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Dissertations / Theses on the topic 'Paediatric'
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1
Sylvester, Dianne. "Genes underpinning predisposition to childhood cancer." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/22458.
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The genetic changes underpinning cancer predisposition in children are not clearly defined and warrant further research, as identification of a genetic contribution to a patient’s disease can be beneficial for patients and their families. With technological advances, it is now possible to discover a broad spectrum of genetic changes implicated in cancer predisposition by sequencing the genome. An analytical review of six publications utilising germline genome sequencing in paediatric oncology found that these studies differed in the selected childhood cancer diagnoses and the genes considered for interpretation, resulting in differences in the proportions of childhood cancer patients that were reported to carry clinically relevant pathogenic germline variants. In this study, childhood cancer patients that presented with phenotypes indicative of a genetic susceptibility to cancer, such as multiple cancer diagnoses, a family history of cancer and/or a genetic diagnosis, underwent germline exome sequencing. Sequencing data were analysed for rare germline variants in over 1000 cancer predisposition, cancer associated and DNA repair genes, that were predicted to cause a loss of function or to be deleterious. Almost one quarter of childhood cancer patients with features suggestive of a genetic predisposition to cancer were found to carry pathogenic or likely pathogenic germline variant/s in 12 known cancer predisposition genes. A rare variant burden analysis of 31 autosomal dominant cancer predisposition genes found that deleterious germline variants were significantly enriched in a cohort of 63 childhood cancer patients compared to a cohort of 1107 genetically matched healthy aged controls. Novel germline variants not previously associated with cancer predisposition were also detected in 10 genes in 16 childhood cancer patients. This study has expanded our understanding of cancer predisposition in children, by discovering the diagnostic potential of sequencing patients with defined phenotypic features, and by linking pathogenic or likely pathogenic germline variants in known predisposition genes with new cancer diagnoses. Ultimately, by combining the analysis of family pedigrees with functional gene studies and data-sharing, the significance of novel germline variants associated with the onset of cancer in childhood will be established. As more childhood cancer predisposition genes are identified and characterised, screening processes may be more routinely incorporated into paediatric clinical care.
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Kamath, S. V. "Inflammation in paediatric asthma." Thesis, Queen's University Belfast, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269034.
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Do, Chau Giang. "Paediatric tuberculosis in Vietnam." Thesis, Open University, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.701361.
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There are approximately one million cases of tuberculosis (TB) in children each year. Despite this, there has been a chronic neglect of research into diagnosis, treatment and prevention of paediatric TB. The difficulties in confirming a diagnosis and the scattered, nature of cases have hampered research efforts. In the last decade, efforts have been made to systematically address the evidence gaps for paediatric TB diagnosis and management and to advocate for improved funding and resource allocation. Despite the successful nationwide implementation of Directly Observed Therapy Short course (DOTS), it is only recently that policymakers of the Vietnamese National TB control Program (NTP) have begun to consider TB in children. The aims of this thesis are to understand the epidemiology of TB among Vietnamese children including trends in disease, to evaluate the efficiency of a novel technique (GeneXpert) in diagnosis of TB and to identify risk factors for treatment of lost-to- follow-up in paediatric TB cases in Vietnam, a resource-limited, high-burden setting.
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Boss, Patricia M., and res cand@acu edu au. "Indicators of Satisfaction & Success For a Paediatric Outreach Nursing Service in Metropolitan Sydney, NSW." Australian Catholic University. School of Nursing, 2005. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp118.25102006.
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The purpose of this study was to determine the indicators of customer satisfaction and service success of a newly established paediatric outreach nursing service. Referring agents and care recipients were both consumers of the paediatric outreach nursing service. Both groups of consumers were surveyed to determine their satisfaction with the service delivery. Two satisfaction survey tools were developed to measure customer satisfaction. The tools were piloted and refined prior to distributing them. Both tools had a series of closed-ended questions and 3 open-ended questions. Eight service indicators were developed. These were designed to test the effectiveness of the service provided. The service indicators were piloted over two periods of three months and then modified based on the findings of the pilot period. The Paediatric Outreach Service (POS) is a positive service model for health care delivery. The survey results indicated that stakeholders were generally satisfied with the service delivery. When measured against service indicators that were developed for POS, the service performance was above average, with some opportunity to improve practice. Underpinned by a family-centered framework, POS has the capacity to empower children and their families in the planning and implementation of a management plan for the child’s illness. Such empowerment may lead families to practice better healthcare, develop better health-seeking practices and ultimately lead to healthier children. The results from this study has implications for nursing practice. The data obtained from this study may be useful to service providers considering commencing a paediatric outreach nursing service. Data may also be useful for existing service providers to use in order to review the aspects that consumers value against the service they currently provide. Keywords ambulatory care; paediatrics; home-nursing; community; evaluation; satisfaction; success; indicators
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Goswami, Madan Gopal. "An approach towards the development of an expert system for paediatric problem domain." Thesis, University of North Bengal, 1999. http://hdl.handle.net/123456789/1039.
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Jaffray, E. C. "Characterisation of paediatric odontogenic bacteraemia." Thesis, University College London (University of London), 2006. http://discovery.ucl.ac.uk/1444663/.
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Transient, asymptomatic bacteraemia can occur following dental extraction. Such events may lead to the development of serious systemic disease including infective endocarditis and abscesses of the brain and other organs. The aims of this PhD were to establish the prevalence, intensity, duration and microbiota involved in dental bacteraemia. Blood was sampled from 500 children before and after extraction post-extraction samples were taken at randomly allocated time intervals ranging from 10 seconds to 1 hour following treatment. Post-extraction bacteraemia was found to be most prevalent at 1 minute post-extraction with 76% of samples being culture-positive. Bacteraemia was low grade, with greatest intensity at 1 minute post-extraction with a range of 0.17 to 40.83 cfu/mL detected. The majority of isolates recovered were typical oral microbiota, most prevalent were streptococci and Actinomyces spp. Bacteraemia was judged to be resolved between 7.5 and 15 minutes post- extraction. Identification of streptococci, especially those related to the mitis group species proved difficult. Streptococci were identified using a polyphasic approach, including comparative 16S rRNA gene sequencing, biochemical testing and the development of a sodA PCR-RFLP method. The sodA PCR-RFLP method was found to identify 71.7% of the isolates to species level compared to only 55.1% using 16S sequencing. Two hundred and twenty eight isolates from 121 subjects were assayed for resistance to five antibiotics: ampicillin, erythromycin, penicillin, tetracycline and vancomycin. Thirty one percent showed resistance to at least 1 antibiotic at the break-point concentrations used, with some isolates displaying resistance to 4 of the antibiotics tested. The use of molecular techniques for investigation of bacteraemia was evaluated. Detection limits for Gram-positive and Gram-negative isolates and the effect of inherent PCR inhibitors were investigated. It is hoped that this work will promote the understanding of bacteraemia following dental extraction and provide more information to clinicians assessing the risk of focal infection.
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Mårtenson, Wikström Eva. "Information exchange in paediatric care." Doctoral thesis, Linköpings universitet, Omvårdnad, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-18007.
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Information exchange is an essential component for all involved in the paediatric care encounter. Despite this, most of the research about information exchange concerns adults and the significance of the child’s existence in the encounter have not been given sufficient attention. Therefore, the overall aims of this thesis were twofold. Firstly, the aim was to identify, describe and generate concepts in information exchange between minors, parents/guardians and health care professionals in paediatric care situations. Secondly, the intention was to formulate a theoretical construction, a theory, of the phenomenon of information exchange in paediatric care situations. This thesis is based on four studies. In studies I, II and III grounded theory was used according to Glaser and data have been analyzed using the constant comparative analysis method. Data have been collected through observations and medical records (I, II and III) and also with additional follow-up interviews (III). In study IV, at first a qualitative content analysis of Løgstrup’s ethical demand was conducted and, second, a simultaneous concept analysis of the findings from studies I, II and III and the findings from the qualitative content analysis was carried out. There were a total of 67 participants in the three observational studies: 28 minors (I), 24 parents/guardians (II) and 15 health care professionals (III), who exchanged information in different paediatric care encounters. The information exchange interaction process was resolved by the minors “balancing the circumstances” (I), the parents/guardians used “firm handling” (II) and the health care professionals were “sharing and contributing the responsibility” (III). The qualitative content analysis of Løgstrup’s ethical demand provided the mediation and the social norms. The simultaneous concept analysis finally gave the advanced outcome to intergrade, which means to merge gradually with another through a continuous series of intermediates. At the same time as we intergrade in paediatric care, we protect the totality of minors, recognize the dependency of the parents/guardians and the social interplay by the health care professionals, the information exchange is improved. This thesis emphasizes the importance of health care professionals’ communication skills and the need for education and practice in this topic, in order to improve the information exchange with minors and their parents/guardians from an ethical viewpoint. The theory intergrade explains how this could be applied and implemented.
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Rashed, Asia Nasser. "International paediatric drug safety studies." Thesis, University College London (University of London), 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.569067.
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There are limited data on incidences of drug related problems (DRPs) including adverse drug reactions (ADRs) in children. The aim of this thesis is to increase knowledge of the incidence of ADRs and other DRPs and to enhance the understanding of risk factors for ADRs across several countries. This should facilitate the development of appropriate prevention strategies. Two large prospective cohort studies were conducted; ADVISE" recruited patients from five countries to investigate the incidence and characteristics of ADRs. Multivariable regression analysis was conducted to identify risk factors associated with ADRs in hospitalised children. The second study investigated DRPs in children attending the A&E department and/or admitted to a hospital in the Kingdom of Saudi Arabia (KSA) and the UK. ADRs and other DRPs were identified using intensive chart review. In the ADVISE study, 1278 children were included (Australia n=149, Germany n=376, UK n=313, HK n=143, Malaysia n=300). The overall ADR incidence was 18.5% (95% Cl, 16.3- 20.9). There was significant variation in incidence between countries (p<0.001), the highest was in the UK (34.9%). The use of ~five low risk drugs per patient or ~three high risk drugs (e.g. opioids) were strong predictors for ADRs (OR 4.7,95% CI, 2.4-9.3; OR 6.5,95% CI, 2.7-16.0; respectively, p<0.001). In the second study, 990 children were included (KSA n=507, UK n=483). The overall incidence of DRPs was 39.2% (95% Cl, 36.1-42.3). Incidence was highest in the paediatric intensive care units (59.7%; 95% CI, 47.0-71.5). Dosing problems were the most frequent DRP (n=303, 55.5%).80.0% (n=437) of DRPs were preventable. Using standardised methods in both studies enabled comparison of incidences of ADRs and DRPs between countries. The variation between countries was considered to be mainly due to differences in treatment strategies. These studies indicated that improvements to current procedures could reduce DRPs and hence improve patients' health. Also, a focus on paediatric pharmacology and pharmacotherapy within paediatric medical education is important to improve prescribing practices and paediatric patient safety.
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Lugg, Fiona. "The management of paediatric gastroenteritis." Thesis, Cardiff University, 2014. http://orca.cf.ac.uk/64966/.
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Paediatric gastroenteritis [GE] is a common and important condition that causes a considerable burden on the NHS, the families and the patient. Despite this, the evidence for effective management is limited. Only a proportion of patients (and parents) consult, but we know little about their reasons for consulting and how they manage the illness at home. Using a mix of methods this project aimed to explore the current management of paediatric gastroenteritis in the United Kingdom, focussing specifically on home management and primary care consultations. A prospective case series was designed in which primary care clinicians within Wales identified and invited paediatric patients (and their parent) to take part in the study. Baseline information was recorded for all eligible patients. Parents of eligible patients were invited to take part in a qualitative telephone interview as well as being identified through social media. Clinicians were approached to take part in a separate qualitative study. Anonymous patient records of paediatric patients presenting to primary care between 2003 and 2012 were extracted from CPRD Results show a decrease in consultation rates over 10 years however hospital referrals and stool sample requests have increased. Parents’ attitudes toward GE management impacted on their actions around prevention of illness and transmission. The variety of beliefs around causes of and threats from GE also influenced their actions. Reported clinical decisions and advice to parents were often not in line with current guidance from expert bodies. Many clinicians were not aware of guidelines on managing paediatric GE which might account for some of the variability in their management. Variation can ultimately result in inappropriate management and thus increase the burden of illness on both families and the NHS. Parent and clinician beliefs need to be addressed in order to ensure management of GE is appropriate and not detrimental to patients.
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Whitfield, Karen M. "Sedation in paediatric intensive care." Thesis, Aston University, 2002. http://publications.aston.ac.uk/11055/.
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This study consisted of two stages. Stage 1 investigated the reproducibility and practicality of two observational sedation assessment scales for use in critically ill children. The two scales were different in design, the first being simple in design requiring a single assessment of the patient. The second was more complex in design requiring assessment of five patient parameters to obtain an overall sedation score. It was established that nursing staff preferred the second, more complex sedation scale mainly because it was perceived to give a more accurate assessment of level of sedation and anxiety rather than merely level of sedation. Stage 2 investigated the pharmacokinetics and pharmacodynamics of midazolam in critically ill children. 52 children, aged between 0 and 18 years were recruited to the study and 303 blood samples taken to analyse midazolam and its metabolites, 1-hydroxymidazolam (1-OH) and 4-hydroxymidazolam (4-OH). A significant correlation was found between midazolam plasma concentration and sedative effect (r=0.598, p=0.01). It was found that a midazolam plasma concentration of 223ng/ml (±31.9) achieved a satisfactory level of sedation. Only a poor correlation was found between dose of midazolam and plasma concentration of midazolam. Similarly only a poor correlation was found between sedative effect and dose of midazolam. Clearance of midazolam was found to be 6.3ml/kg/min (±0.36), which is lower than that reported in healthy children (9.11-13.3ml/kg/min). neonates produced the lowest clearance values (1.63ml/kg/min), compared to children aged 1 to 12 months (8.52ml/kg/min) who achieved the highest clearance values. Clearance was found to decrease after the age of 12 months to values of 5.34ml/kg/min in children aged 7 yeas and above. Patients with renal (n=5) and liver impairment (n=4) were found to have reduced midazolam clearance (1.37 and 0.74ml/kg/min respectively). Disease state was found to affect production of 1-OH. Patients with renal impairment (n=5) produced the lowest 1-OH midazolam plasma ratio (0.059) compared to patients with head injury (0.858).
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Abdulla, Kamal Chelvakumaran. "Space maintainers in paediatric dentistry." Thesis, Faculty of Dentistry, 1989. http://hdl.handle.net/2123/4277.
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Pinkstone, Emily. "Histone deacetylases in paediatric glioblastoma." Thesis, University of Portsmouth, 2017. https://researchportal.port.ac.uk/portal/en/theses/histone-deacetylases-in-paediatric-glioblastoma(71ef5f70-6dc0-478a-9b4a-21d26f80637e).html.
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Paediatric glioblastoma multiforme (pGBM) is an aggressive childhood brain tumour with less than 10% of children surviving two years post diagnosis. There is no cure, and treatment options are limited and ineffective. Gene expression profiling, whole-exome sequencing and genome wide copy number analyses have revealed a number of ‘oncohistone’ mutations amongst pGBM. Acetylation and deacetylation of histones and non-histone proteins is controlled by histone acetyltransferases (HATs) and histone deacetylases (HDACs). HDACs, critical for development, are involved in modulating key cellular processes, including DNA damage repair, cell cycle control, apoptosis, transcriptional regulation and metabolism. Their functioning in cancer is impaired and the potential use of HDAC inhibitors for cancer treatment is an active area of both basic and clinical research. There are 11 HDAC family members, grouped according to their structure, cellular localization and homology with yeast HDAC proteins. Little is known about HDAC expression in pGBM. The hypothesis for this study was that HDACs would be over-expressed in pGBM, given the wide use of HDACi research. The aims of this project were to; 1) systematically analyse HDAC expression in pGBM using publicly available datasets, 2) Begin to characterise HDAC expression in two, well-characterised paediatric GBM cell lines in order to identify specific HDAC family members that are dysregulated in pGBM.
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BELLONE, Simonetta. "Hormonal aspects in paediatric obesity." Doctoral thesis, Università del Piemonte Orientale, 2014. http://hdl.handle.net/11579/45358.
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Hanna, Sharon. "Perceived Efficacies of Australian Paediatric Surgical Care by Rural and Metropolitan Paediatric Patients and their Parents." Thesis, Griffith University, 2013. http://hdl.handle.net/10072/366663.
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This study is the first to generate two patient satisfaction instruments, the Paediatric Surgical Patient Evaluation Questionnaire (PSPEQ, Parent form) and the Questionnaire on Children’s Surgery in Hospital (QCSH, Child form), with robust preliminary psychometric properties that capture the experiences of 5 to 10-year-old paediatric day-surgery patients and their parents in rural and metropolitan Australia. Patients’ and parents’ evaluations of Australian paediatric specialist surgical care and the impact of travel time on these evaluations was also newly investigated. The theoretical structure was generated to illustrate the interrelationships between the most salient aspects of Australian paediatric surgical care as described by parents. This was also a new contribution to knowledge, since it newly captured the holistic experience of care from seeking a referral to see the specialist through to 1 week after discharge. Evaluations of care by patients and parents were investigated to identify the important needs and issues specific to parent and child using a multiple-method approach. Participants included 214 parents (4 males, 210 females) and 58 paediatric surgical patients aged 5 to 10-years-old (159 males, 55 females). Semi-structured interviews and newly constructed questionnaires shortly after surgery uncovered attitudes and issues on services delivered during the paediatric surgical experience. In the quantitative phase of the study, exploratory factor analysis of the newly constructed PSPEQ (pron. pea - speck) resulted in a four-factor structure and included Hospital Staff, Surgeons, Hospital Facilities, and Access factors. The 41-item solution accounted for 47.2% of the score variance.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medical Science
Griffith Health
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Thiru, Yamuna. "Myocardial function in paediatric meningococcal disease." Thesis, Imperial College London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251576.
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Tan, Hock Lim. "The development of paediatric endoscopic surgery /." Title page, contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09MD/09mdt161.pdf.
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Schock, Bettina C. "Oxidative stress in paediatric lung disease." Thesis, Queen's University Belfast, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.300998.
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Sach, Tracey Helen. "Economic aspects of paediatric cochlear implantation." Thesis, University of Nottingham, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.403949.
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Ward, Samantha Jane. "Genetic abnormalities in paediatric glial tumours." Thesis, University College London (University of London), 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.404885.
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Buck, Sarah. "Memory in paediatric temporal lobe epilepsy." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10057610/.
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Temporal lobe epilepsy (TLE) is a common form of epilepsy and is frequently associated with memory and learning impairments. Medically intractable and lesion-based TLE occurs in 20-30% of the patients, in which case a surgical intervention is proposed. However, there is a clear gap in knowledge about pre-operative memory status in children undergoing surgery and post-operative memory outcome. It is unclear whether paediatric patients show material-specific memory impairments associated with side of pathology and whether specific memory processes are affected more than others, i.e. learning, recall and recognition. Lastly, as opposed to language lateralisation, the neural representation of memory is unknown and memory fMRI has never been explored in paediatric TLE. The aim of this project is therefore to investigate the hippocampal-neocortical network that is at risk of compromise given learning and recall deficits in paediatric TLE at the pre-operative level in order to contribute to the prediction of outcome after surgery. I developed a neuropsychological protocol and a neuroimaging protocol for the investigation of pre-operative memory functions. The neuropsychological protocol is a tablet-based version of a paired-associate learning paradigm that allows comparisons between verbal and non-verbal memory. I validated this protocol in normally-developing children (N=130, 8-18 years). The neuroimaging protocol is a combined language and memory fMRI task that allows the investigation of the interaction between the two networks within one scanning session. This protocol was also validated in normally-developing children (N=28, 8-18 years). The feasibility of these protocols for clinical assessments was explored in a representative sample of children with TLE who were being considered for surgery (N=6, 12-18 years). These protocols add value to the diagnosis of memory impairments associated with paediatric TLE and provide a better understanding of pre-operative memory profile at the individual level. The findings also contribute towards the use of memory fMRI in the surgical decision-making process. Combining information from these protocols could provide prognostic indicators of outcome after surgery.
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Hawkins, L. C. "Parental adjustment following paediatric burn injury." Thesis, University of Liverpool, 2017. http://livrepository.liverpool.ac.uk/3009495/.
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Blundell, James Michael. "Cognitive assessment of paediatric neurodegenerative disease." Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/6042/.
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Inherited metabolic diseases (IMD’s) are a large class of heterogeneous genetic disorders caused by dysfunction within a single pathway of intermediary metabolism. In many of these diseases, the dysfunction of metabolic enzymes leads to the accumulation of toxic metabolites which disrupts the normal development of the central nervous system. With the advent of treatments that positively influence neuropsychological outcomes, there is a need for sensitive and objective neuropsychological measures that allow patients to be systematically tracked in order to understand the efficacy of existing treatments. In this thesis, a neuropsychological test battery consisting of attention, language and oculomotor measures was developed to accurately describe individual and developmental differences between IMD patients and healthy developing controls. The functioning of five diseases was examined: Morquio syndrome (\(N\) = 12), Hurler syndrome (\(N\) = 3), Maroteux-Lamy syndrome (\(N\) = 2), Tyrosinemia type I (\(N\) = 13) and Tyrosinemia type III (\(N\) = 5). Findings indicated that disease effects were not homogeneous across tasks, and that performance on the same tasks was not uniform across diseases. The obtained data offers a promising basis for understanding how biological factors influence the severity and timecourse of developmental effects in future research.
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Roberts, Ian. "Molecular cytogenetic analysis of paediatric rhabdomyosarcoma." Thesis, University of Cambridge, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.621125.
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Slegtenhorst, Sonja. "Antioxidant intake in paediatric oncology patients." Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/18050.
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Thesis (MNutr)--Stellenbosch University, 2011.ENGLISH ABSTRACT: Background: The role of antioxidants and adequate nutrition in the prevention and course of cancer treatment is globally recognised in nullifying the effects of free radicals and increasing the nutritional status of children during treatment. Objective: To investigate whether children with cancer meet their Dietary Reference Values and Safe Intakes for antioxidants, energy and protein. Design: Single centre prospective study. Setting: Children were recruited from the East of England Primary Treatment Centre using convenience sampling over 8 months. Forty-two children and adolescents diagnosed with a Solid tumour, Lymphoma or Leukaemia were eligible for data analysis (n=20 male; n=22 female). Method: Data was collected with an Estimated Food Record (EFR) in the 1st (EFR1) and 3rd month (EFR2) post-diagnosis. In the week following EFR completion, parents and/or children were contacted to complete four non-consecutive days of 24-hr food recalls. Data was categorised into diet alone, diet + food supplement (FS), tube feeding (tube) or diet + multi-vitamin-mineral supplementation (VMS). Malnutrition was determined by weight-for-age z-scores. Nutrient intake was compared to the Recommended Nutrient Intake (RNI), the Estimated Average Requirements (EAR) and the Lower Recommended Nutrient Intake (LRNI). Result: The sample consisted of 33% (n=14) diagnosed with Leukaemia, 24% (n=10) with Lymphoma and 43% (n=18) with Solid tumours. Sixty seven percent (n=28) underwent chemotherapy and 33% (n=14) a combination of therapies. Significant correlations were seen between the assessment tools in the diet alone category for both months for; vitamins A, C, E, selenium and protein and for EFR1 for zinc and energy. In both months greater numbers of children achieved ≥100% of requirements for diet + VMS (EFR 1; p<0.05; EFR2 p<0.05) than for other feeding modes. Vitamin C achieved the highest intakes compared to the RNI at 773% (EFR1) and 829% (EFR2). Intakes above 200% of the RNI were seen for vitamins A, C, E, selenium and zinc. No significant differences were seen between modes of feeding in either month for selenium or zinc. Vitamin A (EFR1≤ 100% diet alone p<0.05) and zinc (EFR1≤ 100% diet alone p=0.02) met the least of the LRNI in the 1st month compared to other antioxidants. No statistical significant difference was observed between the number of children attaining their EAR’s between the 3 modes of feeding in the 1st month and 3rd month. In the 1st month 27% (n=8) of participants consumed vitamin and/or mineral supplements, 18% in the 3rd month (n=4). In the 1st month 5% (n=2) of children were moderately malnourished and 10% (n=4) in 3rd month. Conversely in the 1st month 3% (n=1) were overweight and 3% (n=1) obese; the leukaemia group predominant. Conclusion: The research tools showed good correlation. Children using vitamin and/or mineral supplements mostly achieved their RNI’s compared to other feeding modes. Across feeding modes some children achieved antioxidant intakes above 200% RNI. LRNI’s on diet alone were not achieved for vitamin A and zinc. The study showed Leukaemics as having a higher prevalence of obesity. More research is required to determine the clinical implications of these findings.
AFRIKAANSE OPSOMMING: Agtergrond: Die rol van anti-oksidante en voldoende voeding in die voorkoming en verloop van kanker behandeling word wêreldwyd erken vir vernietiging van die effek van vry radikale en die verbetering van voedingstatus van kinders tydens behandeling. Doelwit: Om ondersoek in te stel of kinders met kanker hul Dieet Verwysingswaardes en Veilige Innames vir anti-oksidante, energie en proteïen bereik. Ontwerp: Enkel sentrum prospektiewe studie. Omgewing: Kinders was gewerf deur middel van gerieflikheidsteekproefneming oor 8 maande vanaf die “East of England Primary Treatment Centre”. Twee-en-veertig kinders en adolessente gediagnoseer met 'n Soliede tumor, Limfoom of Leukemie het in aanmerking gekom vir dataanalise (n=20 manlik, n=22 vroulik). Metode: Data was ingesamel met ‘n Geskatte Voedsel Rekord (GVR) in die eerste (GVR1) en derde maand (GVR2) na diagnose. In die week na voltooiing van die GVR is ouers en/of kinders gekontak om vier onopeenvolgende dae van 24-uur herroepe te voltooi. Data was verdeel in dieet alleen, dieet + voedsel supplement (VS), buisvoeding (buis) of dieet + multi-vitamien-mineraal supplementasie (VMS). Wanvoeding was bepaal deur middel van gewig-vir-ouderdom z-tellings. Nutriënt inname was vergelyk met die Aanbevole Nutriënt Inname (ANI), die Geskatte Gemiddelde Behoeftes (GGB) en die Laer Aanbevole Nutriënt Inname (LANI). Resultate: Die steekproef het bestaan uit 33% (n=14) gediagnoseer met Leukemie, 24% (n=10) Limfoom en 43% (n=18) Soliede tumore. Sewe-en-sestig persent (n=28) het chemoterapie ontvang en 33% (n=14) ‘n kombinasie van terapieë. Betekenisvolle korrelasies was waargeneem tussen die assesseringsinstrumente in die dieet alleen kategorie vir beide maande vir vitamiene A, C, E, selenium en proteïen en vir GVR1 ook vir sink en energie. In beide maande het ‘n groter aantal kinders ≥100% van hul behoeftes bereik vr dieet+VMS (GVR1; p<0.05; GVR2 p<0.05) as vir ander modi van voeding. Vitamien C het die hoogste innames bereik vergeleke met die ANI teen 773% (GVR1) en 829% (GVR2). Innames bo 200% van die ANI was waargeneem vir vitamiene A, C, E, selenium en sink. Geen betekenisvolle verskille was waargeneem tussen modi van voeding in enige maand vir selenium en sink nie. Vitamien A (GVR1≤100% dieet alleen p<0.05) en sink (GVR1≤100% dieet alleen p=0.02) het die minste van die LANI bereik in die eerste maand vergeleke met ander anti-oksidante. Geen statisties beduidende verskil was waargeneem tussen die aantal kinders wat hul GGB’s bereik het tussen die 3 voedingswyses in die eerste en derde maande nie. In die eerste maand het 27% (n=8) van deelnemers vitamien en/of mineraal supplemente ingeneem, en 18% (n=4) in die derde maand. In die eerste maand was 5% (n=2) van kinders matig wangevoed en 10% (n=4) in die derde maand. In die eerste maand was 3% (n=1) van kinders oorgewig en 3% (n=1) vetsugtig, die leukemie groep spesifiek. Gevolgtrekking: Die navorsingsinstrumente het goeie korrelasie getoon. Kinders wat vitamien en/of mineraal supplemente gebruik het het meestal hul ANI’s bereik vergeleke met ander modi van voeding. Oor voeding modi het sommige kinders anti-oksidant innames bo 200% ANI bereik. LANI’s op dieet alleen was nie bereik vir Vitamien A en sink nie. Hierdie studie het aangetoon dat dié met Leukemia ‘n hoër prevalensie van oorgewig/vetsug getoon het. Meer navorsing is nodig om die kliniese implikasies van die bevindinge te bepaal.
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Wynchank, Sinclair. "Aspects of paediatric gastro oesophageal scintigraphy." Doctoral thesis, University of Cape Town, 1988. http://hdl.handle.net/11427/27191.
Full textAbstract:
This work is concerned with the application of scintigraphy in studies of foregut motility in paediatric patients; notably oesophageal transit during swallowing, gastro oesophageal reflux (GOR) and stomach emptying as measured by the gastric contents 30 and 120 minutes after deglutition of liquid. Relevant anatomy, physiology, pathophysiology and non-radioisotopic methods of gastro oesophageal examination are outlined. The extremely important question of dose deposited by ionising radiation in paediatric patients is also considered. Because currently available estimations of absorbed dose after swallowing non- absorbable radionuclides are unsatisfactory and often contradictory, a new model was derived. It is based on more physiological principles than previous models, with a continuously varying exponential passage between four compartments in the gastrointestinal tract. From a review of previous work and our experience, a standard method of examination was developed. There is emphasis on normal physiological manoeuvres. The broad extent of useful information available in the study stems from the positions in which the patient is investigated, the quantity of labelled fluid swallowed, its physiological nature and observations of oesophageal transit, GOR, gastric emptying and pulmonary aspiration after two hours. The wide range of paediatric problems amenable to investigation by this means is described, including those of a life-threatening nature. Also, the importance of using this examination to determine the likelihood of successful surgical intervention in the gastro oesophageal region is explained. By using the observations made during swallows in neonates, the closure of the lower oesophageal sphincter (LOS) was observed during a short series of rapid deglutitions. This extends previous knowledge of the function of the neonatal LOS. These findings were very clearly demonstrated by the condensed image technique. A comparison between the abilities of radiology and scintigraphy to detect GOR in paediatric patients, with and without oesophagitis, gives unequivocal results in favour of scintigraphy. Two independent clear correlations between oesophageal transit time and the severity of GOR and age are demonstrated by variance and correlation analysis. The mean duration of GOR, maximum height of a GOR, gastric contents 30 and 120 min after deglutition, the effect of the nature of liquid swallowed and age are also examined and their relations are described. The application of the method to assess drug response is illustrated by the paediatric use of cisapride, an experimental drug which increases acetylcholinesterase release. The deductions from this work include values of the radiation dose deposited in paediatric patients of various ages, after swallowing non- absorbed Tc-99m compounds. Other contributions are a scintigraphic means to allow recognition of the importance of oesophageal dysmotility in paediatrics, especially in the absence of GOR and its relevance to the efficacy of surgery in cases of apparent GOR. Also, this gastro oesophageal scintigraphic study provided information on the paediatric use of cisapride, the relevance of GOR to repeated respiratory problems and the recognition of a new paediatric syndrome analogous to the diffuse oesophageal spasm syndrome of adulthood. It has been demonstrated that a routine, uncomplicated, paediatric scintigraphic examination, useful for investigating a wide range of problems in both a first and third world setting is possible for a nuclear medicine practitioner with normally available radiopharmaceuticals, equipment and radiographical expertise.
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Brink, Anita. "Reproducubility of the Paediatric radionuclide renogram." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/3369.
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Wami, Welcome Mkululi. "Paediatric schistosomiasis : diagnosis, morbidity and treatment." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/15674.
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Schistosomiasis is a major parasitic disease caused by parasitic helminths of the genus Schistosoma which affects children in Africa, with negative impacts on general health, growth and cognitive development. Infection and morbidity are controlled by treatment with the antihelminthic drug praziquantel. Preschool children (aged ≤5 years old) have been neglected both in terms of research and control, and it is only recently that the World Health Organization (WHO) recommended praziquantel treatment and the inclusion of preschool children in control programmes. However, the burden of disease in this age group still remains poorly understood, and the performance of the currently available tools for detecting infection and morbidity is still yet to be systematically evaluated. The aim of this thesis was to compare the utility of currently available tools for diagnosing S. haematobium infection and related morbidity. The initial study cohort consisted of 438 Zimbabwean children (age range: 1-10 years) who were endemically exposed. Point-of-care schistosome-related morbidity markers applicable in the field, as well as serological biomarkers (CHI3L1, CRP, ferritin, resistin and SLPI) and inflammatory cytokines (IL-4, IL-5, IL-10, IL-13 and IFN-γ) that could predict early stages of immune-mediated pathology due to schistosomiasis were measured. Using a combination of applied statistical methods, the effect of treatment on factors associated with S. haematobium exposure, infection and morbidity in children aged 1-5 years was determined and the findings compared with those observed in children aged between 6-10 years old, who are the current targets of the schistosome control programmes. In this thesis, I able to demonstrate that preschool children carried significant infection, further reiterating the need for their inclusion in control programmes. Furthermore, this study demonstrated the importance of using additional sensitive diagnostic methods as this has implications on the required intervention strategies for the targeted populations. This study further revealed that preschool children can be effectively screened for schistosome-related morbidity using the same currently available diagnostic tools applicable to older children. Urinalysis markers microhaematuria, proteinuria and albuminuria are recommended in this thesis as the best choice for rapid assessment of morbidity attributed to S. haematobium infection in the field. Additionally, it was shown that the praziquantel treatment regimens aimed at controlling schistosome infection and morbidity currently designated for primary school-aged children and older populations are applicable to preschool-aged children. The involvement of serum biomarkers and immune correlates in the biological processes of inflammation suggests that these markers can be potential early predictors of schistosome-related pathology. Further research efforts are required to establish the relationship between these biomarkers and presence of schistosome-related morbidity as measured using point-of-care indicators in larger cohorts of populations chronically exposed to schistosome infections. In summary, the findings of this thesis highlight the need for the refinement of existing diagnostic methods for accurate detection of infection and morbidity in children. This will enable appropriate and timely intervention strategies, aimed at improving the current and future health of preschool aged-children to be implemented. The findings presented here will aid researchers and other stakeholders in making informed choices about intervention tools for control programmes targeting young children.
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SANNAPPA, VENKATRAMAN SOUNDAPPAN SOUNDAPPAN. "Surgeon performed ultrasound in Paediatric Surgery." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/24950.
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Ultrasound is a ubiquitous imaging technique which has undergone rapid acceleration in technology since the1970s and its use has expanded to many specialties of medicine. It is however operator dependent and hence remained predominantly in the realms of sonographers and radiologists. The development of portable ultrasound equipment has enabled clinicians to increasingly use ultrasound as an extension of their clinical arm. Ultrasound has been used in outpatient evaluation, intensive care units, emergency and in the operating theatres for diagnostic and therapeutic purposes. While this practice is widespread in adult practice it is not as prevalent in paediatrics and specifically paediatric surgery. With the clinician’s first-hand knowledge of the patient’s history and physical examination the interpretation of the images should be more accurate, hence aiding diagnosis. Its application is particularly attractive in children because of absence of exposure to radiation and lack of need for an anaesthetic. The aim of this thesis is to extend the use of ultrasound into Paediatric Surgical clinical practice in a scholarly manner. Diagnostic and therapeutic role of use of surge
Chapter 2 is a literature review tracing history of diagnostic ultrasound and POCUS in
paediatrics.
Chapters 3-5 aimed to determine if Surgeon performed diagnostic ultrasound:
• Is as accurate as that performed by radiologists in diagnosis of common
acute paediatric surgical conditions.
• It will improve overall care in terms of time and cost-saving.
Chapter 6 studies the therapeutic role of ultrasound in percutaneous insertion of
central venous lines.
The study aimed to demonstrate if Ultrasound guided insertion was safe, time-saving
and avoid long-term complications.
21
Chapter 7 is a review on skills required and discussion on accreditation in POCUS.
on performed ultrasound was studied.
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Graham, David Warwick. "Corpus callosotomy outcomes in paediatric patients." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17980.
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Corpus callosotomy is a palliative disconnective neurosurgical treatment that is typically employed for patients with medically refractory epilepsy characterised by injurious drop attacks. This thesis describes the 20 year experience with corpus callosotomy at Great Ormond Street Hospital for Children (GOSH) in London and the Children’s Hospital at Westmead (CHW) in Sydney. Between January 1995 and December 2015, 76 patients underwent corpus callosotomy at GOSH (n=47) and CHW (n=29); 55 patients met inclusion criteria. Patient records were analysed for changes in seizure type and frequency, changes in injuries, changes in use of antiepileptic drugs, and neurological and surgical complications. Rare or no drop attacks was analysed using Kaplan–Meier event-free survival curves using right-censoring of data. Multivariable regression analysis was used to assess the effect of clinical characteristics on outcome at last follow up. Median follow up was 36 months (interquartile range 34 months). Overall 26/55 patients (47.3%) had rare or no drop attacks at last follow up. Of the children who had drop attacks at last follow up, 26/29 of these patients (89.7%) had a return of drop attacks within 12 months of surgery. There were no significant predictors of developing drop attacks post-surgery. Neurological complications occurred in 11/55 operations (20.0%) and resolved within 6 weeks in all patients. Surgical complications occurred in 6/55 operations (10.9%), with only one major complication (hydrocephalus) and no deaths. Corpus callosotomy was a well-tolerated palliative procedure that was effective at reducing the severity of drop attacks in this case series. In patients for whom drop attacks return, they are likely to do so within 12 months of surgery. Several other case series and systematic reviews provide evidence to support the hypothesis that corpus callosotomy is a safe and effective palliative treatment for patients with medically refractory generalised seizures that is typically characterised by injurious drop attacks. But there is no strong evidence to demonstrate the validity of that hypothesis. A case study is presented to highlight some of the bioethical issues of corpus callosotomy in children. Parental resistance to epilepsy surgery is a well-known barrier to access for all epilepsy surgery. While earlier intervention has demonstrable benefits on quality of life, some parents find the prospect of disconnection syndrome challenging and resist corpus callosotomy. The case study is then used to frame issues relating to consent and the best interests of children undergoing corpus callosotomy, highlighting the shortcomings of the concept of autonomy.
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Lorentzos, Michelle Sarah. "The Psychiatry of Paediatric Movement Disorders." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20602.
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I compared the rate of psychiatric comorbidity in children with Non-tic movement disorders to children with tics and TS. In addition, this PhD explores whether children with Non-tic movement disorders have elevated rates of psychiatry compared to other hospital populations, including Emergency patients and other Neurology patients, as well as a healthy community control group. My hypothesis was that children with Non-tic movement disorders would have rates of psychiatric comorbidities that are similar to children with tics and TS.To examine this hypothesis, I recruited children between the ages of 5 and 16 years from Neurology clinics at The Children’s Hospital at Westmead, Australia, and Great Ormond Street Hospital, United Kingdom, for the following two movement disorder groups: tic movement disorder cohort (consisting of patients with tics and Tourette Syndrome, n=158) and Non-tic movement disorder cohort, (consisting of patients with all other movement disorders, n=102). An additional 137 patients were recruited for two clinical control groups: the Emergency department control cohort (n=100) and the Neurology control cohort including children with peripheral neuropathy or epilepsy (n=37). In addition, data from 10,438 British children were included as a retrospective community control. All patients were screened for psychiatric comorbidities using the Development and Wellbeing Assessment Tool (DAWBA). My primary outcome was that the difference in the rate of psychiatric comorbidity in the Non-tic cohort (39.2%) and the Tic cohort (41.8%) was not statically significant. Importantly, the rate of psychiatric comorbidity in the Non-tic cohort was more than four times the rate of psychiatric diagnosis observed in the large retrospective community cohort (9.5%) (p<0.00001). This is the largest study to date exploring psychiatry in children with paediatric dystonia (n=66) and psychiatric comorbidities occurred in 33.3% of these patients. In conclusion, this study recognises that children with non-tic movement disorders are just as vulnerable to psychiatric comorbidities as children with tics and TS. This new evidence may encourage clinicians to consider screening for psychiatric comorbidities in their movement disorder patients, therefore allowing for earlier diagnosis and treatment.
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Simmonds, J. D. "Improving outcomes in paediatric heart transplantation." Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1433332/.
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For patients with end-stage heart failure, heart transplantation remains the only viable long-term option. During the last fifty years, the procedure has become more successful, and the majority of candidates can now expect to recover and lead relatively normal day-to-day lives. Unfortunately, however, it is not a perfect cure. Daily lifelong immunosuppression is required to protect against rejection, and current drug regimens have substantial side-effects including infection, renal failure and hypertension, all of which further shorten life expectancy. Current post-transplant graft survival is estimated at 15 to 20 years, after which re-transplantation is indicated; with donation rates decreasing, and potential recipient numbers increasing, this is by no means certain. This thesis represents a body of work aiming to show improving outcomes for children at different stages of the transplant journey. Pre-transplant diagnosis has long been thought a predictor of outcome, with worse results for patients transplanted for congenital heart disease than cardiomyopathy. This work showed that with increasing specific surgical expertise, this bias has now largely disappeared. Restrictive cardiomyopathy, pre-transplant extra-corporeal membranous oxygenation and extreme donor:recipient weight ratio were all shown to increase the need for extra-corporeal life support as a rescue therapy in the immediate post-operative phase; this was associated with excellent medium-term survival in patients surviving to hospital discharge. Preimplantation use of the induction immunosuppression basiliximab was evaluated, indicating a reduction in acute rejection and mortality in the first 6 months posttransplant. Maintenance immunotherapy was also investigated, suggesting an improved side-effect profile seen in children taking tacrolimus rather than ciclosporin. Finally, cytomegalovirus was linked to the most important cause of death for patients over five years post-transplant – namely coronary allograft vasculopathy – as well as morphological and functional impairment in the systemic vasculature of heart transplant recipients. In summary, this thesis indicates an improving outcome for children at every stage of the post-transplant journey.
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Hollis, Amy Louise. "Dental anxiety amongst paediatric cardiology patients." Thesis, University of Leeds, 2012. http://etheses.whiterose.ac.uk/3238/.
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Background: The dental health of paediatric cardiology patients has been shown to be poorer than that of healthy children. Multiple factors could be implicated with dental anxiety potentially playing a major role. However, there is no published research specifically looking at dental anxiety amongst paediatric cardiology patients. Aims: The primary aim was to determine whether there was a difference in the level of dental anxiety between paediatric cardiology patients and a group of healthy children. The secondary aim was to establish whether dental anxiety was affected by previous medical history as measured by number of overnight hospital admissions, number of general anaesthetics and cardiac complexity category. Materials and Methods: Fifty-four participants were recruited into the study group from the outpatient cardiology clinic at Leeds General Infirmary. The control group comprised 53 children who attended consultant-led new patient orthodontic clinics. All participants were aged 8-16 years old. The children completed the Modified Child Dental Anxiety Scale (faces version) and their parents completed the Modified Dental Anxiety Scale along with a questionnaire regarding their child‟s medical and dental histories. Results: The mean level of dental anxiety was significantly higher in the study group (p<0.05). Other significant findings between the two groups related to socio-economic status, exodontia experience, overnight hospital admissions and general anaesthetic history. Analysis of covariance indicated that only the admission history might have had an effect upon child dental anxiety in this study. Conclusion: Paediatric cardiology patients had significantly increased levels of dental anxiety. It is likely that aspects of their medical history, notably overnight hospital admissions, are moderating factors but due to the multifactorial aetiology of dental anxiety, further research is required in order to identify specific factors involved.
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Swart, Gillian. "Measurement of absorbed dose for paediatric patients for the purpose of developing dose guidelines in paediatric radiology." Thesis, Peninsula Technikon, 2004. http://hdl.handle.net/20.500.11838/1546.
Full textAbstract:
Thesis (MTech (Radiography))--Peninsula Technikon, 2004The radiation risks associated with children are higher than the risk for adults. Children have growing organs and they have a longer life expectancy than that of adults. As a consequence the effects of damage from radiation could be greater than in adults. Children who receive radiation damage may pass genetic damage onto future generations. This study was carried out to investigate the optimal effective x-ray dose young children need to receive who have radiographic examination to the chest at Tygerberg Hospital, South Africa. Chest radiographs are documented as being the most common radiographic examination done on children. The age groups of children participating in this study were 0-1 year, 1-5 years and 5-10 years. A total of 67 children were involved and the absorbed doses for 134 views of the anterior-posteria (AP) chest and lateral chest were measured. Entrance surface dose (ESD) values were determined, and measured mean ESD (mGy) and the ESD range was reported for each age group. This was done by attaching thermolurninescent dosirneters (TLD pellets) to the patients skin at the entrance point of the x-ray beam. The results were compared to similar studies done in Ireland and Nigeria From the ESD values obtained the absorbed doses ofthe eyes, heart, liver, thyroid and genitals could be calculated by using the "Childdose" programme ofthe NRPB. The ESD dose levels for South Africa compare favourably with Ireland. However the Nigerian values differed greatly from those of Ireland and South Africa It was very encouraging to note the comparative results achieved at Tygerberg Hospital especially due to the fact that this was the first time such study had been conducted in the Tygerberg Hospital Radiology Department. The results also compare favourable with that achieved by a group working in the United Kingdom. This group does similar surveys every five years as part of their radiation protection programme. The results were also in line with the UNSCEAR document of2000. v This study could serve as a valuable source of reference to radiographers and radiologists when performing paediatric radiology especially as the radiation absorbed dose could be used as a baseline to create awareness of size of dose received, and to limit deleterious radiation doses to patients and to prevent unnecessary exposures. A second significant outcome of the study was the effect that added filters had on the x-ray beam generated. Experiments were done in which the filtration filters were added sequentially. It was found that if the filtration was increased to 2mmAl the dose to the patient decreased by more than 20%. At 50 and 60 kV the density of the x-ray image on film only increased by 2%. From these results it may be concluded that an increase in filtration thickness used for paediatric chest x-rays should be giVIng reduced dose readings and assisting with radiation protection ofthe patient.
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Ramnarayan, Padmanabhan. "Clinical decision-making in acute paediatrics : evaluation of the impact of an internet-delivered paediatric decision support system." Thesis, Imperial College London, 2009. http://hdl.handle.net/10044/1/7373.
Full textAbstract:
A newer generation diagnostic aid (Isabel), capable of rapid advice provision using a simplified user interface, was developed at St Mary's Hospital in 2000. This thesis describes a series of evaluations conducted to explore Isabel's effects on diagnostic decision-making in acute paediatric practice. Preliminary assessment of system performance by the developers using a wide variety of hypothetical and real cases indicated that Isabel demonstrated significant accuracy with minimal usage time. In the next stage of evaluation, clinicians used the system to make decisions on a balanced set of cases in a simulated field study. Changes in the quality of diagnostic assessment by various grades of subjects were measured before and after Isabel consultation. Since no suitable metric was available to perform this measurement, a new reliable and valid score was developed as part of this investigation. All grades of subjects benefited from the use of the diagnostic aid in easy and difficult cases. Despite variability in the clinical features input into the Isabel system, diagnostic suggestions did not vary significantly across subjects. In the next step of evaluation, an assessment of Isabel's impact on junior doctors' decision making was performed in a multi-centre clinical trial at four paediatric sites. Subjects improved their diagnostic performance by including a number of important diagnoses in their workup after system consultation. Numerous technical, cultural and systematic barriers presented the routine use of decision support. Findings from this project provide valuable insights into how newer generation diagnostic aids can be designed and used to achieve a reduction in diagnostic error.
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Mould, Jonathan Mark. "Paediatric nursing : an investigation of the effect of specialist paediatric nurse education on the quality of children’s nursing care in Western Australia." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2012. https://ro.ecu.edu.au/theses/508.
Full textAbstract:
In Australia, specialist education in paediatrics is not a requirement for nurses caring for hospitalised children. Thus, nurses can work in paediatrics without any prior knowledge of the unique needs of children such as developmental stages or separation anxiety. As a consequence, there are some clinicians and authors who advocate that when children require health care, they should be cared for by nurses who are educated in, and understand the specific physical, psychological and social needs of children. Despite this, the evidence is lacking as to whether specialist nurse education affects the quality of care in paediatrics. This study investigates whether the quality of care that children and their families receive is different to when they are nursed by specialist paediatric nurses (SPNs) compared to nonspecialist paediatric Registered Nurses (NSPNs). SPNs are Registered Nurses who have undertaken specific or further education in paediatrics and NSPNS are Registered Nurses who have no specific or further education in paediatrics. This research was prompted by national policy changes in Registered Nurse (RN) education which shifted the focus from hospital-based training to the tertiary sector. There has not been a review of paediatric nurse education in Australia since these changes in 1994. Quality measures have been developed for the admission procedure as it is the most common clinical procedure performed in hospital on children. The quality measures were defined by the literature and a Delphi Panel of international paediatric nursing experts. The five stage methodology incorporated: (i) a desk analysis of the literature and policies regarding paediatric nursing and education to identify quality measures (QMs); (ii) development of QMs for the most common hospital procedure for children, the admission procedure; (iii) the development of a consensus definition of QMs using the Delphi method; (iv) observation of RNs using video during the admission of children to the hospital to test the proposed QMs and measure whether SPNs behaved differently to NSPNs; and (v) a follow-up on-line survey of all of the observed RNs regarding their perceptions of other factors influencing their practice. This research found that overall, SPNs meet the quality measures during the admission procedure significantly more often than NSPNs (p=0.009). When the QMs were analysed individually, the analysis showed a significant relationship between education and some of the QMs, but not in others where the relationship was not statistically different. This leads to the assumption that there are other factors than the level of specialist education which affect the quality of care such as prompts on admission forms and/ or the RNs‘ personal experiences. However, in the on-line survey of the sample, the RNs reported that tailored education has played a major role in their care delivery to children and their families. The findings of this research indicate that in Australia, the ‗comprehensive‘ nursing model, which leads to the qualification of RN, may not be the best model for delivering the highest quality of care to children and their families.
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Mohamed, Noor Dzul Azri. "DNA methylation in paediatric germ cell tumours." Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/27671/.
Full textAbstract:
Germ cell tumours (GeTs)affect both paediatric and adult populations, and can occur either in gonadal or extragonadal regions along the body's ventral midline. These tumours can be broadly categorized into two subgroups, seminomatous (SEM) or nonseminomatous (N-SEM). The latter can be further subcategorized into embryonal carcinoma (EC), teratoma, yolk sac tumour (YST) and choriocarcinoma (eC) according to their differentiation. As in many other tumours, DNA methylation has been proposed to be involved in GCTdevelopment. However to date, most studies were performed using adult testicular GCTs. Furthermore, these studies only include a handful of genes in their analysis. Thus, the roles of DNA methylation in paediatric and extragonadal GeTs have not been explored. Therefore, this project attempted to fill this gap in knowledge by performing methylation analysis in a cohort of paediatric GCT samples and GCTcell lines. Although paediatric GCTsmostly consist of teratomas, seminomas or YSTs, only the latter two were included in the methylation analysis as they were the only samples in the available tumour bank. Using the methylation level of L1NE-l repeat elements as a measurement of global genome methylation, we found that both paediatric seminoma and YST samples displayed global hypomethylation as compared to somatic controls. However, when methylation at gene promoter regions was investigated using Illumina Golden Gate methylation arrays, seminoma and YST exhibited very different methylation features. YSTs were found to be highly methylated at many of the sites investigated. Surprlslnglv, we found that the methylation features in seminoma were similar to the somatic controls. From this analysis, we identified 85 genes that were differentially methylated in the VSTs. However, by correlating our methylation data with the expression array data performed by our collaborators on the same samples, only eight of these genes (PYCARO, CASPB, C02, HOAC9, TFAP2C, ETV1, EV/2A, HLA-F) were differentially expressed. As in previous GCTstudies, our analysis was focused on the methylation at epG islands. During the course of this project technological advancement led to the creation of new methylation arrays that offer wider genome coverage. One example is the Infinium Methylation 450K array that covers more than 450,000 CpG sites and includes regions flanking the CpG islands such as the CpG shores and CpG shelves. Since no previous GCT studies have attempted to investigate methylation in those regions, we utilized this methylation array on four GCTcell lines; TCAM2 (seminoma), NT2Dl (teratocarcinoma), GCT27 (embryonal carcinoma) and GCT44 (yolk sactumour). Similar to previous GCT studies, we found that nonseminomatous GCT cell lines displayed higher methylation at the CpG islands as compared to the seminoma cell lines. Strikingly, expanding our analysis to other regions (CpG shores and shelves etc.) revealed that each GCT subtype exhibited distinct methylation features. Both ECand teratoma cell lines displayed higher methylation than the seminoma and YST cell lines at all regions. Interestingly, the YST cell line only showed higher methylation than the seminoma cell line at the CpG islands and to a lesser extent at the CpG shores while the seminoma cell line exhibited higher methylation at the CpG shelves as compared to the YST cell line. This is the first time such features have been reported for GCTs. From this Infinium methylation data, we have also identified a high number of hypermethylated genes including those that are uniquely methylated for each cell line. By correlating this methylation data with Affymetrix gene expression data, 98 genes that were differentially methylated and differentially expressed in the YST cell line have been identified. However, further analysis needs to be performed to understand the role of these genes in YST development. As in other types of tumour, the hypermethylation observed in the YST cell line might be caused by many epigenetic modifiers. Using real-time RT-PCR on three epigenetic modifiers (DNMT38, EZH2, SUZ12), we found that DNMT38 was highly expressed in the YST samples and cell line as compared to the seminoma samples and cell line. This suggests that DNMT38 might contribute to YST hypermethylation and resulting differences in their biology. However, knockdown of DNA methyltransferases (DNMTs) and DNMT38 using 5-azadeoxycytidine and microRNA-29b respectively, did not seem to have any effect on the response of all four GCT cell lines towards cisplatin. On the other hand, both knockdowns only caused little effect on cell migration; affecting only the seminoma and YST cell lines. Nonetheless, further analysis is still needed to fully assess the role of DNA methylation in regulating cell behaviour. In summary, paediatric YSTs displayed hypermethylation at many promoter regions as compared to seminomas. Meanwhile, methylation analysis at regions outside of CpG islands in GCTcell lines revealed unique methylation features for each GCT subtype which might indicate different underlying mechanisms in their development. Further analysis on genes found to be differentially methylated and differentially expressed in both paediatric and GCTcell lines are now needed to fully establish their role in GCT development.
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Vassalos, Tony. "End organ effects of paediatric cardiopulmonary bypass." Thesis, University of Glasgow, 2011. http://theses.gla.ac.uk/2385/.
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Despite the scientific, technological and surgical improvements of the past 50 years organ dysfunction following elective paediatric cardiac surgery utilising cardiopulmonary bypass continues to account for increased complications, often leading to a protracted course in hospital with a longer stay in intensive care and the potential for irreversible organ damage long term. Furthermore, paediatric cardiac surgeons are routinely undertaking more complex operations with a shift from palliation to early correction. This has resulted in younger children being subjected to longer periods on the bypass machine with increased effects on vital organs. This thesis describes two clinical studies designed to further assess and characterise peri-operative cardiac, renal and pulmonary function in children undergoing elective cardiac repair at a tertiary referral centre in Scotland, UK. In the first instance a prospective, observational study was undertaken in forty-five children to examine the use of tissue Doppler imaging in the assessment of peri-operative cardiac function, its relationship to myocardial injury and clinical outcome. Tissue Doppler parameters were obtained using a Vivid 7 ultrasound scanner with a 7-MHz probe pre-operatively, on admission to paediatric intensive care and on day one. Myocardial injury was assessed using Troponin-I on the first post-operative day by a commercially available chemiluminescent immunoassay. In twenty children within this group peri-operative renal function was also investigated using standard estimates of glomerular filtration rate, namely creatinine clearance measured by the kinetic Jaffe method during the first and second twelve hour post-operative periods, in comparison to serum creatinine and the novel biomarker cystatin C. Routine plasma retained pre-operatively and on days 0, 1, 2 and 3 post-operatively was used to measure serum cystatin C and creatinine using a particle-enhanced nephelometric immunoassay and the Roche Creatinine Plus enzymatic assay respectively. The association between cystatin C and recorded perfusion parameters including bypass duration, pump flow, haematocrit, oxygen delivery and Troponin-I was investigated. Peri-operative pulmonary function was evaluated through a phase IV, randomised, double-blind, placebo controlled trial. In total, twenty four children were randomised to receive oral sildenafil or equivalent volume placebo four times the day before surgery. Blood samples were collected peri-operatively to measure serum cyclic guanosine monophosphate with a commercially available competitive enzyme immunoassay. Haemodynamic data and echocardiography were acquired at two and twenty four hours post-operatively including pulmonary vascular resistance index and bi-ventricular contractility. Post-operative oxygenation was also determined at the same time by oxygen delivery and oxygenation index. In Chapter 2, peri-operative cardiac function as assessed by tissue Doppler imaging was examined. The results of this study demonstrated that pre-operatively, bi-ventricular systolic function in the study group was reduced compared with normal controls, displaying a significant step-wise decrease with increasing complexity of lesion. This picture persisted post-operatively predominantly in the right ventricle and was significantly associated with the extent of myocardial injury. Impaired peri-operative left ventricular function correlated with clinical outcomes. In Chapter 3, peri-operative renal function as assessed by cystatin C and its association with parameters of perfusion was examined. The results of this study demonstrated that in comparison to serum creatinine, cystatin C had a superior correlation with glomerular filtration rate in the early post-operative period. An elevated level of this biomarker was significantly associated with bypass duration, minimum pump flow and post-operative myocardial injury. Haematocrit was not directly linked to renal dysfunction in this study although evidence of a critical dysoxic threshold within the kidney was suggested indirectly through oxygen delivery calculations. In Chapter 4, peri-operative pulmonary function and vascular reactivity in association with the pre-operative administration of oral sildenafil (0.5mg/kg, six hourly) was examined. The results of this trial demonstrated that compared to placebo, pre-operative sildenafil resulted in modest elevations of serum cyclic guanosine monophosphate, limited effects on pulmonary vascular resistance index, significant reductions in peri-operative bi-ventricular contractility, significant reductions in post-operative oxygen delivery and a trend for increasing ventilatory support. In summary, the current thesis has demonstrated that in children undergoing corrective cardiac surgery peri-operative bi-ventricular function can be accurately assessed by tissue Doppler imaging which to date has had limited use in this patient group. With regards to renal function, cystatin C was shown to be a better estimate of glomerular filtration rate and a more sensitive marker of early renal dysfunction in children after surgery. Furthermore, cystatin C identified a transient post-operative renal impairment, the magnitude of which was associated with duration of bypass, pump flow and myocardial injury. In relation to pulmonary function, this research identified that pre-operative administration of oral sildenafil to children undergoing cardiac surgery produced limited effects on pulmonary vascular resistance but was associated with reduced ventricular contractility and post-operative oxygenation raising significant concerns over its routine clinical use.
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Vadivelu, Ramanan. "'Fixclips' : internal fixation system in paediatric orthopaedics." Thesis, University of Warwick, 2008. http://wrap.warwick.ac.uk/2305/.
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Parham, Rhian. "Caregiver burden in paediatric chronic kidney disease." Thesis, Canterbury Christ Church University, 2011. http://create.canterbury.ac.uk/10347/.
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Section A provides an overview of the role of family caregivers of individuals with chronic illness, and describes key conceptualisations and theories posited in the caregiver literature. This is followed by an overview of research conducted with caregivers of children with chronic kidney disease (CKD), a summary of the limitations of this research, and suggestions for future research. Section B Despite a recognised need to monitor caregiver burden in caregivers of children with CKD, there is no measurement tool currently available to meet this aim. The present research documents the development of a measure of caregiver burden specific to family caregivers of children with CKD. Methods: Interviews were conducted with 16 caregivers of children with CKD and 10 healthcare professionals in order to generate measure items. A provisional version of the measure was developed and piloted with 18 caregivers of children with CKD and five healthcare professionals. Results: An initial pool of 97 items was generated from the content of interviews, which was reduced to 60 items following review for item redundancy. A piloting exercise provided preliminary evidence for the usability, readability, and relevance of measure items; adaptations further to piloting resulted in the 51-item ‘Paediatric Renal Caregiver Burden Scale’ (PR-CBS). Conclusions: It is hoped that the PR-CBS will serve to identify areas of need amongst caregivers of children with CKD, and in turn improve outcomes for this caregiver population and children with CKD. Section C is a critical appraisal of the conducted research study, and includes an overview of research abilities acquired during its completion, reflections on how the research may have been conducted differently, implications for future clinical practice, and ideas for future research.
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McCrossan, Brian. "The role of telemedicine in paediatric cardiology." Thesis, Queen's University Belfast, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.517757.
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McFadden, Sonyia Lorraine. "Radiation dose optimisation in paediatric interventional cardiology." Thesis, University of Ulster, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.516452.
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Lewis, Angela. "Parental experiences of paediatric extracorporeal membrane oxygenation." Thesis, University of London, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.589456.
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Background and objectives Research suggests that parents of children supported on Extracorporeal Membrane Oxygenation (ECMO) may be at risk of posttraumatic stress symptoms (PTSS), although no specific investigations have been carried out. The current study explored PTSS in this group. Associations with family functioning and parenting self-esteem were also investigated. Method Parents were identified from the hospital database and recruited in a cross-sectional, single group design by postal invite. Participants (n = 52) completed questionnaires measuring PTSS, family functioning, parenting self- esteem, depression and anxiety. Results Participants reported levels of intrusion and hyperarousal symptoms which were not statistically different to those found in parents from a comparison paediatric population. Avoidance symptoms were significantly higher in the current sample. Participants reported significantly more effective family functioning than parents from a comparison paediatric population. Family functioning and parenting self-esteem were also greater than that reported in community samples. Family functioning was not independently 3 I DClinPsy project: PARENT EXPERIENCE OF ECMO associated with PTSS and PTSS were not independently associated with parenting self-esteem. Conclusions PTSS appear to be a problem for some parents of children supported on ECMO. While associations exist between family functioning, PTSS and parenting self-esteem, it seems likely that these are indirect relationships. 4
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Tan, Leek Moy. "Psychosocial adaptation to paediatric illness in Singapore." Thesis, King's College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391806.
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Leung, Terence Sze-tat. "Time-frequency characterisation of paediatric heart sounds." Thesis, University of Southampton, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287001.
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Andreoletti, Gaia. "Genomic analyses of paediatric inflammatory bowel disease." Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/403112/.
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Spiteri, Michaela. "Imaging biomarkers in paediatric brain resection MRI." Thesis, University of Surrey, 2017. http://epubs.surrey.ac.uk/842478/.
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High resolution brain magnetic resonance (MR) images acquired at multiple time points across the treatment of a patient allow the quantification of localised changes brought about by disease progression. The aim of this thesis is to address the challenge of performing automatic longitudinal analysis of magnetic resonance imaging (MRI) in paediatric brain tumours. The first contribution in this thesis is the validation of a semi-automated segmentation technique. This technique was applied to intra-operative MR images acquired during the surgical resection of hypothalamic tumours in children, in order to assess the volume of tumour resected at different stages of the surgical procedure. The second contribution in this thesis is the quantification of a rare condition known as hypertrophic olivary degeneration (HOD) in lobes within the brain known as inferior olivary nucleii (ION) in relation to the development of posterior fossa syndrome (PFS) following tumour resection in the hind brain. The change in grey-level intensity over time in the left ION has been identified as a suitable biomarker that correlates with the occurrence of posterior fossa syndrome following tumour resection surgery. This study demonstrates the application of machine learning techniques to T2 brain MR images. The third contribution presents a novel approach to longitudinal brain MR analysis, focusing on the cerebellum and brain stem. This contribution presents a technique developed to interpolate multi-slice 2D MR image slices of the brain stem and cerebellum both to infill gaps between slices as well as longitudinally over time, that is, in four-dimensional space. This study also investigates the application of machine learning techniques directly to the MR images. Another novel method developed in this study is the Jacobian of deformations in the brain over time, and its use as an imaging feature. Unlike the previous contribution chapter, the third contribution is not hypothesis-driven, and automatically detects six potential biomarkers that are related to the development of PFS following tumour resection in the posterior fossa. The limited number of patients considered in each study posed a major challenge. This has prompted the use of multiple validation techniques in order to provide accurate results despite the small dataset. These techniques are presented in the second and third contribution chapters.
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Hussain, Mohammad. "Magnetic resonance imaging in paediatric coronary vasculopathy." Thesis, King's College London (University of London), 2013. https://kclpure.kcl.ac.uk/portal/en/theses/magnetic-resonance-imaging-in-paediatric-coronary-vasculopathy(95c54f8b-b1e5-4aac-a8ef-51efefb9bb48).html.
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Background: Coronary Allograft Vasculopathy (CAV) is the leading cause of late death for children after heart transplantation. It often presents late due to lack of ischaemic symptoms from the denervated allograft and it is difficult to detect using conventional angiography. A non-invasive diagnostic tool would be invaluable for the early detection and therefore, prevention of disease. MRI has the potential to achieve this by imaging coronary lumen, vessel wall and central vascular stiffness in a child-friendly free-breathing protocol lasting thirty minutes. Methods: A three-dimensional steady-state-free-precession (3D SSFP) imaging sequence for coronary artery lumen imaging was optimised for its use in children. Patient based studies were performed to show the clinical potential for this approach. Furthermore, contrast-enhanced inversion-prepared coronary vessel wall imaging was investigated for its ability to detect intimal disease in CAV, using intravascular ultrasound to validate the findings. Finally, MRI was used to study the potential of aortic screening for rapid assessment of CAV. Results: MRI coronary artery lumen imaging is feasible in children and reference values are provided. Contrast-enhanced vessel wall imaging has 91% accuracy in the detection of significant CAV. Further improvements in the technique can be achieved using high-field MRI (3.0 Tesla) or sublingual nitroglycerin. Central aortic stiffness is increased in children after heart transplantation and a relationship between this and CAV is demonstrated. Conclusions: Coronary artery lumen and vessel wall MRI can be used to follow up children after heart transplantation. Non-invasive follow-up can be more frequent and has the potential to allow early prevention. From this research, there are wider implications for congenital heart disease, Kawasaki disease and cardiovascular atherosclerosis imaging.
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Kawadler, J. M. "Neuroimaging biomarkers in paediatric sickle cell disease." Thesis, University College London (University of London), 2015. http://discovery.ucl.ac.uk/1464063/.
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Sickle Cell Disease (SCD) is a collection of genetic haemoglobinopathies, the most common and severe being homozygous sickle cell anaemia. In the UK, it has been estimated that 1 in 2000 children are born with SCD. The disease is characterised by chronic anaemia, recurrent pain crises and vascular occlusion. Neurologically, there is a high incidence of stroke in childhood, as well as cognitive dysfunction. Newborn screening programmes and preventative treatments have allowed a much longer lifespan; however recently, neurological research has shifted to characterising subtler aspects of brain development and functioning that may be critically important to the individual’s quality of life. This thesis overviews the neurological and neurocognitive complications of SCD, and how magnetic resonance imaging (MRI) can provide biomarkers for severity of disease. During the PhD, retrospective and prospective cognitive and MRI data were collected and analysed. Diagnostic clinical MRI sequences and advanced MRI sequences were applied, as well as a neuropsychological test battery aimed at intelligence and executive function. First, this thesis reviews the intelligence literature in SCD and includes previously unreported data, finding patients, regardless of abnormality seen on conventional MRI, have lowered full-scale intelligence quotient than controls. Then, to determine imaging biomarkers, volumetric differences and diffusion characteristics were identified. Patients were found to have decreased volumes of subcortical structures compared to controls, in groups corresponding to disease severity. Results from a three-year longitudinal clinical trial suggest evidence of atrophy in paediatric patients, with no apparent protective effect of treatment. Diffusion tensor imaging revealed reduced white matter integrity across the brain, correlating with recognised markers of disease severity (i.e. oxygen saturation and haemoglobin from a full blood count). Overall, the four experiments bridge a gap in the cognitive and neuroimaging literature of the extent of neurological injury in children with SCD.
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Bainbridge, Stephen. "Parental coping with paediatric encephalitic brain injury." Thesis, University of Leicester, 2005. http://hdl.handle.net/2381/31205.
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The literature on encephalitis including its aetiology, prevalence and neuropsychological impact on paediatrics is outlined. This leads on to a critical review of the current literature detailing how parents cope with the impact of paediatric brain injury and chronic illness in children. The need for further qualitative studies examining parental coping with paediatric brain injury is highlighted, along with a call for including the experiences of fathers. This study set out to examine how parents cope with their children's encephalitic acquired brain injury, and whether any differences in coping exist mothers and fathers. Semi-structured interviews were conducted with five parents who volunteered through the Encephalitis Society to take part in the study: two spousal couples and a single mother. Interviews were transcribed verbatim and analysed according to the grounded theory method (Charmaz, 2003). Main categories were generated from the analysis and a core category was identified entitled 'Thinking Positively'. A process model of coping was developed. All parents appeared adjusted and were coping when the interviews were conducted. Data analysis revealed gender differences; mothers were seen to be taking on more coping demands and engaging in more problem-solving activities related to their child's brain injury than did the fathers. A consideration of the constraints in interpreting the current findings on the basis of (N=5) is made. Implications for NHS and clinical psychology services in understanding how parents cope are outlined, and ideas for future research suggested. The critical appraisal chronicles the researcher's reflections on the research process. Learning points are outlined and ideas for disseminating research findings suggested.
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Sarginson, Julia Holly. "The inflammatory response in small paediatric burns." Thesis, University of Bristol, 2017. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.761195.
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