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1
Bishop, Katherine G. "From their perspectives children and young people's experience of a paediatric hospital environment and its relationship to their feeling of well-being /." University of Sydney, 2008. http://hdl.handle.net/2123/3962.
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Doctor of Philosophy (PhD)This study was conducted to increase our understanding of children and young people’s experience of a hospital environment and to identify the salient attributes of the physical environment in their experience. There were three specific aims: to describe children and young people’s experience of a hospital environment and identify what constitutes a supportive paediatric environment; to examine the role of the physical environment in patients’ feeling of well-being; and to highlight the capacity of participatory research with children and young people to inform evidence-based paediatric design. At this stage, there has been very little healthcare design research carried out with populations of children and young people. Well-being research with children and young people in paediatric environments that identifies the potential supportive attributes in this environment is also very limited. Historically research on children’s health and well-being has been dominated by a focus on the prevalence of disorders, problems and disabilities. More recently, in response to the change to health promotion, positive attributes have been included in well-being and satisfaction measures. At this stage, there are still many fewer positive measures. Within the body of literature that exists in healthcare, healthcare design research, and well-being research, there are only a small number of participatory studies that focus on children and young people’s experience of hospitalisation, and an even smaller number that include children and young people’s experience of hospital environments. The picture that is created by the research that exists is patchy. There is a need for a more holistic understanding of children and young people’s experience of hospitalisation and of hospital environments from their own perspectives. Based on these gaps in current knowledge, two research questions were developed. The first was concerned with describing children and young people’s experience of the sociophysical environment of a paediatric hospital. The second question was concerned with understanding the role of the physical environment in children and young people’s feeling of well-being in a hospital environment. In addressing these questions, the intention was to identify attributes within the hospital setting which collectively comprise a supportive environment for children and young people and which contribute to children and young people’s feeling of well-being in a paediatric setting. The current study was conducted as an exploratory qualitative case study and carried out at the Children’s Hospital at Westmead, in Sydney, Australia. Using participatory research techniques, the sequence of the study included two pilot studies and the main study. The focus was on understanding the experiences of longer-term patients of a paediatric hospital environment. In the main study 25 children and young people, aged between 9-18 years, who had been in hospital for at least a week completed semi-structured interviews in which they talked about their response to the environment of the hospital and their experience of hospitalisation. Data analysis was completed using a combination of concept mapping and thematic analysis techniques. Preliminary findings were used as the basis of a further member-checking task carried out with a further six children and young people before conclusions were reached. The findings reveal that children and young people’s experience of a paediatric setting involves a number of major areas of influence including their personal situation, their social experience, their interaction with the physical environment, opportunities and characteristics of the organisation, and the effect of time. The findings also reveal that children’s feeling of well-being within this experience is linked to their ability to feel comfortable in the environment, to maintain a positive state of mind, and to remain positively engaged with the experience and the environment. This research reveals a dynamic relationship between children and young people and a paediatric environment that children and young people actively manage and shape. It reveals some of the key considerations in children and young people’s experience of hospitalisation. It also reveals why these considerations are important and what role they play in patients’ experience and feeling of well-being. These findings provide the basis for further research and they have implications for future design and research practice in paediatric healthcare settings.
2
Lee, Wing-yee Wendy. "Hospital as playground." Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25948295.
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Karnas, Diana Maria Girardi. "The psychology of the environment in children's health care setting : James Whitcomb Riley Hospital for Children - Cancer Unit." Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/845987.
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Hospitals are constantly evolving to keep pace with the latest medical technologies. Whether it is a refurbishment of an existing facility or the addition of a new unit, the design process usually focuses on the technological requirements rather than the human elements of such an undertaking. The Riley Hospital for Children in Indianapolis presents an architectural opportunity to incorporate psychology of the environment into the design and construction of a new Cancer Unit. By balancing the technological requirements with the physical and psychological needs of the pediatric bone marrow transplant and hematology/oncology patients, one can create a healing environment more conducive to a rapid recovery.Department of Architecture
4
Soo, Yan Ho Michelle. "Coping with hospital admission in children /." St. Lucia, Qld, 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17815.pdf.
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Aniruth, Sunildutt. "Maxillofacial fractures in children attending the Red Cross War Memorial Children's Hospital." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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The literature shows that maxillofacial fractures in children are uncommon. Although the Department of Oral and Maxillofacial Surgery of the Faculty of Dentistry, of the University of the Western Cape, has been providing a service to the Red Cross Children&rsquos Hospital (RXH) for the past twenty years, no study had been undertaken to determine the age, gender, number of patients per year, aetiology, patterns, and management of maxillofacial fractures at this institution. A retrospective records based study was undertaken to determine these features. This study accessed the records of patients seen at the trauma unit at RXH, from 1994 to 2003 inclusive, and referred for maxillofacial attention.
One-hundred-and-five patient records were obtained and analyzed using the SPSS statistic package. One-hundred-and-twenty-seven fractures were recorded in one hundred and five patients. The age of the patients ranged from one to thirteen. Sixty-five male and forty female patients were seen. Dentoalveolar fractures were the most common fracture seen in both the midface and mandible. Midface fractures were more common than mandibular fractures. Falls, followed by motor vehicle accidents, were the most common cause of facial fractures. Most fractures were successfully managed by closed procedures. At this institution, nasal and frontal fractures have surprisingly little or no input from the Department of Oral and Maxillofacial Surgery.
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Lee, Wing-yee Wendy, and 李穎怡. "Hospital as playground." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31985294.
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Gurria, Juan P. "Thrombocytosis Following Pancreatectomy with Islet Autotransplantation in Children: Cincinnati Children's Hospital Experience." University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1521191336859138.
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O'Reilly, Glenda. "Families in today's health care system : the experience of families during pediatric admission." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=78189.
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The purpose of this study was to explore the experiences and needs of families during the admission of a child to a paediatric ward in an acute care hospital. Qualitative research methods were used to access the caregivers' and professionals' perceptions of the culture that families experience in a paediatric in-patient setting. For this project, data collection methods included a review of the literature in the area, individual interviews with caregivers, and focus groups with paediatric health care professionals.In the study, both parents and paediatric professionals described a multitude of experiences and needs of families during a child's admission to a paediatric ward in an acute care setting. Understanding the experiences and needs of families is important for professionals. The information collected in this study provides some insight into the culture that families experience when their child is admitted to a paediatric ward in an acute care hospital.
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Cyphers, Natalie, and Andrea D. Clements. "Caring for Foster Children in the Hospital Setting." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/7239.
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Children who are in the foster care system have already faced adverse childhood experiences (ACEs) placing them at greater risk for chronic health problems as well as a greater likelihood of experiencing traumatic medical stress. Additional challenges exist for children who are in the foster care system and are hospitalized. Biological and foster parents may not be available to support the child during their hospitalization. Procedures may trigger traumatic stress responses from child abuse or neglect. Pediatric nurses are in a unique position to support children in foster care during hospitalizations. Trauma informed care principles provide a guide for empathetic, family-centered nursing care. However, natural supports for children in foster care are often not available requiring nurses to collaborate in multidisciplinary approaches.
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Carvalho, Ana Rosa Rebelo Ferreira de. "A classe hospitalar sob o olhar de professores de um hospital público infantil." Pontifícia Universidade Católica de São Paulo, 2008. https://tede2.pucsp.br/handle/handle/15776.
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Previous issue date: 2008-12-15Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
This aim of this study was to understand the significance that teachers in a Hospital Class, at a children's hospital in São Paulo, give to their work. The term Hospital Class is recognized by the Ministry of Education and Sport s (MEC/ SEESP) Bureau for Special Education, and refers to pedagogic-educational care for children and young people, which takes place in health-care environments, whether in cases of hospitalization, daily or weekly outpatient services or full mental health treatment. Three teachers who have worked in Hospital Classes at a public children s hospital for at least a year took place in this research. Data were collected through semistructured interviews and analyzed from a qualitative approach perspective, by analyzing content. Data was collected at the hospital at a time and place chosen by the participants. After examining the data and the purpose of the study, three main themes were identified: the importance that the participants attach to their work; prospects for the future of the participants, and the participants educational background. The analysis showed that the teachers believe their work has a role that goes beyond that of a mere teacher. However, the participants reported feeling satisfied and recognized for the duties they perform, despite finding it difficult to cope with the socioeconomic status of patients and with possible deaths. The deaths of child patients affect their professional, personal and family lives, which probably occurs because of the lack of specific training, interdisciplinary work and psychological support. The results demonstrate that there is a need for specific preparation for working in a hospital environment and such individuals should be included in the health care team
O presente trabalho teve por objetivo compreender o significado que as professoras da Classe Hospitalar, de um hospital público infantil de São Paulo, atribuem ao seu trabalho. O termo Classe Hospitalar é reconhecido pela Secretaria de Educação Especial do Ministério da Educação e do Desporto (MEC/SEESP), e refere-se ao atendimento pedagógico-educacional a crianças e jovens, que ocorre em ambientes de tratamento de saúde, tanto em circunstância de internação como em atendimento em hospital-dia e hospital-semana ou em serviços de atenção integral à saúde mental. Participaram desta pesquisa três professoras que atuam em Classes Hospitalar de um hospital público infantil, a pelo menos um ano. Os dados foram coletados através de entrevistas semi-estruturadas e analisados a partir da perspectiva da abordagem qualitativa, por meio da análise de conteúdo. A coleta de dados foi realizada na instituição hospitalar em local e horário definidos pelas participantes. A partir dos dados coletados e do objetivo da pesquisa, foram definidos três núcleos temáticos: significado atribuídos ao trabalho pelas participantes; perspectivas de futuro das participantes; e contexto histórico de formação das participantes. A análise indicou que as professoras atribuem ao seu trabalho uma função que extrapola o papel de professor. Entretanto, as participantes relatam sentirem-se gratificadas e reconhecidas pela função que exercem, apesar de demonstrarem dificuldades em lidar com a situação socioeconômica dos pacientes e com possíveis óbitos. Em relação ao óbito de crianças, relatam afetá-las nas esferas profissionais, pessoais e familiares, o que provavelmente ocorre devido à falta de formação específica, à ausência de um trabalho interdisciplinar e de um serviço de apoio psicológico. Os resultados apontam para a necessidade de preparo específico para atuar no ambiente hospitalar e de incluir tais profissionais na equipe de saúde
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Tarrants, Marcy Lynnette Herman Robert D. "Pediatric versus non-pediatric hospital markets : determinants of operating margins." Diss., UMK access, 2007.
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Thesis (Ph. D.)--Henry W. Bloch School of Business and Public Administration and Dept. of Economics. University of Missouri--Kansas City, 2007."A dissertation in public affairs and administration and education." Advisor: Robert D. Herman. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed July 30, 2008 Includes bibliographical references (leaves 86-90). Online version of the print edition.
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Neal, Kamilah J. "An exploratory study of children’s hospital social workers’ attitudes toward children with physical disabilities." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2000. http://digitalcommons.auctr.edu/dissertations/3777.
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Social workers who interact with disabled children have developed unique attitudes and perceptions about physical disability in children and the disabling effects of material, social, and environmental components of society. Because of the unique problems associated with the care of physically disabled children, social workers are needed to provide ongoing services to help these children manage their disabilities and address their social and health concerns. This study was designed to elucidate the attitudes of social workers which may affect their interactions with disabled children. This information can be used to increase the effectiveness of social workers who plan to work with disabled children. This nationwide study is a preliminary investigation of the attitudes of social workers in children’s hospitals which are members of the National Association of Children’s Hospitals (NACH). Surveys were sent to seventeen social services departments in these hospitals and were distributed to full time social workers who interact with disabled children between the ages of 6 and 17. Sixteen surveys from 5 different hospitals were returned. All returned surveys were used in the study The survey consisted of three parts: 1) a demographic section; 2) the Attitudes Toward Disabled Children Scale; and 3) the Attitudes Towards Disablement Scale. The data were analyzed by using the Statistical Package for Social Sciences. Although the number of participating social workers was small, preliminary results indicate that social workers who serve physically disabled children have a positive attitude toward disabled children and feel that societal components are responsible for further disabling those children
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Smith, Lara. "Neurocognitive outcome of HIV-infected children on antiretroviral therapy at Red Cross Children's Hospital." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/11190.
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Includes bibliographical references (leaves 54-59).Central nervous system involvement contributes significantly to the morbidity and mortality of paediatric HIV infection. The spectrum of CNS morbidity varies from minor developmental disabilities to severe, progressive encephalopathy. Therefore regular developmental evaluation should be regarded as an essential component of the overall care of HIV-infected children. Antiretroviral therapy may arrest or even reverse neurocognitive and motor deficits associated with HIV infection.
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Navaratnarajah, Paramalingam Kandasamy. "Child malnutrition mortality at St Barnabas Hospital is high - is it due to practices and attitudes of staff?: a study in a rural district hospital." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
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The case fatality rate for malnutrition at St Barnabas Hospital over the past years has been around 38%. The rates in other district hospitals in the Eastern Cape province were found to be in excess of 30%. In June 2000, the Eastern Cape Department of Health introduced a protocol for in-patient management of children with severe malnutrition, with the aim of reducing case fatality rate below 10%. St Barnabas Hospital introduced the Eastern Cape protocol in August 2003. An evaluation was done in November 2003 to assess the protocol's impact on the case fatality rate. The rate remained high, at 37.5%. This study descibed the current practices and attitudes of the nurses as St Barnabas Hospital paediatric ward, in the management of severely malnourished childen.
15
Ravert, Russell D. (Russell Douglas). "Hospitalized School-Age Children: Psychosocial Issues and Use of a Live, Closed-Circuit Television Program." Thesis, University of North Texas, 1993. https://digital.library.unt.edu/ark:/67531/metadc500433/.
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This descriptive study utilized semi-structured interviews and observations to examine the experiences of hospitalized school-age children, and explore the potential of a live, closed-circuit television program as a psychosocial intervention. Among findings, Phase I data from 16 subjects indicates a) concern with painful medical procedures, particularly intraveneous (IV) injections, b) a desire for more information, especially concerning medical equipment, c) a variety of responses to social issues among subjects, d) the importance of activities, and e) the central role of the hospital playroom. Phase II data indicates that live, closed-circuit television can provide ambulatory and room-bound children opportunities for making choices, social interaction, participation, and information on their environment. Conclusions and implications are included.
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Omarjee, Zakiyya. "An audit of endocrine dysfunction in children with craniopharyngiomas at Red Cross Children's Hospital and Groote Schuur Hospital from 1976 to 2004." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/26765.
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Background: Craniopharyngiomas account for 6-10% of childhood brain tumours and are the third most common intracranial tumours of childhood. Despite their benign histological appearance, they are often associated with a poor outcome and have significant associated morbidity. Aim: To analyse the data of children with craniopharyngiomas at Red Cross Children's Hospital and Groote Schuur Hospital from 1976 to 2004 with respect to age at presentation, presenting symptoms and preoperative and post-operative endocrine dysfunction. Patients and methods: The records of 45 children aged between 9 months and 13 years were reviewed. The majority of children in the study were aged between 5 and 10 years. There was a considerable delay in the diagnosis in most cases especially in areas outside of Cape Town. Pre-operative tests prior to 2000 were incomplete but have improved since then. Twenty nine percent of our patients had a near total excision of the craniopharyngioma and 29% had partial excisions necessitating adjuvant radiotherapy. The endocrinological, neuro imaging and presenting symptoms were analysed and post-operative tests were reviewed. Where possible neuropsychiatric assessments were accessed as well in order to assess long term neurocognitive deficits Results: The age of presentation of craniopharyngiomas in our group of patients was much younger than in other studies with the largest group of affected children being between 5 and 10 years of age. The most common presenting symptoms in this group were headaches (62%) and visual disturbances (57%). Sixty four percent of the children had preoperative endocrine testing for pituitary dysfunction of which 59% were ACTH and TSH deficient and only 38% were growth hormone deficient. After surgery multiple endocrinopathies were universal with 56% of children having pan hypopituitarism at follow up. There was no reversal of pre-existing hormone deficits after surgery. The management of craniopharyngiomas remains controversial. Twenty nine percent of our patients had a near total excision and 29 % had a partial excision combined with radiotherapy with a further 6 patients receiving intratumoral bleomycin for recurrences. Post operatively the majority of children were on replacement therapy but only 6 patients (14%) received human growth hormone or are receiving human growth hormone currently due to a lack of funds to provide human growth hormone for children with growth hormone deficiency. Seventy percent of the children had central diabetes insipidus post operatively reflecting posterior pituitary damage. Our overall survival rate from 1976 to 2004 was 91 % with a mortality rate of 13%. Most of the deaths were attributed to recurrences of the craniopharyngioma and the complications of bleomycin treatment. Conclusion: Craniopharyngiomas remain tumours associated with significant morbidity. Total excision of the tumour remains a favourable option but the proximity of the craniopharyngioma to the pituitary gland and optic tracts results in devastating sequelae. Although the medical and surgical management of craniopharyngiomas has improved, a significant number of patients had endocrine sequelae. The management of craniopharyngiomas in an African context compares favourably internationally but with limited resources especially with regard to growth hormone replacement, a large proportion of our children are not receiving optimal treatment.
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Sfandyari, Fard E. "An investigation into the consideration of children and young peoples' preferences in children's hospital design." Thesis, University of Salford, 2013. http://usir.salford.ac.uk/30693/.
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This study was conducted to increase the understanding of the involvement of children in the design process of the children's hospitals environment from their perspectives. It was aimed to build rich picture of the process, methods, benefits and problems associated with engaging children during the design process of children’s hospital. It also provides a set of guidelines to apply for the process of involvement, which can be applied in future design projects conducted with children. This study was conducted to increase the understanding of the involvement of children in the design process of the children's hospitals environment from their perspectives. It was aimed to build rich picture of the process, methods, benefits and problems associated with engaging children during the design process of children’s hospital. It also provides a set of guidelines to apply for the process of involvement, which can be applied in future design projects conducted with children. The research methodology employed a case study approach, including two case studies: Royal Alexandra children’s Hospital and Royal Manchester Children’s Hospital. The process of identifying children’s preferences and considering them into the different stages of the design process is described. Different research techniques have been applied, including literature review and synthesis, interviews and content analysis. The contribution of this research is to address the gap identified in the literature and practice between the hospital design process and the needs of its users, i.e. children. It is intended to addresses the role of user perspective, the empowerment of the users, and the quality of the final outcome. These issues are examined from the points of view of hospital staff, designer, PFI. As a result, a better understanding of children and young people’s participation during the design process of hospital was achieved. The research has produced a set of guidelines for the process of involvement, which can be applied in future design projects to support project teams to define the process and tools for children’s participation.
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Myers, Basil Joseph. "School, hospital information exchange, boundary spanning for chronically ill children." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/nq20759.pdf.
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Costa, Diogo Manuel Ferreira Dias da. ""Joãozinho", Hospital de S. João do Porto: a proposal for a brand identity for the new pediatric hospital." Master's thesis, NSBE - UNL, 2012. http://hdl.handle.net/10362/9520.
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and EconomicsThe purpose of this research is to recommend a brand identity for Joãozinho brand. This one is linked with the new pediatric hospital of Hospital de São João do Porto and with the fundraising project named “Um Lugar para o Joãozinho”. For this, a 360º market research, with the most important stakeholders, was conducted. The aim was to comprehend how children perceived the brand’s mascot (Joãozinho), what characteristics of a pediatric service parents look for, what makes companies help this project (either through sponsorship agreements or other means of financial aid) and what do brand builders want for the brand.
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Switala, Juli. "Evaluation of children with haemophagocytic lymphohistiocytosis (HLH) at Red Cross War Memorial Children's Hospital 1991-2010." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11104.
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Includes bibliographical references.Haemophagocytic Lymphohistiocytosis (HLH) is a rare haematological disorder in children. However, this is probably an underestimation due to the difficulty in diagnosing the disease. HLH is characterized clinically by persistent fevers, organomegaly, cytopaenias and typical biochemical derangements viz. hypertriglyceridaemia, hyperferritinaemia and hypofibrinogenaemia. Other associated findings include decreased natural killer cell (NKC) function and raised soluble CD 25. The exact pathophysiology of HLH is not completely understood but involves a trigger (often an infection) which sets off an uncontrolled inflammatory cascade, characterized by an increase in hyperactivated macrophages and T lymphocytes which leads to increased production of cytokines, alongside reduced cellular cytotoxicity as a result of reduced or absent NKC function.
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Buys, Heloise. "Klebsiella pneumoniae bloodstream infections in hospitalised children at Red Cross War Memorial Children's Hospital : 2006 - 2011." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/19901.
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Background: Klebsiella pneumoniae (KP) is a significant paediatric bloodstream pathogen in children. There is little data about KP in South African children. The focus for the present study was to address this knowledge gap. Methods: This study addressed a retrospective case notes review on bloodstream Klebsiella pneumoniae infections at a children's hospital in Cape Town, South Africa 2006-2011 using conventional descriptive and comparative statistical methods. Results: Of 410 hospitalised children with laboratory confirmed KP bloodstream infection (KPBSI), 339 (83%) were presumed extended-spectrum β-lactamase (ESBL) producing isolates. The median age (interquartile range, IQR) was 5.0 (2-16) months, 212 (51.7%) were male, 82 (20%) were HIV-infected, and 241 (58.8%) were moderately or severely underweight. The infection was nosocomial or healthcare-associated in 389 (95%) children and community-acquired in 21 (5%) children. Significant risk factors for the acquisition of ESBL-KP bloodstream infection included cephalosporin exposure in the preceding 12 months prior to the KPBSI p=<0.0001: aRR 1.25 (95% CI: 1.15-1.36); and those who had intravenous infusions for more than 3 days prior to the KPBSI, p=0.004: aRR 1.18 (95% CI: 1.05-1.31).
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Lindsay, Bruce. "Who cares? : the morphology of 'caring' in children's hospitals, 1852-1950, with special reference to the Jenny Lind Hospital for Sick Children, Norwich." Thesis, University of East Anglia, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.323466.
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Stewart, Moira Connell. "An examination of the factors associated with the presentation of children at the Royal Belfast Hospital for Sick Children and of the hospital resources used in their management." Thesis, Queen's University Belfast, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.357511.
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Berkley, James Alexander. "Invasive bacterial infections in children at a sub Saharan district hospital." Thesis, University of Newcastle upon Tyne, 2002. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.289202.
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Rini, Annie. "Anticipatory Mourning in Caregivers With Children Who Die in the Hospital." UNF Digital Commons, 2002. http://digitalcommons.unf.edu/etd/219.
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The death of a child has tremendous impact on a caregiver. Even when prognosis is poor and death appears imminent, care of the dying child typically focuses on achieving cure. Consequently, caregivers are often ill prepared to cope with the grief they experience as their child is dying. Anticipatory mourning allows caregivers time to begin grief work prior to the death of a loved one. Literature suggests that those who experience anticipatory mourning have a less complicated bereavement period. The purpose of this qualitative study is to (a) describe the presence (or absence) and role of anticipatory mourning in caregivers who recently experienced the death of a hospitalized child and to (b) determine if consistent themes exist that caregivers describe as helpful or detrimental to them during this process. An exploratory, descriptive design was used to answer questions in focused, guided, semi-structured, in-depth, tape-recorded interviews. Thematic content analysis derived themes from the interview transcripts of a sample of 11 caregivers who recently experienced the death of a hospitalized child. Caregivers' descriptions of their experiences surrounding the death of their child reveal an environment and health care team that is often ill prepared to deal with the impending death of a child. Also described are instances that reflect a compassionate process that positively affects the experience while facilitating appropriate grief work. Offered are recommendations for health care professionals that may assist caregivers in coping with the death of their child.
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Dame, Joycelyn Assimeng. "Pseudomonas aeruginosa bloomstream infection at a tertiary referral hospital for children." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32633.
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Introduction This study describes the disease burden, clinical characteristics, antibiotic management, impact of multidrug resistance and outcome of Pseudomonas aeruginosa bloodstream infection (PABSI) among children admitted to a tertiary referral hospital for children in Cape Town, South Africa. Methods A retrospective descriptive study was conducted at a paediatric referral hospital in Cape Town, South Africa. Demographic and clinical details, antibiotic management and patient outcome information were extracted from medical and laboratory records. Antibiotic susceptibility results of identified organisms were obtained from the National Health Laboratory Service database. Results The overall incidence risk of PABSI was 5.4 PABSI episodes / 10,000 hospital admissions and the most common presenting feature was respiratory distress, 34/91 (37%). Overall, 69/91 (76%) of the PA isolates were susceptible to all antipseudomonal antibiotic classes evaluated. Fifty (55%) of the PABSI episodes were treated with appropriate empiric antibiotic therapy. The mortality rate was 24% and in multivariable analysis, empiric antibiotic therapy to which PA isolate was not susceptible to, infections present on admission, and not being in the intensive care unit at the time that PABSI was diagnosed were significantly associated with 14-day mortality. Conclusion The study provided insight into factors associated with PABSI in a tertiary hospital in SubSaharan Africa. Empiric antipseudomonal antibiotic therapy was associated with a decrease in 14-day mortality.
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Malebye, Manthodi Alina. "Causes of Hospital re-administrations of HIV / AIDS children at Dr George Mukhari hospital during the year 2003." Thesis, University of Limpopo (Medunsa Campus), 2011. http://hdl.handle.net/10386/1080.
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Thesis (MPH) -- University of Limpopo, 2011.Introduction HIV/AIDS is major cause of child mortality and an increase in the number of sick children presenting to health services worldwide (UNICEF 2008). A significant number of children live with HIV/AIDS in South Africa. Research indicates that in poor resourced countries, there is an increase in the prevalence of hospital admissions and re-admissions among HIV infected children as compared to developed countries. Research data on hospital admissions, treatment and care of HIV positive children South Africa is limited. Objectives This study was therefore initiated to determine the demographic and clinical causes of HIV positive children admitted and readmitted at the paediatric ward of Dr George Mukhari Hospital (DGMH), South Africa in the year 2003. Methods This was mainly a descriptive quantitative study using medical records of HIV infected children admitted and readmitted in the paediatric ward of DGMH from 1st January to 31st December 2003. A full census of all the records of children admitted in the two paediatric wards was carried out. Descriptive and inferential statistics were used to analyze data. Results The study comprised 74 children, 28 (37.8%) female and 48 (62.2%) males. The average mean of initial admission length of hospital stay was 12.3 days and (SD = 12.1) days. The different diagnoses were classified in accordance with World Health Organization (WHO) Clinical Staging of HIV disease for infants and children with established HIV infection. Out of a total of 581 initial admissions, 74 (12.7%) children were readmitted. The mean interval days between the discharge date and readmission date was 9.8 days (SD = 7.0 days) and 94.6% of the readmissions occurred within the first two weeks of discharge date. Second readmission decreased by 75.3% as only 18 patients were readmitted. A further 95.9% decrease in the third readmission was noted with only 3 patients getting readmitted. iv The commonest causes of admission with HIV were broncho-pneumonia, gastro-enteritis, vomitting, oral thrush, immunosuppression with symptoms like fever,cough, respiratory distress. Causes of readmissions were broncho-pneumonia, oral thrush, diarrhoea, vomitting, immunosuppression, pulmonary tuberculosis, wasting and failure to thrive, dehydration associated with symptoms like fever, cough, respiratory distress and upper respiratory distress. Conclusion The rate of readmission was (12.7%) and majority of the readmitted children were in the 0- 2-year age group. The study results show a high prevalence of diseases of the respiratory system with a high frequency of broncho-pneumonia and a high prevalence of diseases of the digestive system with a high frequency of gastro-enteritis. The average mean of the initial hospital admission stay was 12.3 days, which was significantly higher than other studies previously conducted. The probable reason for a long hospital stay could be the high prevalence of co-infections among the children admitted.
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Chung, Yuk-lan Ida, and 鍾玉蘭. "A systematic review on integrated care pathway for children who need surgical intervention." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B45011758.
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Mlotha-Mitole, Rachel. "A retrospective review of acute liver failure in children admitted at Red Cross War Memorial Children's Hospital." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33863.
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Acute liver failure (ALF) describes a clinical syndrome resulting from severe liver damage and extensive loss of functional parenchymal liver mass triggered by various factors. Early recognition and initiation of specific therapy may improve outcomes and reduce the need for liver transplantation, a treatment modality not universally available in resource constraint areas. There is paucity of data describing this syndrome in Sub-Saharan Africa in children. Objective This study aims to retrospectively review and determine the clinical presentation, aetiology, complications & outcome of ALF in children admitted at the Red Cross War Memorial Children's Hospital (RCWMCH). Methods All records of children from 0 to 13 years admitted at the RCWMCH over the period from January 2005 to December 2016 with ALF were retrospectively reviewed, after obtaining ethical approval. Patients with pre-existing evidence of chronic liver disease were excluded. Demographic variables as well as clinical presentation and investigations were captured, with determination of outcomes at 3 weeks and 6 weeks of diagnosis. Results Study included 24 children., 16 females (66.7%) and 8 males (33.3%). Median Age was 15 months, with interquartile range from 5 to 28 months. Diarrhoea, jaundice, respiratory distress, hepatomegaly and encephalopathy were common clinical features. Aetiology was infection in 37.5 % of cases (n=9, 2 of whom had autoimmune hepatitis comorbidity) and hepatitis A was most common infectious cause (n=4, 44%). Causes were indeterminate in 29.2%. Two patients had autoimmune hepatitis without co-morbidity; Reye syndrome 12.5% and 17% had miscellaneous causes. Transaminases were raised to thousands in viral causes of hepatitis, with a low C reactive protein. INR >4 and Total Bilirubin>210umol/L were associated with death outcome (p=0.04 and p=0.03 respectively. Conclusion Viral hepatitis A is the leading infective cause of acute liver failure in this study cohort and 29.2% of cases were indeterminable. INR >4 and Bilirubin > 210umol/l were predictors of poor outcome. Follow up study is recommended to better understand clinical spectrum and outcomes of children with acute liver failure in this low resource setting.
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D'Agostino, Janice. "A child's impressions of hospitalization /." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33457.
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The research problem in this qualitative, pilot study explores a child's impressions of hospitalization while in hospital.Nine children who were in-patients on a pediatric unit of an acute care hospital were interviewed using a semi-structured, self-constructed questionnaire.
The principal finding indicates that these children experienced a neutral emotional response to their hospitalization. Although the subjects were chosen randomly, all children resided in two parent families. This may be a significant factor in enhancing their ability to master hospitalization. Second, their neutral impression of hospitalization may be based on receiving a reasonable level of health care in a child centred environment with support from family.
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Kinnula, S. (Sohvi). "Hospital-associated infections and the safety of alcohol hand gels in children." Doctoral thesis, Oulun yliopisto, 2012. http://urn.fi/urn:isbn:9789514299001.
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Abstract Viral infections are common in childhood and a usual cause for hospitalization. Viruses are easily transmitted among children both in pediatric wards and in other child care facilities, like child day-care centers. Hand hygiene is an important part of prevention of the transmission of viruses. Since hospitalization times are getting shorter, hospital-associated infections often manifest after discharge. The aim of the study was to evaluate the magnitude of hospital-associated infections during and after hospitalization in pediatric wards with a focus on the effect of the ward structure. Data were collected during two periods of two years in the pediatric infectious diseases ward in Oulu University Hospital; data collection in the latter period was done using electronic follow-up methods. A two-year study period was also carried out in University Children’s hospital in Basel and in North Karelia Central Hospital in Joensuu. Paper questionnaires and electronic questionnaires were compared as methods of doing continuous surveillance of hospital-associated infections during and after hospitalization. The safety of alcohol-based hand gels in children’s use was studied using alcometer measurements after hand rub. Experiences on the use of alcohol-based hand gels in child day-care centers were collected by interviewing the personnel with questionnaires. Altogether 5.8 to 17.5% of hospitalized children (N=7046) got a hospital-associated infection; 65 to 93% of the infections became evident after discharge. The number of hospital-associated infections was lowest in wards where single rooms and cohorting based on infection etiology were used. Increased risk for hospital-associated infection was associated with young age, longer hospitalization time and a shared room. A higher response rate was achieved with electronic follow-up compared with questionnaires on paper, 84 vs. 61%. The costs of follow-up were €13.61 and €15.07 per patient in electronic and conventional follow-up, respectively. Electronic follow-up decreased annual expenses by 17.1%. Alcohol-based hand gels were found to be safe in children’s use, as no absorption was detected despite several contacts between hands and mucous membranes. Personnel in child day-care centers were active in using hand rubs and found them useful and easy to use. Earlier, there had been one incident with fire when using matches while hands were still wet with alcohol. The majority of hospital-associated infections in children become evident after discharge, and electronic follow-up is useful in evaluating their magnitude. The number of hospital-associated infections can be decreased with single room bedding and careful infection control. Alcohol-based hand gels are safe in children’s hand hygieneTiivistelmä Lapset sairastavat usein virusinfektioita, jotka ovat yleinen sairaalahoidon syy. Virukset leviävät herkästi lasten keskuudessa, lastentautien osastoilla ja lapsiryhmissä, kuten päiväkodeissa. Virusten leviämistä voidaan estää hyvällä käsihygienialla. Lyhyiden hoitoaikojen vuoksi osa virusten aiheuttamista sairaalainfektioista ilmenee vasta kotona. Tutkimuksen tarkoituksena oli selvittää sairaalainfektioiden määrä hoidon aikana ja kotiutuksen jälkeen sekä osastorakenteen vaikutus sairaalainfektioihin lastentautien osastoilla. Sairaalainfektioaineisto kerättiin Oulun yliopistollisen sairaalan lasten infektio-osastolla kahtena kahden vuoden jaksona, joista jälkimmäisessä käytettiin sähköistä seurantajärjestelmää. Lisäksi kahden vuoden aineistot kerättiin Pohjois-Karjalan keskussairaalan lastentautien osastolla ja Baselin yliopistollisen sairaalan lastenosastoilla. Paperikyselylomakkeilla ja sähköisesti tehdyn sairaalainfektioseurannan toteutusta verrattiin. Lisäksi tutkittiin alkoholikäsihuuhteiden käytön turvallisuutta lapsilla päiväkotiolosuhteissa. Alkoholin imeytymistä tutkittiin poliisin tarkkuusalkometrillä käsihuuhteen käytön jälkeen. Oulun kaupungin päiväkodeista kysyttiin käsihuuhteiden käyttökokemuksista kyselylomakkeilla. Sairaalainfektion sai 5,8-17,1 % sairaalassa hoidetuista lapsista (N=7046). Infektioista 65-93 % tuli oireisiksi kotiutuksen jälkeen. Sairaalainfektioiden määrä oli pienin osastoilla, jossa käytettiin yhden hengen huoneita ja potilaiden kohortointia taudinaiheuttajan mukaan. Sairaalainfektion riskiä lisäsivät lapsen nuori ikä, pitkä sairaalahoitoaika ja jaettu potilashuone. Sähköisessä sairaalainfektioseurannassa oli parempi kotiutuksen jälkeinen vastausprosentti kuin paperilomakkeilla, 84 % vrt. 61 %. Potilasta kohden kuluja tuli sähköisessä seurannassa 13,61 euroa ja paperilomakkeilla tehdyssä seurannassa 15,07 euroa. Sähköisen seurannan käyttö laski vuosikuluja 17,1 %. Alkoholikäsihuuhteiden käyttö todettiin turvalliseksi lapsilla. Useista limakalvokontakteista huolimatta käsihuuhteen käytön jälkeen alkoholia ei imeytynyt verenkiertoon. Käsihuuhteiden käyttö päiväkodeissa on aktiivista, ja henkilökunta koki sen helpoksi ja hyödylliseksi. Aiemmin oli tapahtunut yksi vaaratilanne tulen kanssa tulitikkua sytytettäessä käsien ollessa vielä käsihuuhteesta märät. Lasten sairaalainfektioista suuri osa ilmenee kotiutuksen jälkeen, ja näiden infektioiden määrää voidaan arvioida sähköisellä seurantajärjestelmällä. Sairaalainfektioiden määrää voidaan vähentää käyttämällä yhden hengen huoneita ja huolehtimalla hyvästä hygieniasta. Alkoholihuuhteiden käyttö lasten käsihygieniassa on turvallista
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Rutledge, M. Hannah. "Patient Family and Hospital Staff Information Needs at a Pediatric Hospital: an Analysis of Information Requests Received by the Family Resource Libraries." Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc801947/.
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This research explored the information needs of patient families and hospital staff at a pediatric hospital system in Dallas, Texas. Library statistics recorded in four hospital libraries from 2011 - 2013 were used to analyze the information requests from patient families and hospital staff. Crosstabulations revealed the extent to which patient families and hospital staff used the libraries to satisfy their information needs. The data showed that patient families used the libraries very differently than hospital staff. Chi-square tests for independence were performed to identify the relationships between the Classification (Patient Family, Hospital Staff) and two descriptors of information needs (Request Type, Resources Used). There were a total of 1,406 information requests analyzed. The data showed that patient families and hospital staff information requests differed greatly in the number of information requests, the type of information requested, the resources used and the time the library staff spent on the requests. Chi-square analyses revealed relationships statistically significant at the p < .05 level; however, the strength of the relationships varied.
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Page, Jacqueline. "Parent and physician decision making in children with suspected ear infection presenting to a children's hospital emergency department." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0017/MQ48175.pdf.
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Kija, Edward Nkingwa. "Bone metabolism abnormalities in children with epilepsy at Red Cross War Memorial Children's Hospital, Cape Town, South Africa." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27013.
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Introduction: Epilepsy is the most common neurological condition worldwide. Literature on the antiepileptic medications and biochemical markers of bone metabolism has revealed inconsistent results. Most of these studies were undertaken in Europe and America where the burden and the associated comorbidities are different to the ones in Africa. Methods: A hospital based case control study was undertaken at Red Cross War Memorial Children's Hospital where children were recruited from a dedicated Epilepsy clinic and controls were obtained from a day surgical ward. Blood and urine samples were taken for the assessment of markers of bone metabolism. Results: Seventy-five cases and 75 controls were recruited. The median age for the children with epilepsy was 9 years with a range of 1 to 17 and controls 3 years with a range of 1 to 12. Vitamin D deficiency was present in 11(16.2%) of children with epilepsy compared to 6(8.8%) in the control group. Vitamin D insufficiency was present in 30(44.1%) in children with epilepsy compared to 27(39.7%) in the control group. Children with epilepsy on enzyme inducing AEDs had lower mean Vitamin D levels (24.67±11.4 vs 30.72±7.4, p=0.08), lower mean Vitamin D2 (0.25±0.07 vs 0.4±0.17,p=0.0018),lower mean Vitamin D3 (1.61±1.06 vs 2.58±0.86,p=0.004), lower mean serum phosphate levels (1.39±0.2 vs 1.76±0.7,p=0.000) and a higher mean parathyroid hormone levels (4.47±2.33 vs 2.7±0.97, p=0.03) compared to the control group. Children with Epilepsy on enzyme inhibitors had higher mean Vitamin D2 (0.44±0.37 vs 0.25±0.07,p=0.000004) and mean Vitamin D3 (2.26±0.86 vs 1.61±1.06,p=0.028) compared to children on enzyme inducers. Dietary intake and ancestry did not influence Vitamin D levels between the cases and controls. Conclusion and Recommendations: Vitamin D deficiency is common in children with epilepsy on AEDs. Children on enzyme inducing AEDs should be investigated for vitamin D deficiency and managed accordingly.
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Mteshana, Phindile. "Use of the PCR technique to diagnose meningitis in children admitted to Red Cross War Memorial Children’s Hospital." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30122.
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Introduction: Viral meningitis (VM) is more common than bacterial meningitis (BM) and is a self-limiting disease. Clinicians still tend to admit patients with VM and treat them for BM because they fear the morbidity and mortality that is associated with a delay in treating or not treating BM. Unnecessary admissions have huge cost implications and they separate children from their parents while exposing them to painful procedures and unnecessary antibiotics.
Methods: A structured literature review was undertaken to see whether clinical manifestation and examination findings and laboratory findings including viral PCR of cerebrospinal fluid can help to diagnose viral meningitis and avoid unnecessary admissions.
Results: Viral and bacterial meningitis have similar clinical findings. CSF examination is crucial in confirming the diagnosis of meningitis. Microscopy and culture remain the gold standard in making the diagnosis. The introduction of the Haemophilus influenzae type b and pneumococcal vaccines into the South African Expanded Programme on immunization (EPI) markedly reduced the incidence of invasive Haemophilus influenzae type b and pneumococcal disease in children under 5 years-of-age as in other countries where they are used. Viral meningitis is the leading cause of childhood meningitis however the clinical and CSF findings in viral meningitis and bacterial meningitis overlap. The sensitivity of CSF culture has been shown to be around 81.3%, but is very much affected by prior antibiotics. Traumatic/bloody CSF taps also make it difficult to interpret 10 results. Inflammatory markers have been used in conjunction with CSF results in differentiating between BM and VM however, the use of polymerase chain reaction technique in the diagnostic methodology improves the sensitivity to more than 95%.
Conclusion: Viral meningitis is common worldwide. Real-time multiplex PCR offers value in accurately detecting common viral and bacterial pathogens thus allowing for appropriate patient management. In order to avoid the risk of not identifying organisms not included in the PCR assay and further not being able to do susceptibility testing on those organisms, it important to realize that PCR testing would have to be done in addition to culture, and not as a replacement.
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Eke, Christopher Bismarck. "A Retrospective review of medical gastrointestinal endoscopy in children attending Red Cross War Memorial Children’s Hospital, Cape Town." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31539.
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Background: Gastrointestinal endoscopy has evolved to become an important diagnostic, therapeutic as well as surveillance and follow-up modes of management in children with diverse gastrointestinal diseases. There is a paucity of data on gastrointestinal endoscopy in children in the sub- Saharan African region. The objectives of the study were to describe the socio-demographic characteristics; presenting symptoms; indications; endoscopic yield; impact of endoscopy on management; as well as its safety profile and complications. In addition algorithms for the indications of medical gastrointestinal endoscopy in children were designed using the results derived from the presenting symptoms and indications for gastrointestinal endoscopy among the patients. Methods: This was a cross sectional descriptive study. Subjects were children < 18 years attending Red Cross War Memorial Children’s Hospital (RCWMCH) who underwent medical gastrointestinal endoscopic procedures from 2007 to 2016. Study ethical approval was obtained from University of Cape Town while written permission from the RCWMCH Research and Management Committee prior to the commencement of the study. Data sheet was used in retrieving relevant patients variables from the hospital’s medical records and the Division of Paediatric Gastroenterology endoscopy and laboratory (histopathology) databases. Data was analysed using Stata 13.1. A p- value of less than 0.05 was considered statistically significant. Results: A total of 402 children were studied with 773 endoscopies performed comprising 670 oesophagogastroduodenoscopies (OGD) and 103 colonoscopies. For OGD: 179 (26.7%), 287(42.8%) and 204 (30.4%) procedures were for diagnostic, therapeutic and follow - up indications. A total of 78 (10.1%) combined OGD/colonoscopy were carried out. Out of 103 total colonoscopies performed, 67 (65.0%), 30(29.1%), and 6 (5.8%), were for diagnostic, follow - up and therapeutic indications respectively. vi Feeding difficulty 112 (25.4%) and rectal bleeding 11 (2.7%) were the main presenting symptoms for OGD and colonoscopy respectively. Main diagnostic indications for OGD, combined OGD/colonoscopy and colonoscopy alone respectively were chronic abdominal pain 51 (12.6%) and probable inflammatory bowel disease (IBD) 30 (7.5%) and IBD 30 (7.5%). Change 143 (35.6%)/ insertion 87(21.6%) of percutaneous gastrostomy were the most common therapeutic indications for OGD and polypectomy 8 (2.7%) for colonoscopy. Abnormal (positive) macroscopic findings on endoscopy were reported on 79/179(44.1%), 35/68(51.55%), and 46/67(53.7%) of OGD, combined OGD with lower scope, and colonoscopy alone respectively. Also, positive histological findings on OGD, combined OGD with colonoscopy, and colonoscopy alone were reported in 62/179(34.6%), 34/68(50.0%), and 32/67(47.8%) respectively. The overall normal endoscopic findings (both abnormal macroscopic findings on endoscopy and histological findings) were 63/179(35.3%) and 25/67(37.3%) for OGD and colonoscopy while overall diagnostic (endoscopic) yield was 116/179(64.8%) for OGD and 42/67(62.7%) for colonoscopy respectively. For OGD the main endoscopic yield reported were gastritis in 50(27.9%) and oesophageal varices 31(17.3%) while inflammatory bowel disease (Crohn’s disease 9(13.4%), ulcerative colitis 7(10.4%), juvenile polyps 9(13.4%) and intestinal tuberculosis 7(10.4%) were observed in colonoscopy respectively. A significant impact of endoscopy on the management of subjects were recorded in 298(74.1%) (p < 0.001) including diagnostic (change of medication, addition of new medication) and therapeutic (insertion/change of PEG; sclerotherapy 29 (9.8%) , band ligation of oesophageal varices 28 (9.4%), and polypectomy 8(2.7%)). The overall complication rate was 4.0% (16 patients). Conclusion: Feeding difficulty and rectal bleeding were the most common presenting symptoms for OGD and colonoscopy; with chronic abdominal pain and IBD being the most common indication for performing OGD and colonoscopy respectively. Therapeutic modalities of endoscopy performed were PEG insertion/change, polypectomy, sclerotherapy/band ligation for varices. vii Endoscopic yield was 116/179(64.8%) for OGD and 42/67(62.7%) for colonoscopy respectively a significant impact of endoscopy on the management of subjects were recorded in 298(74.1%) (p < 0.001). No mortalities were recorded following the procedures, however 16(4%) had some complications. Use of societal guidelines in selecting children with appropriate indications for gastrointestinal endoscopy will result in higher diagnostic yield and application of therapeutic modalities in children with gastrointestinal disorders resulting in significant impact on patient’s management and minimize complications.
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Jroundi, Imane. "Epidemiology and aetiology of severe respiratory infections among children under five, admitted to the children hospital of Rabat, Morocco." Doctoral thesis, Universitat de Barcelona, 2015. http://hdl.handle.net/10803/396205.
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Pneumonia is one of the major public health problems threats to child survival in large parts of the world. The burden of this disease in terms of morbidity and mortality remains unacceptably high with almost one million children dying every year as a result of pneumonia episode. Over 90% of these pneumonia-associated deaths in young children occur in developing countries and are mainly secondary to bacterial infections. The availability of effective vaccines against bacterial pneumonia, coupled with adequate and efficacious antibiotic treatments, should be sufficient to reduce this burden.
In Morocco, a middle income country of North Africa, Pneumonia is the first cause of death of children under five of age. However, few data is available regarding its etiology and epidemiology.
The first article of this thesis attempts to comprehensively review what was the available knowledge regarding pediatric pneumonia in Morocco, prior to the initiation of this project. Indeed, scarcity of data often hinders the implementation of measures to prevent and better manage these infections. This review confirms the alarming lack of recent data regarding pediatric pneumonia one of the major killers of children in Morocco.
The second article of this thesis is a general overview on the epidemiology, etiology and the clinical presentation of acute respiratory infections in Moroccan children under the age of five years. Through our study, we were able to show a high prevalence of viral infections, with wheezing as the major clinical symptomatology. These findings are similar to what can be found in wealthy countries and markedly differ from the high bacterial burden that can be found in poorer settings, although overall case fatality rates remained unacceptably high in our setting.
As a result of afore mentioned high case fatality rates in our series, we decided to investigate the specific risk factors upon admission for a bad prognosis during hospitalization. The results of this analysis are presented in the third article of this thesis. The article concluded that the early identification of factors associated with a poor prognosis could improve management strategies and the survival likelihood of Moroccan children with severe pneumonia.
In the fourth article of this thesis, we chose to focus on two highly prevalent and potentially hazardous viruses causing acute respiratory infections in our setting, namely respiratory syncytial virus (RSV) and Human metapneumovirus (hMPV). In this analysis, we compared the epidemiological, clinical and laboratory features of these two infections, and concluded that despite the clinical presentation of those two pathogens was almost indistinguishable, hMPV tented to be highly more severe and significantly associated to a poor outcome. An early recognition of these viruses and good management of the cases is important to guarantee a better outcome.
The fifth article of this thesis specifically addresses the use of antibiotics to treat acute respiratory infections in Morocco. By analyzing data on pre-admission antibiotics use, and intra-hospital antibiotics utilization, we discuss whether such valuable drugs are used rationally in the country. This analysis also reflects on whether antibiotic usage may have had or not an impact on antimicrobial resistance rates.
The last article of this thesis examines data on the distribution of serotypes among streptococcus pneumoniae isolates from the nasopharynx of healthy children and compares it to those isolated among admitted children with clinical severe pneumonia. These data will be used as a baseline to help assessing the impact of the pneumococcal vaccine and to monitor any potential serotype replacement phenomena.
Altogether, this thesis tries to offer a comprehensive snapshot of the situation of pediatric pneumonia in Morocco.A pesar de los esfuerzos hechos para reducir la carga de mortalidad causada por las infecciones respiratorias agudas, estas enfermedades se mantienen como uno de los principales peligros para la salud infantil en amplias zonas del mundo. Las medidas de control existentes son claramente insuficientes a la hora de reducir globalmente el impacto de infecciones tan comunes en la infancia. De hecho, la carga de estas enfermedades en términos de morbilidad y mortalidad persiste inaceptablemente alta con, anualmente, cerca de un millón de muertes anuales, lo que es lo mismo, una muerte cada 34 segundos. Las infecciones respiratorias agudas, siendo la neumonía su forma más paradigmática, son responsables del 15% de las muertes de niños menores de 5 años en el mundo. Más del 90% de estas infecciones respiratorias agudas se producen en los países en vías de desarrollo, fundamentalmente asociadas a neumonías bacterianas. Mientras que la enfermedad clínica puede afectar a cualquier grupo de edad, la mortalidad por neumonía se ve esencialmente circunscrita a los niños menores de cinco años en los países pobres. La disponibilidad de vacunas efectivas contra las neumonías bacterianas, sumada al uso adecuado de los tratamientos antibióticos, debería ser suficiente para reducir esta carga. Sin embargo, la identificación y tratamiento precoz de los episodios clínicos y al acceso a los centros de salud parecen constituirse como barreras infranqueables en la mayoría de los países pobres. Adicionalmente, la malnutrición y el bajo nivel socio económico imperante en muchos de estos entornos dónde las neumonías son un mayor problema, contribuyen desfavorablemente al mal pronóstico de estas infecciones. El conocimiento de los determinantes locales específicos de la enfermedad respiratoria aguda pediátrica en esos entornos ayudaría a entender o mejor por qué todavía estamos muy lejos de controlar adecuadamente estas infecciones, y profundizar sobre las razones por las cuales siguen causando un impacto tan importante en la salud del niño.
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Antwi, Sampson. "Audit of posterior urethral valve (PUV) in children at Red Cross Children Hospital, Cape Town, January 2002 - January 2009." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/11891.
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Includes abstract.Includes bibliographical references (leaves 64-72).
Posterior urethral valve (PUV) is a congenital obstructing membrane of the male urethra. It is the commonest cause of bladder outlet obstruction in male children. PUV as a cause of obstructive uropathy is an important cause of end stage renal failure (ESRF) in children. Early detection and surgical intervention can slow down progression to ESRF.
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Chen, Ying. "Epidemiological analysis of inpatient cases of rotavirus diarrhea in a children's hospital in Guangzhou, China." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42994056.
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Sherman, Sandra Anne. "Healing effects of the built environment." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 2008. http://wwwlib.umi.com/cr/ucsd/fullcit?p3321036.
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Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2008.Title from first page of PDF file (viewed Aug. 1, 2008). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 120-127).
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Mutale, Wilbroad. "Assessing palliative care needs in children with HIV and cancer: the case of children attending University teaching hospital in Zambia." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16655.
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Includes bibliographical referencesBackground: WHO has been advocating for provision of palliative care for all who need it according to needs and context. Though significant advances have been achieved in providing palliative care for adults in Sub Saharan Africa, very little progress has been made in providing paediatric palliative care. Coverage of paediatric palliative care services have remained low and there is lack of evidence on child specific palliative care needs and tools for assessing these needs. This study tested applicability of some tools for assessing palliative needs in children in the Zambian context and reports palliative care needs of children and their families attending the University Teaching Hospital (UTH) in Lusaka, Zambia Methodology: This was a mixed study with quantitative and qualitative components. The quantitative component assessed and applied 2 new research tools for assessing palliative care needs in children attending University teaching hospital in Lusaka, Zambia. The tools assessed included the Needs Evaluations questionnaire (NEQ) and the paedsQL4 questionnaire. Cronbach's alpha was used to determine reliability while factor analysis was used to identify relevant factors. Focus group discussions were conducted with selected group of parents/legal guardians of children. In-depth interviews were conducted with key informants. All participants were purposely selected to take part in the study and were informed about the voluntary nature of the study. Results: The NEQ and the paedsQL4 questionnaires were both found to be reliable for assessing palliative care needs for children in the Zambian context (Cronbach's alpha >0.8). Generally there were very high need gaps across all hospital wards with 15/23 items having need gap of >50%. Overall the largest need gap was in the information domain. The HIV ward had least need gap with only 8/23 items having a need gap of > 50%. Results from the paedsQL4 showed that there were significant mean differences across the three categories of patients in all domains of functioning with oncology patients performing worst. In physical functioning domain, the items showed that 6/7 items had significant mean differences (p<0.05).Confirmatory factors analysis showed that 2 items were loading highly on the physical functioning factor. These were running and participating in sports (0.896).In the emotional functioning domain, 2 items loaded highly on factor analysis, feeling sad (0.842 and angry (0.666).In the social functioning domain, highest loading were in 2 items, both related to making friends. In the school domain missing school to go to hospital loaded highly on factor analysis (0.842) followed by difficulty paying attention in class (0.716) Qualitative results supported findings from quantitative data. Several needs were highlighted by the parents/guardians and health workers. The major family needs focused on economic/financial and bereavement support. Most families were referred to the UTH from very far off places without any form of support. In line with quantitative findings, there was high demand for information for families which health workers did not adequately provide. One major barrier identified to provision of palliative care was poor coordination of services with most patients missing out on services which were already available. While social workers were available, poor funding negatively affected this service. There were very few trained health workers in palliative care. Pain management remained poor with many clinicians still not comfortable to prescribe stronger analgesia such as morphine for severe pain. Conclusion: This study applied two quantitative tools for assessing palliative care needs in Children. The results showed that the tools were fairly reliable and applicable in the Zambian context. The findings indicate huge needs gap for child palliative care services in Zambia. The major family needs were economic and bereavement support. There was high demand for information for families which health workers did not adequately provide. Pain control remained sub-optimal especially for children with cancer. One major barrier identified to provision of palliative care was poor coordination of services.
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Zar, Heather. "Pneumonia in HIV-infected children admitted to hospital in Cape Town, South Africa." Doctoral thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/11105.
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Bibliography: leaves 129-163.There is little information on the aetiology and outcome of HIV-associated pneumonia in African children and no comprehensive data from South Africa. Studies of HIV-infected adult in Africa reported that the spectrum of pulmonary disease differs from that of developed countries with tuberculosis and pyogenic pneumonia predominating and Pneumocystis carinii pneumonia (PCP) occurring uncommonly. Knowledge of the aetiology and outcome of pneumonia is important for the development of paediatric management guidelines and of policies for allocation of resources especially in South Africa, where the HIV pandemic has resulted in increasing numbers of HIV-positive children requiring admission to hospital or intensive care units for pneumonia. Furthermore in countries with limited resources, development of cost effective diagnostic procedures to investigate the aetiology of pneumonia is necessary.
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Lennartsson, Otto. "Characteristics of the SGA children in the placenta biobank at Örebro University Hospital." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-48367.
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Allen, Rebecca. "Isolation vs. interaction." This title; PDF viewer required Home page for entire collection, 2007. http://archives.udmercy.edu:8080/dspace/handle/10429/9.
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Pelter, Gabrielle Beatrice. "In hospital but not forgotten : an exploration into children and young people's narratives about their experiences of hospitalisation and hospital school." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6662/.
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Today, increasing numbers of children and young people (CYPs) live with chronic health conditions. A fact reflected in recent UK legislation which highlights the necessity of supporting these CYPs to fully access education. This study explores the experiences and perspectives of children and young people with chronic conditions (CYPCCs) regarding hospitalisation and hospital school. A narrative methodology was selected to explore the experiences of five hospitalised CYPCCs (aged 12 to 16 years) in addition to the meanings they ascribed to these experiences. Findings contribute important insights into CYPCCs' experiences of hospitalisation in relation to the following family, personal growth, health-related identity, relationships, coping, unpredictability and uncertainty and medical intervention and physical pain. This research makes a unique contribution to the field, in relation to the substantive topic (how CYPCCs perceive educational experiences in hospital settings) and the original application of a narrative research methodology. I argue the necessity for professionals to recognise CYPCCs as a potentially vulnerable group. Ethical issues concerning access to hospitalised CYPCCs for research purposes are highlighted and the value of narrative research with CYPs is endorsed. Implications for professional practice and research are discussed which seek to improve the educational opportunities, experiences and outcomes for CYPCCs.
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Walton, Marilyn. "The Relationship Between Asthma Education and the Number of Hospital Visits of Asthmatic Children." Youngstown State University / OhioLINK, 2000. http://rave.ohiolink.edu/etdc/view?acc_num=ysu1007754892.
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Shah, Phalguni S. "Children's preventive health care center with aspect of play for a child." Virtual Press, 1994. http://liblink.bsu.edu/uhtbin/catkey/897516.
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Children are the most important asset for the society's future. They develop into maturity depending upon how they are moulded by their families, society, and the environment. They are very sensitive and could easily get influenced or affected by the slightest change. Therefore it is important to maintain a normal set-up for them under all of their routine and disturbed mental and physical conditions.Sickness and hospitals are one thing that affect a child's psychology. Children dread to get into the harsh technological environments of today's medical environments. Hospitals are constantly evolving to keep pace with the latest medical technologies. Additions or refurbishments or a totally new set-up usually focuses on the technological requirements rather than the human element of such an undertaking. The Riley Hospital for Children in Indianapolis presents an architectural opportunity to incorporate psychology of the environment into the design and construction of a new outpatient unit. By balancing the technological requirements with the physical and pschological needs of a child patient, one can create a healing environment more conducive to a rapid recovery. This thesis explores one of the possibilities of creating such an environment.Department of Architecture
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Swanepoel, Geertje. "Voorbereiding van die pre-primere kind op hospitalisasie 'n Spelterapeutiese benadering /." Pretoria : [s.n.], 2004. http://upetd.up.ac.za/thesis/available/etd-10082004-072158.
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Stowers, Louisa Lockhart Lau Tin-Man. "An approach to improve children's hospital facilities by incorporating a play system with stimuli that allows for imaginative play to aid in children's development." Auburn, Ala, 2009. http://hdl.handle.net/10415/1744.
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Maree, Leana. "Investigating the aetiology of respiratory tract infections in children admitted to Tygerberg Children’s Hospital using molecular methods and viral culture." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71902.
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Thesis (MMed)--Stellenbosch University, 2012.Includes bibliography
ENGLISH ABSTRACT: Introduction Acute respiratory tract infections cause significant morbidity and mortality worldwide, and are the main reason for the utilisation of health care services. Identifying the aetiological cause of lower respiratory tract infections (LRTIs) is difficult at the best of times, and more than 20 viruses and bacteria have been associated with LRTIs, which cannot be distinguished with clinical examination alone. Viruses can be detected in respiratory samples by a variety of methods, and without exception molecular methods have proven to be more sensitive than non-molecular-based tests. The increased sensitivity of molecular methods may assist in expanding our knowledge of the pathogenesis of severe respiratory tract infections, and could have a positive influence on patient management, infection control, vaccination strategies and public health. Aims and objectives 1. Determine the viral causes of lower respiratory tract infections requiring admission in using shell vial culture with immunofluorescent staining and two multiplex PCR assays, the Seeplex® RV15 ACE Detection system (Seeplex® RV15 ACE) and the Respiratory Multiplex Real-Time RT-PCR LightMix® Customised Kit (Resp Multiplex RT-PCR). 2. Compare the Seeplex® RV15 ACE and the Resp Multiplex RT-PCR with shell vial culture for the detection of respiratory viruses in routine diagnostic respiratory samples. 3. Examine the demographic and clinical characteristics associated with each respiratory viral pathogen. Materials and Methods One hundred and thirty-eight paediatric patients, admitted to Tygerberg Children’s Hospital from May 2010 to August 2010 with a presumptive diagnosis of an acute respiratory tract infection were included in the study. Nasopharyngeal or tracheal aspirates were collected, and all samples were tested by all three diagnostic methods. Clinical, demographic and laboratory data were collected through a systematic review of medical and laboratory records and subsequently anonymised Results Thirty-seven viruses were detected in 36 samples (26.1%) by shell vial culture with immunofluorescent staining; 169 viruses in 102 samples (73.9%) with the Seeplex® RV15 ACE; and 90 viruses in 73 samples (52.9%) with the Resp Multiplex RT-PCR. Shell vial culture had excellent specificity, but low sensitivity for all of the respiratory viruses. Conversely, the Seeplex® RV15 ACE had excellent sensitivity for all viruses, but slightly lower specificity. This was due to the detection of additional viruses, which may have been true positives due to the increased sensitivity of this assay. The Resp Multiplex RTPCR had excellent sensitivity and specificity. At least one respiratory pathogen could be identified in 80% of the patients. At least one virus was detected in 57% of patients, bacterial micro-organisms in 6%, and both viral and bacterial pathogens in 17%. Viral-bacterial co-infections were associated with increased severity compared to other infections, as these children were more likely to receive steroids and a blood transfusion (p = 0.002), and more likely to require mechanical ventilation (p < 0.001) and admission to the intensive care unit (p = 0.04). Conclusions We confirmed that molecular techniques are significantly more sensitive than shell vial culture for the detection of respiratory viruses in children. Due to their highly specific nature and the genetic variability observed in viruses, an excellent, continuous quality control programme is essential to ensure the continued superiority of these assays. Viral-bacterial co-infection is associated with increased severity of LRTIs in children. Further research is needed to elucidate the precise pathogenic and immunologic mechanism of this interaction.
AFRIKAANSE OPSOMMING: Inleiding Akute lugweg infeksies is verantwoordelik vir beduidende morbiditeit en mortaliteit wêreldwyd en is die hoofrede vir die benutting van gesondheidsdienste. Identifisering van die oorsaak van laer lugweg infeksies is baie moeilik en meer as 20 virusse en bakterieë word hiermee geassosieer. Ongelukkig kan kliniese ondersoek alleen nie onderskei tussen die verskillende organismes nie. Respiratoriese virusse kan deur ‘n wye verskeidenheid van toets metodes aangetoon word. Molekulêre metodes is sonder uitsondering meer sensitief as nie-molekulêre metodes. Hul verhoogde sensitiwiteit mag help om ons kennis oor die patogenese van erge lugweg infeksies te verbreed en kan ’n positiewe invloed op pasiëntbehandeling, infeksiebeheer, immunisasie strategieë en publieke gesondheidsorg hê. Doel van die Ondersoek 1. Bevestig die virale oorsake van laer lugweg infeksies deur gebruik te maak van “shell vial” kultuur met immunofluoressensie en twee veelvoudige molekulêre toetse, die Seeplex® RV15 ACE en die Resp Multiplex RT-PCR. 2. Vergelyk die Seeplex® RV15 ACE en die Resp Multiplex RT-PCR met “shell vial” kultuur vir die aantoning van respiratoriese virusse in roetine diagnostiese monsters. 3. Ondersoek die demografiese en kliniese eienskappe wat met elke respiratoriese patogeen geassosieer word. Metodiek en Materiaal Een honderd agt-en-dertig kinders wat toegelaat is tot Tygerberg Kinderhopitaal vanaf Mei 2010 tot Augustus 2010 met ’n voorlopige diagnose van ’n akute lugweg infeksie is in die studie ingesluit. Nasofaringeale of trageale aspirate is van elke pasiënt gekollekteer en met al drie diagnostiese metodes ondersoek. Kliniese, demografiese en laboratorium data is gekollekteer deur ’n sistematiese ondersoek van mediese en laboratorium rekords en daarna anoniem gemaak. Resultate Sewe-en-dertig virusse is in 36 monsters (26.1%) aangetoon deur “shell vial” kultuur met immunofluoressensie; 169 virusse in 102 monsters (73.9%) deur die Seeplex® RV15 ACE; en 90 virusse in 73 monsters (52.9%) deur die Resp Multiplex RT-PCR. “Shell vial” kultuur het uitstekende spesifisiteit gehad, maar sensitiwiteit was laag vir al die virusse. Teenoorgesteld hiermee het die Seeplex® RV15 ACE hoë sensitiwiteit vir al die viruses gehad, maar effe laer spesifisiteit. Dit was as gevolg van die aantoning van addisionele virusse, wat moontlik ware positiewe resultate kon wees as gevolg van die verhoogde sensitiwiteit van hierdie toets metode. Die Resp Multiplex RT-PCR het uitstekende sensitiwiteit en spesifisiteit gehad. Ten minste een respiratoriese patogeen is in 80% van die pasiënte geidentifiseer. Een of meer virusse was in 57% van die pasiënte aangetoon, bakterieë in 6% en beide virale en bateriële patogene in 17%. Virale-bakteriële ko-infeksies, in vergelyking met ander infeksies, was geassosieer met meer ernstige lugweg infeksies aangesien hierdie kinders meer geneig was om steroïede en ’n bloedtransfusie te ontvang (p = 0.002). Hulle het ook meer waarskynlik meganiese ventilasie (p < 0.001) en toegang tot die intensiewe sorg eenheid benodig (p = 0.04). Gevolgtrekkings Ons het bevesitg dat molekulêre tegnieke aansienlik meer sensitief is as “shell vial” kultuur vir die aantoning van respiratoriese virusse in kinders. As gevolg van hul hoogs spesifieke aard en die genetiese variasie waargeneem in virusse, is ’n uitstekende deurlopende kwaliteitsbeheer program noodsaaklik vir die voortgesette uitneemendheid van hierdie metodes. Virale-bakteriële ko-infeksies word geassosieer met meer ernstige laer lugweg infeksies in kinders. Verdere navorsing is nodig om die presiese patogenetiese en immunologiese meganisme van hierdie interaksie toe te lig.