristics of the CABS were also evaluated. The CABS is comprised of one component, accounting for 67% of observed variance. Analyses established evidence of internal consistency reliability (Cronbach's α = 0.97), construct and convergent validity. Sensitivity was 84%, specificity was 65%, and the AUROC curve was 0.74 (95% CI: 0.69-0.80). Findings suggest that the CABS holds promise as a reliable, valid tool for healthcare provider use in screening for bullying exposure in the clinical setting. K E Y W O R D S bullying, classical test theory, instrument development, psychometrics, youths 1 | INTRODUCTION Youth bullying is a critical public health problem experienced by approximately 20% of American middle school youths each year (Kann, 2016; US Department of Education, 2016). The current federal definition for bullying is "Any unwanted aggressive behavior(s) by another youth or group of youths who are not siblings or current dating partners that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated" (Gladden, Vivolo-Kantor, Hamburger, & Lumpkin, 2014). In meta-analyses and systematic reviews, exposure to bullying has been linked to numerous psychosocial, and academic problems (
International Nursing Review, Sep 7, 2018
Aim: The aim of this study was to describe bullying experienced by professional nurses working in... more Aim: The aim of this study was to describe bullying experienced by professional nurses working in the Russian Federation. The frequency and type of bullying behaviours experienced, the personal and professional consequences of bullying and the actions taken to address bullying were all examined. Background/Introduction: Workplace bullying negatively affects nurses, patients and healthcare organizations. To date, no research has been conducted on workplace bullying among nurses in the Russian Federation. Methods: This was a descriptive study using survey methodology. Members of the Russian Nurses Association were invited to participate via email and social media. Participants completed the 26-item, webbased Bullying in the Workplace Survey. Data were analysed using descriptive statistics. Results: Of the 438 participants, 63% reported being bullied at some point during their career. The majority were female and worked fulltime for an average of 20 years. Over half the nurses were working in staff positions when bullying occurred, and administrators were most commonly identified as the bully. Bullying caused moderate to severe distress in 73.5%. Half of the nurses reported that bullying affected their work, and 83.3% reported that it affected their health. Just over 70% took action to address the bullying situation; 59% of those who did were dissatisfied with the outcome. Conclusion: Bullying is prevalent in the nursing workplace in the Russian Federation. The perpetrators were most frequently the nurse administrator or physician administrator. Workplace bullying negatively affects nurses' ability to function and subsequently impacts nursing teamwork and patient care.
Nursing Outlook, Sep 1, 2013
Discharge Readiness for Transition from Hospital to Home for Children with Cerebral Palsy Undergoing Orthopedic Surgery
Social Science Research Network, 2022
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Journal of Pediatric Nursing, Mar 1, 2022
Horizonte de enfermería, May 5, 2016