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Dissertations / Theses on the topic 'Pediatric healthcare'
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1
Gillespie, Gordon Lee II. "Violence Against Healthcare Workers in a Pediatric Emergency Department." University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1212109392.
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Johnson, Kiana, Cuoghi Edens, Peter Chira, Aimee O. Hersh, Y. Ingrid Goh, Joyce Hui-Yuen, Rebecca E. Sadun, et al. "Differences in Healthcare Transition Views, Practices, and Barriers Among North American Pediatric Rheumatology Providers from 2010 to 2018." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7015.
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Background/Purpose: Healthcare transition is the “purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems.” The American College of Physicians has partnered with national organizations, including the ACR, to develop guidelines and tools to promote a smooth transition to adult care. We aim to assess current transition practices and beliefs among North American pediatric rheumatology providers and to identify differences from a 2010 provider survey published by Chira et al.
Methods: In April 2018, Childhood Arthritis and Rheumatology Research Alliance (CARRA) members received a 25-item online survey about healthcare transition. Got Transition’s Current Assessment of Health Care Transition Activities for Transitioning Youth to Adult Health Care Providers was used to measure clinical transition processes on a scale of 1 (basic) to 4 (comprehensive). Bivariate data analysis was used to compare 2010 and 2018 survey findings.
Results: Over half of CARRA members completed the 2018 survey. Participants included pediatric rheumatologists (74%), adult- and pediatric-trained rheumatologists (4%), pediatric rheumatology fellows (18%), and other (4%), including emeritus faculty and mid-level providers. Most belonged to university-affiliated practices (87%) in the U.S. (91%). Providers aim to transfer patients at age 18 (23%) or 21 (33%), but the actual age of transfer is often 21 or older (56%). The most common target age to begin transition planning was 15-17 (49%). Few providers use the ACR transition tools (31%) or have a dedicated transition clinic (23%). Only 17% have a transition policy in place; 63% do not consistently address healthcare transition. Transition outcomes of interest included an adult rheumatology visit within 6 months of the last pediatric visit (80%), adherence to medications and plan of care (78%), continuous insurance coverage (78%), and patient-reported gaps in access to care (76%). When compared to the 2010 survey, improvement was noted in 3 of 12 transition barriers: availability of adult primary care providers, availability of adult rheumatologists, and transition knowledge and skills of pediatric staff (p<0.001). However, more providers cited the close bond among adolescents, parents and pediatric providers as a barrier (Figure 1).
Conclusion: This survey of pediatric rheumatology providersdemonstrates some improvement in transition barriers since 2010, though most practices still maintain minimal support for patients and providers around healthcare transition. Further research is needed to understand how to effectively facilitate transition to adult care for young adults with childhood-onset rheumatic diseases.
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Sun, Pei-Chen Angela. "Paediatric pharmacovigilance : utility of routinely acquired healthcare data." Thesis, University of Aberdeen, 2014. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=225729.
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Dutro, Anna R. "An Art-Light Mosaic Light Distraction for the Pediatric Healthcare Environment." Diss., Virginia Tech, 2016. http://hdl.handle.net/10919/73543.
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In his classic book, Experiencing Architecture, Rasmussen (1959) noted that architects inspired by addressing problems in built environments created buildings with a special spirit: a distinctive stamp. Recent problems in healthcare facilities, specifically those related to reducing stress and anxiety, have inspired designers to create positive, uplifting distractions to redirect a patient's attention from a sterile environment and/or noxious event. In doing so, healthcare facilities have become special environments with a caring spirit.
This study examined a specific aspect of creating a caring environment: determining whether or not a positive distraction, a child's art-light mosaic movie developed by the researcher, would lower pain and distress in children 4, 5, and 6 years old during an immunization procedure. The researcher conducted a randomized controlled study in two locations using a child's self-report pain scale, heart rate, parent/guardian report, and nurse report measures. After collecting and analyzing data from 76 well-participants receiving one to five immunizations, the researcher found no statistically significant difference between the conditions for any of the measures. Thus, the null hypothesis, the art-light mosaic image would not assist in lowering pain and distress in pediatric patients, 4 to 6 years old, during an immunization procedure, was not rejected. From these results, the researcher recommended future studies incorporate training the parent and child on how to use the distraction, combine the distraction with a topical analgesic, provide a clear understanding of pain and distress from the child's point of view, and develop more sensitive self-report measures of pain for children.Ph. D.
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Park, Jin Gyu. "Environmental color for pediatric patient room design." Thesis, [College Station, Tex. : Texas A&M University, 2007. http://hdl.handle.net/1969.1/ETD-TAMU-2420.
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Tong, Amanda Kai-Lai. "Brilliant Baby Brainiacs (BBB) - Pediatric Brain Tumors: Assessing Healthcare Provider Knowledge." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/593599.
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Background: Brain tumors are the most common solid tumors found in children. Current research is determining whether diagnosing brain tumors earlier will help improve prognosis and reduce long-term deficits; however, childhood brain tumors are often diagnosed late with a median time of 1-4 months from onset of symptoms. Prolonged symptom intervals before diagnosis have been associated with life-threatening risks, neuro-cognitive disabilities, and detrimental professional relationships between healthcare providers and families. Pediatric brain tumor clinical presentations are often non-specific and resemble less serious illnesses; therefore, healthcare providers are failing to include this in their differential diagnoses list. Purpose: To assess healthcare provider knowledge of signs and symptoms of pediatric brain tumors using The Brain Pathways Guideline. Methods: A one group pre-test and post-test e-mailed separately to nurse practitioners that have active membership in National Association of Pediatric Nurse Practitioners (NAPNAP) Arizona Chapter. Results: The Wilcoxon Signed Rank Test revealed that the matched test scores were not statistically significant (p=0.157) after viewing The Brain Pathways Guideline educational materials. Conclusion: The results of this study did not show a statistically significant difference in the test scores and therefore it cannot be concluded that presenting an evidence-based guideline to assist healthcare providers to assess and diagnose patients with brain tumors will be helpful to improve pre-diagnostic symptom intervals.
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Sacks, William Andrew. "Healthcare providers' experience of chronic grief in a pediatric subacute facility." CSUSB ScholarWorks, 2001. https://scholarworks.lib.csusb.edu/etd-project/2034.
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The purpose of this study was: (1) to evaluate the level of grief experienced by healthcare providers in a pediatric subacute facility, (2) to compare the levels of grief between different groups of healthcare providers (Certified Nurses' Aides, Licensed Nurses, and Respiratory Care Practitioners), and (3) to describe the personality/demographic factors that influence a healthcare provider's ability to cope effectively with compound grief.
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Merianos, Ashley L. "Healthcare Resource Utilization and Tobacco Smoke Exposure among Pediatric Emergency Department Patients." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563272489318599.
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Meyer, Aja M. "Pediatric healthcare providers' screening practices : impact of training on early identification of autism." [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001687.
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Vindrola, Padros Cecilia. "The Participation Of NGOs In Healthcare: The Case Of Pediatric Cancer Treatment In Argentina." [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0002864.
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Taylor, Jennifer. "Exploring Pediatric Healthcare Initiatives of Non-Governmental Organizations in Low-and Middle-Income Countries." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/40670.
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Objective: To explore and describe how healthcare non-governmental organizations provide and evaluate programs and services that result in positive and sustainable health outcomes in children and adolescents living in low-and middle-income countries and to better understand the role of nursing within these organizations.
Scoping Review: A scoping review informed by the Arksey & O’Malley framework was completed to explore the research on the delivery of pediatric health services by non-governmental organizations in low-and middle-income countries.
Qualitative Study: Semi-structured interviews were conducted to share the voices and experiences of stakeholders working in the field of NGO practice to provide clarity, further insight and depth to the results from the scoping review and broaden the understanding of the role of nursing on this topic.
Conclusions: Despite variability in practice and a multitude of competing priorities, outcome evaluation is growing within the field of pediatric NGO practice, and progress is being made towards evaluation of broader health outcomes besides unidimensional health indicators or outputs. Nurses can play a significant role in improving pediatric NGO program development and evaluation practices and are well positioned to be global health leaders who can influence policy and practice for the achievement of positive and sustainable health outcomes in children and adolescents in low-and middle-income countries.
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Lin, Nancy Y. "Applications of Hyperpolarized 129-Xenon Magnetic Resonance Imaging in Pediatric Asthma." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1593268100652155.
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Jackson, Joseph L. "Decreasing Total Healthcare Costs and Length of Stay in the Admitted Pediatric Odontogenic Cellulitis Patient: An Inquiry into Patient and Treatment Characteristics." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1338308849.
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Woo, Teri Moser. "Weight bias in pediatric healthcare providers : an exploratory study using photo elicitation with focus groups /." Connect to full text via ProQuest. Limited to UCD Anschutz Medical Campus, 2008.
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Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008.Typescript. Includes bibliographical references (leaves 127-142). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;
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Grimley, Mary E. "Survey on Pediatric Palliative Care Care For Healthcare Providers (SPPCHP): Identifying Knowledge, Barriers, and Support Needs." Scholarly Repository, 2011. http://scholarlyrepository.miami.edu/oa_dissertations/614.
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Objective: A significant number of children suffer from life-limiting illnesses, with many dying each year in the U.S. Services, beyond standard medical care, aimed at increasing overall quality of life for children with life-limiting illnesses, are greatly needed within and outside of our hospitals. Palliative care is conceptualized as treatment provided to relieve symptoms and improve quality of life. Despite the empirically supported benefits of providing pediatric palliative care, only a small percentage of pediatric patients actually receive these services. Thus, there is a great need for the development and provision of these services. The first aim of the current study was to compare results from Holtz Children’s Hospital (HCH) at the University of Miami with those from Lucile Packard Children's Hospital (LPCH) at Stanford University, where a survey assessing pediatric healthcare providers’ palliative care needs was originally developed. The second aim was the modification and further development of the measure, including an evaluation its psychometric properties. The third aim was to identify the educational and training needs of healthcare providers in providing pediatric palliative care. The fourth aim was to evaluate whether completing the survey improved awareness of a palliative care team. Method: Two hundred and twenty five healthcare providers at HCH completed the Survey on Pediatric Palliative Care for Healthcare Providers (SPPCHP). Participants were diverse with regards to ethnicity/race and profession. Results: Healthcare providers at both hospitals reported feeling inexperienced in similar aspects of delivering palliative care and desired further training and support. The SPPCHP demonstrated strong internal consistency and good construct validity, evidenced in factor analyses. Pediatric healthcare providers at HCH reported only feeling “somewhat” experienced in all aspects of pediatric palliative care and rated families’ inability to accept terminal diagnosis as the top barrier to providing this care; half of healthcare providers reported not receiving adequate support. Although referrals did not increase six months after study completion, awareness at the hospital was improved. Conclusions: Clinical implications include the need for systematic training and support in palliative care for a range of pediatric professionals, with an emphasis on addressing key barriers to care. Given the similarity of the findings at HCH and LPCH, these results appear generalizable to a variety of children’s hospitals.
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Eisen, Sarajane L. "The healing effects of art in pediatric healthcare: art preferences of healthy children and hospitalized children." Diss., Texas A&M University, 2003. http://hdl.handle.net/1969.1/5772.
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Art is assumed to possess therapeutic benefits of healing for children, as part of patient-focused design in healthcare. Research on adult patients suggests that by infusing art into the healthcare setting, the design may reduce stress that could impede the healing process. Since the psychological and physiological well-being of children in healthcare settings is extremely important in contributing to the healing process, it is vitally important to identify what type of art supports stress reduction. Nature art was anticipated to be the most preferred and have stress-reducing effects on pediatric patients. The objective of this study was to investigate what type of art children prefer, and what type of art has potentially stress-reducing effects on pediatric patients. This study used a three-phase, multimethod approach: a focus group study, a randomized study, and a quasi-experimental study design. Findings from three phases were evaluated. The objective of Phase 1 was to discern what type of art school children prefer, Phase 2 focused on what type of art hospitalized children prefer and to compare these preferences identified in Phase 1. Phase 3 was a quasi-experimental study to determine if nature art has a potentially healing effect on pediatric patients when compared to abstract art or no art at all. The findings of this study demonstrate that nature art is the preferred type of art by children from age 5 to 17. But there were no significant differences among the three art intervention groups of pediatric patients. These findings led to design recommendations regarding what art should be placed in children'ÃÂÃÂs hospital rooms in order to create a stress-reducing, healing environment.
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Francia, Bacilio Eduardo Alberto, Rosas Joseph Steven Perez, and Jimmy Armas-Aguirre. "Mobile solution to optimize process for healthcare delivery referral in pediatric patients with a presumptive cancer diagnosis." Institute of Electrical and Electronics Engineers Inc, 2020. http://hdl.handle.net/10757/656631.
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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.In this paper, we propose a mobile solution to optimize the medical referral process for pediatric patients with presumptive cancer diagnosis. This proposal allows the automation of the process through the identification of the main gaps that are covered by the following functionalities: (1) Registration and interaction of the actors in the process, (2) Support for timely diagnosis with first-hand information, (3) Creation of request tickets and personalized medical appointments, and (4) Creation of reports on the response time and compliance with the process. The proposal is described in three sections: (1) The automation of the medical referral process, (2) The functionalities of the mobile solution, and (3) the designed technology architecture. The validation of the proposal was carried out in a social health insurance in Lima-Peru, with data and information of the process obtained by the institution. The measurement was made through the mobile solution which allowed obtaining the response times of the process with the main actors such as the pediatric doctor, an oncology specialist and a pediatric patient's guardian. The results showed that the time of the referral process is optimized between an interval of [95%-97.5%], which mainly generates a social benefit to the community by assuring a timely treatment of the pediatric cancer patient, based on diagnosis and early care.
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Spaeth, Christine Grey. "Evidence for and Barriers to a Team-Based Approach for Genetic Services in Pediatric Healthcare Specialty Settings." University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1211913285.
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Jenkins, Ashley M. M. D. "Pediatric Hospital Utilization During Transition to Adult Healthcare for Adolescents and Young Adults with Chronic Conditions of Childhood." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1592133724158817.
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Hanberger, Lena. "Quality of Care in Children and Adolescents with Type 1 Diabetes : Patients’ and Healthcare Professionals’ Perspectives." Doctoral thesis, Linköpings universitet, Institutionen för klinisk och experimentell medicin, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-59336.
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Background: Type 1 diabetes is a chronic disease for which there is currently no cure, and high quality care is essential if acute and long-term complications are to be avoided. Many children and adolescents have inadequate metabolic control with increased risk for complications later in life, and adolescent girls have reported low quality of life. Differences in metabolic control between treatment centres have been found but the reasons for this are unclear. Diabetes is a largely self-managed disease. Patient education is central to successful self-management but little is known about how to make best use of diabetes communities on the Internet and integrate them into a practitioner-driven service. Aim: The main objective of this thesis was to gain better understanding of how to improve the quality of diabetes care for children and adolescents, aiming to have near-normal blood glucose, to prevent both acute and late complications and to have good quality of life. Methods: The geographic populations of two paediatric centres (n=400) received validated questionnaires on perceived quality of care and Health-Related Quality of Life (HRQOL). An intervention with a web portal containing diabetes-related information and social networking functions was carried out within the same population. Clinical variables from 18 651 outpatient visits registered in the Swedish paediatric diabetes quality registry, SWEDIABKIDS were analysed. Using data from SWEDIABKIDS, five centres with the lowest mean HbA1c, five with the highest, and five with the largest decrease in centre mean HbA1c between 2003 and 2007 were identified. Team members (n=128) were asked about structure, process, policy, and the messages given to patients about important diabetes issues. Results: Specific areas that were identified as needing improvement included information about self-care, waiting time at outpatient clinics and for treatment, and access to care. Diabetes seemed to reduce HRQOL. Subjects with better metabolic control and with higher frequency of injections reported slightly higher HRQOL, as did those living with both parents compared to those with separated parents. Only 35% of children and adolescents with diabetes in Sweden had an HbA1c level below the treatment target value. Mean HbA1c showed a correlation with mean insulin dose, diabetes duration, and age. A difference between centres was found, but this could not be explained by differences in insulin dose, diabetes duration, or age. Adolescent girls reported lower HRQOL, as did parents of girls aged < 8 years. Girls also had poorer metabolic control, especially during adolescence. In teams with the lowest and the most decreased mean HbA1c, members gave a clear message to patients and parents and had a lower HbA1c target value. Members of these teams appeared more engaged, with a more positive attitude and a greater sense of working as a team. Members of teams with the highest mean HbA1c gave a vaguer message, felt they needed clearer guidelines, and had a perception of poor collaboration within the team. High insulin dose, large centre population, and larger teams also seemed to characterize diabetes centres with low mean HbA1c. The most frequently visited pages on the web portal were the social networking pages, such as blogs, stories and discussions, followed by the diabetes team pages. Those who used the portal most actively were younger, had shorter diabetes duration, and lower HbA1c, and were more often girls. The web portal was not found to have any significant beneficial or adverse effects on HRQOL, empowerment or metabolic control. Conclusions: The quality of diabetes care for children and adolescents in Sweden is not sufficiently good and needs to improve further if complications in later life are to be avoided. Psychosocial support for children and adolescents with diabetes should be appropriate for age and gender. The attitudes of the members in the diabetes care team and the message they give to patients and their parents seem to influence metabolic control in children and adolescents. A clear and consistent message from a unified team appears to have beneficial effects on metabolic control. A web portal that includes comprehensive information about diabetes, and the opportunity to communicate with other people with diabetes and with healthcare professionals may be a useful complement to traditional patient education tools. Members of the diabetes team should encourage its use.
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Zhang, Biao S. M. Massachusetts Institute of Technology. "Decision analysis of novel point-of-care diagnostics for Pediatric Pneumonia : implementation in Developing countries with tiered healthcare systems." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/98001.
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Thesis: S.M. in Technology and Policy, Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2015.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 94-99).
Pediatric Pneumonia (PNA) is the single leading cause of death in children under five, accounting for 19% of all childhood deaths worldwide. Due to severe resource constraints on healthcare, the global burden of the disease in children is disproportionately shared by developing countries. In particular, India, having the highest incidence rate of PNA, accounts for more than 30% of the world's neonatal deaths from pneumonia every year. The three-tier referral systems, shared by many other developing countries, has introduced inefficiencies into delivering appropriate healthcare to patients in need. Point-of-care (POC) diagnostics is a type of tool used to assist physicians to make clinical decisions. Its key advantage include the quick turnaround of results, low cost and high diagnostic power could potentially improve India's pressing situation due to pneumonia. Since the disease progresses quickly in infants and babies and transportation of patients within the healthcare system is time consuming, POC diagnostic is crucial in lowering both the mortality of children with pneumonia and the cost of treating PNA. To this effect, we investigate the potential impact of POC diagnostics when implemented in a three-tier referral system. Using India as a case country, I construct a decision tree model that evaluates cost, mortality, and the combined cost-effectiveness in Tree-Age software as a framework which evaluates five implementation strategies of a POC diagnostic for PNA within the Indian public healthcare system. The strategies reflect various prescription decisions and referral patterns in current medical practice in India. I concluded that (1) the diagnostic will result in both higher cost and mortality in areas where the practice is to provide all patients antibiotics and thus not recommended, (2) the diagnostic is very likely to achieve lower cost and mortality when patients do not always receive antibiotics and sometimes are given only symptom-relieving drugs and thus recommended, (3) the diagnostic has great potential in generating savings by limiting patients from being transported to urban hospitals, (4) when dual diagnostic is employed combining POC diagnostics and X-ray, confirming positive cases from the diagnostic by X-ray results in lower cost and confirming negative cases results in lower mortality and (5) the diagnostic can save resources and benefit health outcomes and should be implemented in places where X-ray is not available.
by Biao Zhang.
S.M. in Technology and Policy
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Watt, Ian. "Why Are You Here? Exploring the Logic Behind Nonurgent Use of a Pediatric Emergency Department." Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc804858/.
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Caregivers often associate fevers with permanent harm and bring children to emergency departments (EDs) unnecessarily. However, families using EDs for nonurgent complaints often have difficulty accessing quality primary care. Mutual misconceptions among caregivers and healthcare providers regarding nonurgent ED use are a barrier to implementing meaningful interventions. The purpose of this project was to identify dominant themes in caregivers’ narratives about bringing children to the ED for nonurgent fevers. Thirty caregivers were recruited in a pediatric ED for participation in qualitative semi-structured interview from August to November 2014. Interview transcripts were coded and analyzed for themes. Caregivers’ decisions to come to the ED revolved around their need for reassurance that children were not in danger. Several major themes emerged: caregivers came to the ED when they felt they had no other options; parents feared that fevers would result in seizures; caregivers frequently drew on family members and the internet for health information; and many families struggled to access their PCPs for sick care due to challenging family logistics. Reducing nonurgent ED utilization requires interventions at the individual and structural level. Individual-level interventions should empower caregivers to manage fevers and other common illnesses at home. However, such interventions may have limited impact on utilization outcomes among families with poor access to primary care. Afterhours primary care should be expanded to accommodate families with rigid work schedules and limited transportation resources.
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Balasa, Rebecca A. "Patients’ and Parents’ Perceptions of their Role in the Assessment of Nursing Students’ Pediatric Clinical Practice." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39689.
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Background and objective: Patients’ and parents’ involvement in nursing students’ pediatric clinical practice assessment is informal. This study explored patients’ and parents’ perceptions of their role in students’ formative assessment. Approach: Interviews were conducted with patients and parents admitted at the study setting who received care from a nursing student. They were transcribed verbatim. Data was analyzed using a qualitative content analysis while Lincoln and Guba’s criteria of rigor and trustworthiness were upheld. Findings: Three categories emerged from the data: 1) Patients’ and parents’ current involvement in the assessment of nursing students’ pediatric clinical practice; 2) How they would like to be involved; and 3) The benefits and challenges of their involvement. Conclusion: This study has provided an understanding of patients’ and parents’ past encounters with nursing students, the elements of care that they would want to assess, and their perceived benefits and challenges of their involvement.
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Higginson, Andrea. "Exploring the Transition of the Young Person with Chronic Pain." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37329.
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Objective: To explore and describe the current transition environment for young people with chronic pain in Canada.
Quantitative study: An online survey of nurses working in the pediatric and adult chronic pain setting was conducted to describe the current clinical practices used in both settings to support transition of young people with chronic pain in Canada.
Qualitative study: Semi-structured interviews were conducted with young people with chronic pain who had recently transitioned from the pediatric setting to the adult healthcare setting to explore their transition experiences.
Conclusions: The findings from these studies suggest that young people with chronic pain have similar transition related needs to other young people with chronic conditions as well as unique challenges. Nurses can have a positive impact on transition outcomes by developing processes and forming networks of clinicians who work with young people with chronic pain in order to improve transition related outcomes.
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McLoughlin, Robert. "Healthcare Disparities and Noncompliance in Children and Young Adults with Crohn’s Disease." eScholarship@UMMS, 2019. https://escholarship.umassmed.edu/gsbs_diss/1026.
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Objective:
Treatment compliance in children with Crohn’s disease is associated with higher levels of symptom remission. We hypothesized that the management, comorbidities, and complications for children with Crohn’s disease would differ based on a diagnosis of noncompliance.
Methods:
Using the Kids’ Inpatient Database for 2006-2012, we identified young patients (<21 >years) with a diagnosis of Crohn’s disease. Diagnoses and procedures were analyzed according to a recorded diagnosis of noncompliance. Multivariable logistic regression analysis was performed to examine the association between noncompliance and the outcomes of interest.
Results:
There were 28,337 pediatric Crohn’s disease hospitalizations identified with 1,028 (3.6%) hospitalizations having a diagnosis of both Crohn’s disease and noncompliance. The mean age of the study population was 15.9 years and 48.9% were girls. Black patients ( multivariable adjusted odds ratio, aOR,2.27; 95% CI:1.84-2.79) and those in the lowest income quartile (aOR 1.57; 95% CI:1.20-2.05) had an increased likelihood of a noncompliance diagnosis than respective comparison groups. Noncompliant patients had an increased likelihood of concurrent depression, nutritional deficiency, and anemia. Patients with a diagnosis of noncompliance had lower rates of intestinal obstruction (4.0% vs 6.3%), intraabdominal abscesses (2.0% vs 4.2%,), and underwent fewer major surgical procedures (aOR 0.40; 95% CI:0.31-0.53) and large bowel resections (aOR 0.44; 95% CI:0.31-0.64) than patients without this diagnosis.
Conclusions:
We found significant differences in socioeconomic status and race among hospitalized children with Crohn’s disease with, as compared to those without, a diagnosis of noncompliance. Children with noncompliance have different comorbidities, disease-related complications, and are managed differently. Possible explanations for observed treatment differences include a reluctance to offer surgery to those with a diagnosis of noncompliance, a refusal of intervention by noncompliant patients, or implicit bias. Further investigation is warranted to better define noncompliance in this population and to determine the implications of this diagnosis.
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Corey, Pamela Joy. "The Effectiveness of Adult and Pediatric Code Blue Simulation-Based Team Trainings." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2804.
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The adult and pediatric healthcare providers at a New England medical center attended simulation training for responding to cardiac arrests that incorporated the current American Heart Association (AHA) evidence-based standards. The purpose of this concurrent mixed method program evaluation was to compare the adult code blue and pediatric team training programs to the AHA's standards and identify if the staff learned the necessary skills to care for patients in cardiac arrest. The conceptual models used for the study were Crisis Resource Management and the transfer of learning model. The study sample was 660 adult and 269 pediatric healthcare providers who participated in both programs between 2012 and 2015. The research questions explored how the adult and pediatric programs compared, if they provided staff with necessary skills to care for cardiac arrests using current standards, and the staff perceptions of program effectiveness and barriers encountered. The data were collected using evaluation and observation forms and needs-assessment surveys. A chi square analysis identified differences between the programs on staff preparedness and transfer of knowledge into practice. The coding of the qualitative data identified themes from the participants' perceptions on program design. Results prompted a program and curriculum redesign to include multiple opportunities to allow staff to learn and practice skills for low volume high acuity situations. The study promotes social change by giving healthcare providers opportunities to translate evidence-based training into clinical practice. The ability to function effectively as a team in a crisis improves patient outcome and potentially reduces mortality and morbidity within the institution and community. Simulation education also improves staff confidence in performance of low volume and high acuity situations.
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Groll, Kelley Eileen. "Childhood Sexual Abuse Screening And Prevention In The Primary Care Setting: A Survey Of Pediatric Healthcare Providers In The State Of Vermont." ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/435.
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ABSTRACT
Background. Childhood sexual abuse (CSA) is a silent, but pervasive concern across the United States, the prevalence of which is often vastly underestimated. Some research indicates that as many as one in four girls and one in six boys become victims of CSA. CSA is classified as an adverse childhood experience (ACE), which has been shown to have serious longstanding negative physical, emotional, and mental health impacts. The pediatric primary healthcare provider is well posed to intervene to detect and prevent the occurrence of CSA.
Objective. The overall goal of this study is to gain an understanding of the current state of sexual abuse screening and prevention in pediatric primary care settings in the state of Vermont.
Methods. An anonymous, 20-item survey was distributed to Vermont pediatric primary care providers via the electronic mailing lists of three Vermont-based professional organizations for healthcare providers. The online survey was conducted with the Limesurvey software through the secure University of Vermont server. The survey remained active for three weeks, and potential participants received three weekly reminder emails inviting them to complete the survey. As an incentive for volunteer participation in the study, all participants received a list of the available local, statewide, and national resources available to them to assist in sexual abuse detection and prevention following survey completion.
Results. There were 37 participants who completed the survey. The groups were divided based on professional title, patient population, years of experience in practice, geographic location, and access to a social worker. Each of these groups was analyzed against the survey data to determine any underlying trends that existed.
Conclusions. Nurse practitioners were found to be more likely than physicians to routinely screen every child and their caregivers during health supervision visits. NPs were also more likely to report that the electronic health record prompted these screenings. A positive correlation was found between the likelihood of routinely screening children and increased provider confidence with screening. However, no differences were found between NPs and physicians in confidence with screening, nor were there differences in perceived educational sufficiency between the two groups.
Across all professional titles, pediatric providers reported greater confidence in their ability to detect risk factors and red flags than family practice providers. A greater perceived sufficiency of education was positively correlated with provider confidence and comfort with screening. Educational sufficiency was also positively correlated with the perception that area resources are highly available and are effectively used in practice.
Time was reported as the greatest barrier to screening and prevention by those who have the highest perceptions of their ability to make an impact on prevention. Also, those who felt that there were highly available and accessible resources at their disposal also reported time as their greatest barrier. Additionally, those who reported greater than 20 years of experience in practice were significantly less likely to view access to the patient as the greatest barrier that providers face in their efforts to detect and prevent sexual abuse. Further study is indicated to confirm these findings.
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Hensley, Vicki. "CHIILDHOOD BULLYING: ASSESSMENT PRACTICES AND PREDICTIVE FACTORS ASSOCIATED WITH ASSESSING FOR BULLYING BY HEALTH CARE PROVIDERS." UKnowledge, 2015. http://uknowledge.uky.edu/nursing_etds/25.
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Childhood bullying affects over 25% of today’s youth and causes up to 160,000 missed school days per year. Bullying causes short and long term adverse effects to both mental and physical health. Many organizations encourage healthcare providers to take an active role in bullying prevention. However, there has been little research into the role of primary healthcare providers regarding childhood bullying and the effectiveness of different approaches to screening and management.
Therefore the purposes of this dissertation were to a) explore childhood bullying and the role of the healthcare provider in bullying prevention, b) develop and evaluate the psychometric properties of Hensley’s Healthcare Provider’s Practices, Attitudes, Self-confidence, & Knowledge Regarding Bullying Questionnaire. Pediatric healthcare providers were asked to participate in this study if they conducted well-child exams on a weekly basis. Information on the provider’s current bullying assessment practices, attitudes, self-confidence, and knowledge regarding bullying was gathered. Results indicated that approximately one-half (46.6%, n=55) of the healthcare providers reported assessing their patients for bullying behaviors during well-child exams. The strongest predictor of positively assessing for bullying was attitudes, recording an odds ratio of 1.24. This indicated for every one-unit increase in attitudes score, the odds of assessing for bullying will be 24% higher. The odds ratio of self-efficacy or self-confidence was 1.18, indicating that for every one-unit increase in self-efficacy score, the odds of assessing for bullying will be 18% higher.
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Kadariya, Dipesh. "kBot: Knowledge-Enabled Personalized Chatbot for Self-Management of Asthma in Pediatric Population." Wright State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=wright1565944979193573.
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Zulueta, Stacy, Emily Clemans, and Grant Skrepnek. "The Top 25 Comorbidities Reported During Inpatient Stays for Pediatric Hematopoietic Stem Cell Transplant: Patient Demographics and Impact on Inpatient Mortality and Charges." The University of Arizona, 2011. http://hdl.handle.net/10150/614607.
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Class of 2011 AbstractOBJECTIVES: The purpose of this study was to analyze the impact of patient and hospital characteristics as well as selected comorbidities on inpatient mortality and charges in pediatric HSCT. We have determined the top 25 comorbidities reported during all inpatient stays for HSCT as well as for those stays ending in mortality. METHODS: All data was extracted from the AHRQ KID databases for the years 1997, 2000, 2003, and 2006. Two regression analyses were performed to determine the contribution of various independent variables on mortality and charges. Subjects of this study included all cases of HSCT reported in the Healthcare Cost and Utilization Project (HCUP) KID as ICD-9 41.XX. RESULTS: Factors accounting for larger increases in cost included death during hospital stay, the development of disseminated intravascular coagulation (DIC), pneumonia, and length of stay (LOS). The largest decreases in charges were seen for patients coming from a small or “micropolitan” location, patients cared for in teaching hospitals, and in hospitals with large bedsizes. Variables associated with increased risk of mortality on linear regression included development of DIC, sepsis, or pneumonia. CONCLUSION: Further study relating to HSCT is necessary to determine the contribution of specific comorbidities to mortality and charges. Importantly, DIC is associated with both greater risk of mortality and greater charges. It would be prudent to recommend increased monitoring and early treatment for DIC based on these results.
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MARKLUND, ALEXANDER, and Robert Eriksson. "Production control in hospital departments : Improving coordination through better optimization of IT-support tools at Astrid Lindgren Children’s Hospital, a Case Study at the Pediatric Oncology department." Thesis, KTH, Industriell Management, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-147708.
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A challenge for healthcare organizations is that operational efficiency suffers from variation in production. This is because variation in healthcare is hard to predict and the methods and IT-support tools for handling variation are suboptimal. The concept of production control can be used to describe the coordination of activities so that healthcare can be delivered on time, of adequate quality and at a reasonable cost, and thus includes the use of IT-support tools to handle variation. The objective of this report is to suggest improvements for production control in hospital departments through the development of a prototype for a new IT-support tool. In order to achieve this, a case study was conducted at the pediatric oncology department at Karolinska University Hospital (KS). The case study includes observations and interviews to investigate production control at department Q84, as well as associated roles and IT-support tools. Four IT-support tools were identified at the department, two of which were used interchangeably. Due to lack of integration between these systems and the fact that one system contained data manually synchronized from the other, handling changes required double labor. An improvement suggestion is therefore presented, consisting of a prototype which demonstrates that production control can be improved by automating the maintenance of a system at the department while fulfilling the organization’s information security policy. The development of the prototype was aligned with the lean philosophy which KS strives to adopt. Through an investigation of the production system, a role for production control and associated IT-support tools at a hospital department can be identified and analyzed and through the prototyping of an IT-support tool for production control, improvements and optimizations can be made.
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Colwell, Kelly L. "Disseminating the Cost of the Empty Chair: Improving Healthcare Access and No-Show Rates Through Age and Disease-Specific Education in the Pediatric Asthma Patient Populations." Youngstown State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ysu1495470628183933.
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Rodrigues, Mariana Hortolani. "Criação, desenvolvimento e aplicação de serious game educativo para prevenção em saúde bucal infantil - \'Caí, perdi um dente... E aí?\"." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/25/25145/tde-16042015-102716/.
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Jogos são uma ponte natural entre educação e diversão. Seu uso já provou ser eficaz em várias áreas do saber, pois fornece, junto da interatividade, novas formas de aplicação do conhecimento, através de desafios propostos ao usuário. Tal meio, amplamente utilizado na indústria do entretenimento, pode assumir papel social quando aplicado a áreas diversas, como a da saúde. Esta categoria de jogos, com propósitos específicos como treinamento, reabilitação e prevenção, denomina-se serious games. No entanto, os materiais disponíveis para a propagação de conceitos referentes à prevenção em saúde, destinados ao público infantil, ainda são escassos e com pouco nível de atratibilidade. Compostos geralmente por materiais impressos, são meios de difícil acesso a todas as camadas da população. No âmbito da Odontologia, tal área se mostra pouco explorada, oferecendo às crianças apenas orientações quanto à prevenção de doenças, importância da boa higiene bucal e das visitas regulares ao profissional dentista. Esta dissertação apresenta, portanto, a criação, desenvolvimento e aplicação de um serious games, chamado Caí, Perdi um Dente... E daí?, focado no assunto avulsão dentária de um dente permanente, situação comumente vivenciada por responsáveis, educadores e crianças em fase escolar, que necessita de procedimentos rápidos para que o dente perdido possa ser reimplantado, evitando a necessidade de próteses dentárias. A pesquisa se desenvolveu na aplicação e análise dos resultados referentes à comparação de tal material com outros, comumente utilizados (cartilha e desenho animado), mostrando a eficácia da interatividade, quando combinada à educação para a saúde. Este trabalho também ofereceu as prerrogativas para especificar os requisitos de projeto do design do jogo, observando as necessidades evidenciadas para identificar as funções que este deverá desempenhar. Visamos, com este estudo, estimular a pesquisa na área de educação e interatividade dirigidas à saúde, oferecendo novas ferramentas para o auxílio de profissionais e melhoria da qualidade de vida de toda a população.Games are a natural bridge between education and entertainment. Its use has already proven efficient in many areas of knowledge, since it provides (along with interactivity) new forms to knowledge application, through issuing challenges to the user. These means, widely applied in entertainment industry, can play a social role when applied to other areas, such as healthcare. This category of games, with specific purposes such as training, rehabilitation and prevention, is generally classified into the category of serious games. However, the available materials for teaching concepts related to health prevention among children are still scarce and with currently low attractiveness. Composed usually of print material, they are means of difficult access to whole of the population. Since dentistry is a not well explored area by games, children are provided only with some guidance towards the prevention of diseases, the importance of good oral hygiene and regular appointments with the dentist. This dissertation thus presents the concept, the development and the application of a serious game called I Fell Down and Lost my Tooth, So?, focused on a permanent tooth avulsion, usually experienced by persons in charge, educators and children in learning stage, who need rapid procedures to promote tooth reimplantation, avoiding the need for dental prostheses. This work was developed with the application and analysis of results by comparision with other educational materials usually applied (as guidebook and animated cartoon), proving its higher efficiency in interactivity, combined with education towards healthcare. Also, prerogatives were offered to detail the game design requirements, to observing the needs to identify the functions it must perform. It was also aimed to stimulate further research concerning education and interactivity towards healthcare, providing new tools to aid professionals, as well as improvements in the overall life quality of all people.
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Smith, Aimee West. "Parent and Adolescent Factors Related to Adherence and Health Outcomes in Sickle Cell Disease." Kent State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=kent1469208674.
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Jiao, Weiwei. "Predictive Analysis for Trauma Patient Readmission Database." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1492718909631318.
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Locke, Tiffany. "Methicillin-resistant Staphylococcus Aureus in Canadian Hospitals from 1995 to 2007: A Comparison of Adult and Pediatric Inpatients." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/26110.
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The literature directly comparing the epidemiology of MRSA among adult and pediatric hospitalized patients is strikingly minimal. The objective of this thesis was to identify any differences between these two patient groups. The Canadian Nosocomial Infections Surveillance Program MRSA data (1995 to 2007: n=1,262 pediatric and 35,907 adult cases) were used to compare MRSA clinical and molecular characteristics and rates. Hospital characteristics were modeled using repeated measures Poisson regressions. The molecular and epidemiological characteristics of MRSA differed significantly between adults and children. Compared to children, MRSA in adults was more likely to be healthcare-associated, colonization, SCCmec type II, PVL negative, and resistant to most antibiotics. Rates of MRSA in Canada increased in both populations over time but were significantly higher in adults. The hospital characteristics associated with increased MRSA rates differed in adult and pediatric facilities. Implications for infection prevention and control strategies are discussed.
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Jaishankar, Gayatri, and Matthew Tolliver. "Navigating the Complex Healthcare System." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/8872.
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Moror?, Deborah Dinorah de S? "O trabalho do enfermeiro de um hospital pedi?trico de ensino e o SUS: desafios a enfrentar." Universidade Federal do Rio Grande do Norte, 2006. http://repositorio.ufrn.br:8080/jspui/handle/123456789/14768.
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Previous issue date: 2006-06-06This study analyzes the point of view of nurses working at a pediatric teaching hospital on their work process within the scope of the Brazilian unified healthcare system SUS, in order to identify factors that interfere with its development and find out how work relations are taking place between nurses, other nursing professionals and the multidisciplinary staff. It is a descriptive and analytical study, qualitative in nature, which starts with a consideration of a nurse s current practices and moves on to reflect on a perspective of transformation aiming at rethinking their work process pursuant to the principles of SUS. In order to attain these objectives, we decided on using the focal group as a data-collecting technique, which took place from November to December 2005, by using as instruments a questionnaire for the characterization of the persons being researched and a discussion outline. Theoretical support has approached transformations in the world of work, placing it in the context of healthcare and nursing and has tried, specifically, to understand the work process of a nurse engaged in the production of health services. Therefore, the discourse analysis of participants, in the light of theoretical support, has evinced an ambiguity inasmuch as though identified as such in their work process, nurses are also fulfilling multiple functions in health services. Through this study it has also been possible to identify several factors that interfere with the work of these professionals, including poor working conditions and excessive hiring of high school graduate interns as an attempt to make up for a meager nursing workforce, as well as reveal the possibilities brought about by the SUS in retargeting its professional practice to interdisciplinarity and integrality
Este estudo analisa a vis?o das enfermeiras de um hospital pedi?trico de ensino acerca do seu processo de trabalho no contexto do Sistema ?nico de Sa?de (SUS), com vistas a identificar os fatores que interferem na sua efetiva??o e a forma como v?m se estabelecendo as rela??es de trabalho entre estas, os demais profissionais da enfermagem e a equipe multidisciplinar. ? um estudo descritivo/anal?tico de natureza qualitativa, que parte da reflex?o da atual pr?tica das enfermeiras para a perspectiva de transforma??o, no sentido de repensar o seu processo de trabalho em conson?ncia com os princ?pios do SUS. Para atingir tais objetivos, optou-se pelo grupo focal, como t?cnica de coleta de dados, o qual se realizou entre novembro e dezembro de 2005, utilizando-se como instrumentos um question?rio de caracteriza??o dos pesquisados e o roteiro de discuss?o. O referencial te?rico abordou as transforma??es no mundo do trabalho, contextualizando o trabalho na sa?de e na enfermagem e, especificamente, buscou compreender o processo de trabalho do enfermeiro inserido na produ??o dos servi?os de sa?de. Assim, as falas das participantes, analisadas ? luz das refer?ncias te?ricas, evidenciaram ambig?idade no reconhecimento do enfermeiro acerca do seu processo de trabalho, que, apesar de identific?-lo, assume m?ltiplas fun??es nos servi?os de sa?de. Este estudo ainda permitiu a identifica??o de diversos fatores que v?m interferindo na pr?tica desses profissionais, dentre os quais, as deficientes condi??es de trabalho e a excessiva contrata??o de bolsistas de n?vel m?dio, como alternativa de recompor a insuficiente for?a de trabalho da enfermagem, al?m de revelar as possibilidades trazidas pelo SUS na reorienta??o do seu fazer profissional com vistas ? interdisciplinaridade e a integralidade
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Johnson, Kiana, and A. Richmond. "Healthcare Transition among Youth with jSLE." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7016.
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Schetzina, Karen E. "The Role of Healthcare Providers in Breastfeeding Promotion in Appalachia." Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/5025.
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Wood, David L. "Screening Tools in Adolescent Health Care." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5187.
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Learning Objectives: (1) Identify three primary care friendly screening tools useful for identifying behavioral health concerns in adolescents. (2) Describe how a "champion" (quality improvement) team can help facilitate implementation of a screener in a primary care.
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Wood, David L. "An Overview of Neonatal Abstinence Syndrome." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5183.
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Wood, David L. "Social Determinants of Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5168.
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Wood, David L. "New Models of Health and Social Determinants of Health." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5180.
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Pantoja, Falconi Antonella Irma De Lourdes. "Centro Pediátrico de Rehabilitación en Los Olivos." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2020. http://hdl.handle.net/10757/653736.
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Este proyecto consiste en el diseño de un Centro de Salud del Primer Nivel de Atención especializado en la rehabilitación integral de niños y adolescentes. Se basa en una arquitectura terapéutica con la que se diseña un establecimiento de salud generando espacios amplios y abiertos hacia jardines terapéuticos, integrando los espacios naturales y recreativos con las áreas de tratamiento.
Se busca resolver la problemática de nuestra ciudad en la cual tenemos un déficit de centros de salud especializados en la rehabilitación pediátrica. El proyecto se ubica estratégicamente en el distrito de Los Olivos por la demanda en este sector de la población, y la falta de centros de salud de la zona. La población a servir son menores de 18 años con ciertas limitaciones, para que puedan desarrollarse y reintegrarse en la sociedad de manera adecuada.The project consists of the design of a Pediatric Rehabilitation Center. It is based on a therapeutic architecture that is used in designing a healthcare building by creating wide and open spaces to the gardens thus contributing to the user’s rehabilitation. It is intended to integrate the therapeutic gardens and natural areas of the project alongside the treatment areas with the objective to provide care for children and young people from an early age in order for them to develop and reintegrate themselves into society adequately. The project's location is in Los Olivos's district in the northern part of Lima due to the high demand of users and the lack of infrastructure in the area to help them.
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Schetzina, Karen E., and Dawn Tuell. "Use of the AAP CATCH Grant Process to Increase Healthcare Provider Support for Breastfeeding in Rural Appalachia." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/5057.
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Purpose
Breastfeeding affords numerous benefits for mothers, infants, families, and communities. Rates of breastfeeding are disproportionately low in rural Appalachia. We will describe how use of the AAP CATCH Grant process aided in building a community breastfeeding coalition, conducting a breastfeeding support needs assessment, and developing interventions to promote and support breastfeeding in the region.
Methods
In 2005, members of a multidisciplinary regional breastfeeding coalition in Northeast Tennessee wrote and received an AAP CATCH Planning Grant. Funds supported regular meetings of the coalition, a needs assessment consisting of surveys and focus groups conducted with patients and healthcare providers in the region during 2007-2008, and dissemination of the group's findings and recommendations. Patient participants were recruited from three health departments and one Pediatric clinic in the region. Provider participants were recruited from three regional professional conferences. Surveys were entered into and analyzed using SPSS 17. Recordings of focus groups were transcribed and transcripts were reviewed to identify themes.
Results
19 pregnant women in their second and third trimesters of pregnancy, 38 new mothers, and 58 healthcare providers completed a survey. Fifty five percent of new mothers reported ever having breastfed their baby. Thirty seven percent of healthcare providers identified Pediatrics, 21% Obstetrics and Gynecology, and 37% Family Medicine/Primary Care as their primary specialty. 52.6% and 81.6% of pregnant women and new mothers, respectively, reported that their healthcare provider had encouraged breastfeeding. Patients described that their healthcare providers discussed little about breastfeeding other than its benefits. Eighty-four percent of providers reported usually recommending exclusive breastfeeding during the first month of life. Only forty-eight percent of providers considered their advice on breastfeeding to be very important to mothers. Twenty-five percent of providers felt that exclusive breastfeeding for the first sixth months of life is unrealistic for many of their patients. The most commonly cited barrier by providers was that mothers had already decided not to breastfeed before they encountered them. Lack of time and lack of referral resources were other common barriers reported. Providers expressed the lowest levels of confidence in their own skills in evaluating latch, resolving problems of low milk production and breast tenderness, and knowing what referral services exist.
Conclusion
Patients in this sample described receiving little information about breastfeeding from their healthcare provider. Many health care providers in this region do not recognize the importance of their advice on breastfeeding and feel that breastfeeding is unrealistic for many of their patients. The use of study results by a community breastfeeding coalition to increase community awareness of the importance of breastfeeding promotion and support and to address provider concerns about barriers and educational needs will be discussed.
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Watson, Samuel I. "Economic and healthcare related determinants of infant health at birth." Thesis, University of Warwick, 2015. http://wrap.warwick.ac.uk/67738/.
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This thesis analyses the effects of various structural and organisational characteristics of specialist neonatal units on the clinical and economic outcomes of infants treated within them. Data are utilised from the National Neonatal Research Database (NNRD) which is extracted from the electronic patient records of all infants admitted to the vast majority of neonatal units in England over the period 2006-13 along with national healthcare expenditure and demographic data. Firstly, I examine the effects of neonatal unit volume and designation on infant clinical outcomes. In 2003, neonatal units in England and Wales were re-organised into networks to facilitate access to high level and volume neonatal units for the sickest infants as infants treated in these units had previous been shown to be at less risk of adverse outcomes. No previous studies have examined the effects of neonatal unit volume and designation in such a networked setting. Secondly, I estimate the effect of neonatal healthcare expenditure on the risk of mortality, and in so doing determine the cost-effectiveness of neonatal healthcare. Thirdly, I analyse the effect of nurse to patient ratios in neonatal intensive care on the risk of mortality, recent evidence has demonstrated that neonatal units are often understaffed with respect to clinical guidelines, yet little is known about the consequences of this on infant clinical outcomes. Finally, I explore the effect of local economic conditions at the time of conception on infant health at birth. The number of admissions to neonatal specialist healthcare units has increased in recent years to approximately 10% of all live births. Understanding the mechanisms underlying this increase is important both for healthcare capacity planning and also development of policies aimed at improving infant health at birth. The results in this thesis support policies aimed at increasing the proportion of infants born in hospitals with high volume neonatal units along with an increased provision of resources for neonatal healthcare.
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Wood, David L. "Research Methods Overview." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5173.
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Polaha, Jodi, J. D. Smith, Karen Schetzina, and S. C. Smith. "Unlocking Implementation in Primary Healthcare: The Family Check-Up as an Example." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6575.
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Wood, David L. "Transitioning Your Child with Autism to Adulthood." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5182.
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