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Reuter-Rice K.,Duke University | Madden M.A.,The New School | Gutknecht S.,Center for Pediatric Orthopaedics | Foerster A.,Pediatric Nursing Certification Board
Journal of Pediatric Health Care | Year: 2016

Introduction: Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study describes the current practice of the acute care pediatric nurse practitioner (AC PNP) to inform an update of the Certified Pediatric Nurse Practitioner-Acute Care (CPNP-AC) examination content outline. Method: A descriptive analysis was performed of the responses of 319 pediatric nurse practitioners, practicing in an acute care role, who completed a practice survey in 2014. Results: Respondents were primarily White women with a mean age of 40 years; 75% had been formally educated as AC PNPs, compared with 48% in 2009. Regional practice was most heavily concentrated in the Southeast (28%) and Midwest (27%). Most respondents (81%) practiced in urban areas. Respondents reported spending 75% of practice time in inpatient settings. The most frequently cited areas of practice were critical care (36%), followed by emergency department (9%) and subspecialty practices. Discussion: This third analysis of AC PNP practice 10 years after initiation of the CPNP-AC certification examination demonstrates changes in clinical practice and educational preparation. © 2016 National Association of Pediatric Nurse Practitioners.

Sankar W.N.,Childrens Hospital of Philadelphia | Vanderhave K.L.,University of Michigan | Matheney T.,Hunnewell 2 | Herrera-Soto J.A.,Arnold Palmer Childrens Hospital | Karlen J.W.,Center for Pediatric Orthopaedics
Journal of Bone and Joint Surgery - Series A | Year: 2013

Background: The modified Dunn procedure has rapidly gained popularity as a treatment for unstable slipped capital femoral epiphysis (SCFE), but limited data exist regarding its safety and efficacy. The purpose of this study was to present results and complications following this procedure in a large multicenter series. Methods: We reviewed the outcomes of all patients who had been treated with the modified Dunn procedure by five surgeons from separate tertiary-care institutions. All slipped capital femoral epiphyses were defined as unstable according to the Loder criteria. Patients with less than one year of follow-up and those with an underlying endocrinopathy or syndrome were excluded. All surgical procedures were performed by pediatric orthopaedic surgeons who had specific training in the modified Dunn procedure. Operative reports, outpatient records, and follow-up radiographs were used to determine the demographic information, type of fixation, final slip angle, presence of osteonecrosis, and any additional complications. Standardized surveys were administered to determine the pain level (0 to 10 scale), satisfaction (0 to 100 scale), function (modified Harris hip score, 0 to 91 scale), and activity level (UCLA [University of California Los Angeles] activity score, 0 to 10 scale) at time of the most recent follow-up. Results: Twenty-seven patients (twenty-seven hips) with a mean of 22.3 months (range, twelve to forty-eight months) of follow-up met the inclusion criteria. Four patients (15%) had broken implants at three to eighteen weeks after surgery and required revision fixation. Seven patients (26%) developed osteonecrosis at a mean of 21.4 weeks (range, ten to thirty-nine weeks), with each surgeon having at least one case of osteonecrosis. The mean slip angle at the time of the most recent follow-up was 6° (95% confidence interval, 2° to 11°). Patients who did not develop osteonecrosis had significantly better clinical results compared with those who developed osteonecrosis, as demonstrated by a lower mean pain score (0.3 compared with 3.1, p = 0.002), higher level of satisfaction (97.1 compared with 65.8, p = 0.001), higher modified Harris hip score (88.0 compared with 60.0, p = 0.001), and higher UCLA activity score (9.3 compared with 5.9, p = 0.031). Conclusions: This largest reported series of unstable slipped capital femoral epiphyses treated with the modified Dunn procedure demonstrated that the procedure is capable of restoring anatomy and preserving function after a slip but that implant complications and osteonecrosis can and do occur postoperatively. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2013 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.

Segal L.S.,Center for Pediatric Orthopaedics | Segal L.S.,University of Arizona | Shrader M.W.,Center for Pediatric Orthopaedics | Shrader M.W.,University of Arizona
Acta Orthopaedica Belgica | Year: 2011

We report on two patients who sustained Salter-Harris II fractures of the distal femur with physeal widening after being tackled in football games. Preoperative MRI indicated entrapped periosteum at the physeal fracture site for both patients. Both patients underwent open reduction of the physeal fracture with removal of the entrapped periosteum and achieving an anatomic reduction. Follow-up MRI's revealed premature physeal arrest. Subsequent procedures were performed to address sequelae of premature physeal arrest. The presence of physeal widening and entrapped periosteum may reflect high-energy trauma to the physis. This can result in injury to both the epiphyseal blood supply and to the physeal cartilage (germinal zone) resulting in physeal arrest despite anatomic reduction after removal of the entrapped periosteum. Upon literature review, pre-operative MRI demonstrating entrapped periosteum has not been previously reported. We hypothesize that the presence of entrapped periosteum following distal femoral physeal fractures may be associated with an increased risk for premature physeal arrest. © 2011, Acta Orthopædica Belgica.

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