Tesi: "Pediatric care"

1

Bumgarner, D., K. Owens, J. Correll, W. T. Dalton e Jodi Polaha. "Primary Behavioral Health Care in Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6597.

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2

Powell, Cindy M. "Parental perception of pediatric emergency care /". Staten Island, N.Y. : [s.n.], 1997. http://library.wagner.edu/theses/nursing/1997/thesis_nur_1997_powel_paren.pdf.

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3

Polaha, Jodi. "Postpartum Depression in Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6677.

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4

Polaha, Jodi. "Practice Transformation in Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/6665.

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This session will describe the evolution of the Pediatric Primary Behavioral Health Model in one clinic including the integration of behavioral health and social services into a residency training clinic. The implementation strategy used to develop this model will be described.

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5

Palmer, Alexandra Marie. "Pathway into care for pediatric asthma". Thesis, Boston University, 2012. https://hdl.handle.net/2144/12579.

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Thesis (M.A.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
Studies have demonstrated that patients may not adhere to the treatment prescribed by the physician because their respective models of the disease are different. Studies have also demonstrated that the patient may feel inferior to the health care provider and not share his or her model with the doctor for fear of being perceived as ignorant. The interaction between the provider and patient is especially significant to asthma because asthma is a chronic condition that may require management for life. However, there is a gap in the social science literature for studies related to asthma. This thesis presents the way pediatric asthma health care providers and a sample of Boston Puerto Rican parents of children with asthma perceive asthma based on data collected through informal interviews. Puerto Ricans are one of the Latino subgroups who remain most at risk for asthma morbidity and are the most represented Latino subgroup in Boston. Research tends to generalize all of the Latino subgroups and it is important to consider each one separately in order to develop effective public health prevention and intervention strategies. Making each other aware of the other's asthma model will provide an avenue to help the health care providersand Puerto Ricans work together through any differences to an agreed-upon management regimen for the child's asthma. An understanding of why the health care provider is suggesting a particular treatment and why the patient is managing the disease in a particular way may help improve outcomes.

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6

Krishna, Shilpa. "Pediatric Pal". Thesis, California State University, Long Beach, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10635704.

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Global explosion of mobile technology has engendered a new instrument to address the challenges in public health and to revolutionize the paradigm of healthcare access and delivery system. Today mobile phone coverage has increased to a significant 90% of the world’s population. The rising ubiquity and infiltration of mobile phones has kindled the beginning of a new era in healthcare, mobile health (mHealth). mHealth is the amalgamation of mobile telecommunication and multimedia into an on the go mobile health care delivery system.

Pediatric Pal is a mHealth application targeted to care for children and help build a healthier tomorrow for them. Pediatric Pal is designed to be the “Drive Thru” for the pediatric healthcare system. The mhealth app focuses on giving patients access to a highly sophisticated medical diagnosis tool. By using latest searching technologies, the system can take a pattern of symptoms in everyday language and instantly compute from our vast database. The app design and development will be outsourced to a web design Hyperlink solutions agency. Database for the app will be maintained in house and test runs will be run within the house.

The main source of revenue for the app will be from user subscription and upfront cash payment. Premium downloads will bring in the extra revenue as well.

Pediatric Pal puts world’s medical knowledge at the patients fingertips and enables them to make sense of your symptoms. It will change the way patients speak to their doctor forever.

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7

Jaishankar, Gayatri, Deborah Thibeault e Matthew Tolliver. "Team Based Care for Toxic Stress in Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/8854.

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Toxic stress in childhood starts the trajectory toward complex health and social health needs in adulthood. In this breakout, a long-standing team (social work, behavioral health, and medicine) describe their efforts to systematically address toxic stress in pediatric primary care.

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8

Dyer, Halie, Byron Brooks, Karen Schetzina e Jodi Polaha. "Behavioral Health Referrals in Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6624.

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Integrated care is rapidly becoming the new paradigm of healthcare and with the transition into integrated practice, many providers from various disciplines must determine how best to work as a team to improve patient outcomes. One particular setting where the logistics of integrated practice must be scrutinized is pediatric primary care, specifically in rural areas, as many psychological problems are presented in pediatric primary care, and rural children are at greater risk for engaging in unhealthy behaviors, such as sedentary lifestyle, poorer nutrition, and greater substance use. All of these concerns can be ameliorated with successful referral to behavioral health consultants (BHC) who can assist in treating these various psychosocial issues. In order for the BHC to assist with patients with psychosocial concerns, other medical providers must be able to recognize and refer these patients to the BHC. The purpose of this study was to determine the prevalence of psychosocial concerns in pediatric primary care and how often the attending medical provider noticed these concerns and referred the patient for behavioral health services. The study also examined what types of psychosocial concerns were raised, and if the referral was not addressed during the same visit, the latency between the initial referral and the behavioral health service. Retrospective electronic health record data (N=300) was collected from the well visits of all 4 and 5 year old patients in 2014 from a rural Appalachian pediatric primary care clinic. Results indicated that when a psychosocial issue was raised, the majority of medical providers appropriately referred the patient to the BHC. Psychosocial concerns were raised in 21.3% (n=64) of visits. When psychosocial concerns were raised, 62.5% (n=40) were referred for behavioral health services with 87.5% (n=35) to the in house BHC. When patients were referred to the in-house BHC, 83.3% (n =30) received services immediately, while patients who were not seen immediately, 16.7% (n=5), waited for an average 21 days to be seen by the BHC. The most common psychosocial concerns raised were related to toilet training, temper tantrums, sleep hygiene, and hyperactivity. These findings highlight the high prevalence of psychosocial issues presented in rural pediatric primary care and the continued education of providers about recognizing these concerns so the appropriate referral can be made. These findings also highlight the need for more integrated practice as primary care is the often the primary source of healthcare in rural areas and by addressing all concerns about patient well-being in this setting via integrated care, patient physical and mental health outcomes can be greatly improved.

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9

Manson, Leslie, Tawnya Meadows, Jodi Polaha, Sarah Trane, Robert M. Tolliver, Allison Dixson, Julie M. Austen, Hayley Quinn e Sonny Pickowitz. "Toolkit for PCBH in Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6660.

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10

Jarek, Holly Elaine. "Administrative changes in pediatric long-term care". Thesis, The University of Alabama at Birmingham, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10105905.

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This research used a Delphi methodology to solicit challenges that significantly impact the operational success of pediatric long-term care facilities. Further, this study sought to understand the ability of pediatrics administrators to impact, affect, overcome, or resolve these challenges. Round 1 accomplished the desired goal of eliciting a substantial amount of new qualitative information regarding administrative challenges in pediatric long-term care, which previously had been extant in the literature. In Round 2, data were distilled into categories and unique exemplars which in turn were validated by participants. In Round 3, administrators ranked and rated categories and individual challenges in terms of significance and impact.

Findings revealed that the most important challenges for administrators are those of working with an inadequate model that is designed for a geriatric population, inadequate Medicaid funding, and the lack of clinical and administrative indicators in pediatric long-term care. The most important challenges that could be affected by the administrators are related to inadequate model, clinical practice, and the need for diversification. Administrators believe they can strongly impact the rules, regulations, and protocols that are currently geriatric focused, develop pediatric long-term care indicators and evidence-based research, and impact their financial security by diversification.

The Delphi research accomplishes the desired goal of eliciting a substantial amount of new information regarding administrative challenges in pediatric long- term care and contributes to the broader body of knowledge in health services administration. The significant research findings suggest the need for changes in the regulatory and financial models in pediatric long-term care and the need for enhanced clinical practice though evidence-based practice and outcomes.

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11

Polaha, Jodi, e Karen Schetzina. "A Collaborative Practice Model for Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6670.

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12

Polaha, Jodi, William T. III Dalton e Suzanne Allen. "The Prevalence of Psychosocial Concerns in Pediatric Primary Care Serving Rural Children in Pediatric Primary Care Serving Rural Children". Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/6745.

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Objectives: To examine the prevalence of parent-reported emotional and behavior problems in pediatric primary care clinics serving rural Appalachia using methods commensurate with studies of broader samples. Methods: Parents presenting to pediatric primary care clinics completed a rating scale (Pediatric Symptom Checklist) of psychosocial problems for their child. Results: Approximately 21% of all rating scales were in the clinically significant range. Across all parents, 63% identified the child’s physician as their most common source of help. In contrast, mental health professionals had been sought out by only 24% of the sample. Conclusions: These data replicate previous findings showing high rates of parent-rated psychosocial problems in pediatric primary care. Given the prevalence of these problems in primary care and parents’ frequent help seeking in this setting, more research is needed on innovative approaches to integrated care in rural settings.

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13

Crockett, Lisa. "Palliative care needs of pediatric patients & their families : a phenomenological study of multidisciplinary pediatric palliative care team experiences". Thesis, University of Liverpool, 2015. http://livrepository.liverpool.ac.uk/2008831/.

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In the United States, more than 1 million children may be suffering from a life-limiting condition (Ruston and Catlin, 2002, p. 57) for which there is no reasonable hope for cure or long-term survival (Fraser et al, 2012, p. 923). However, less than one percent of these children and their families benefit from the provision of pediatric palliative care (Stayer, 2012, p. 350), which is an innovative health care model designed to address their physical, emotional, psychosocial and spiritual needs from diagnosis through end-of-life. During the last decade, pediatric palliative care has begun to secure a foothold as an emerging health care specialty (Crozier and Hancock, 2012, p. 198), but a dearth of literature has left the lived experience of children and their families poorly understood. Therefore, the Pediatric Palliative Care Study is a qualitative research study that utilizes interpretative phenomenological analysis to address two objectives: (1) understand and articulate the comprehensive lived experience of caring for children with life-limiting conditions and their families and (2) delineate how the collective experiences provide insights into needs that can be addressed by pediatric palliative care. The study was conducted at four research sites within Providence Health & Services. In total, nine major themes emerged from the experiences of 27 multidisciplinary care team providers who participated in the study. The themes have been framed from the perspective of the child and family: 1) Develop an innovative approach to caring for me, (2) Place me at the center of care, (3) Care for me as a whole person, (4) Be my guide, (5) Educate and prepare me for what I need to know, (6) Come alongside me, (7) Cultivate the plan and purpose for my life, (8) Be my voice and help me find my own and (9) Help me thrive. The analysis also contributed to an overarching statement about the experience that articulates the interconnectedness between the themes and creates a story of the phenomenon. The study presents seven implications for future practice related to (1) balancing matters of health care design with the human experience, (2) addressing the aims of health care reform legislation, (3) developing care models for home-based settings, (4) customizing care and developing solutions from the perspective of families, (5) educating about palliative care, (6) understanding the skills needed for palliative care providers and (7) improving data reporting for palliative care. Moreover, the study offers three contributions to extant literature, including: (1) validating and refining the WHO definition of palliative care, (2) completing an assessment of the adult versus pediatric palliative care literature from 2011-2014 and (3) addressing a known gap in the literature by offering the first IPA study to articulate the comprehensive lived experience. Limitations of the study and implications for future research are delineated as a research agenda for those seeking to build upon the study findings.

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14

Matias, Erica Oliveira. "Nursing practice assessment in the process of pediatrics intravenous drug administration". Universidade Federal do CearÃ, 2015. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=13393.

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The delivery process of the intravenous (IV) medication, one of the activities of greater responsibility of the nursing team, has a high incidence in child care in urgent and emergency situation. This process is considered highly complex and when not planned, controlled and monitored through indicators is exposed to unpredictable results affecting the quality of care. The objective was to evaluate the nursing practice in drug administration in child trough IV. Exploratory, descriptive, observational, quantitative study. It was developed in the urgency and emergency department in a pediatric referral hospital of the municipal sphere of Fortaleza. The study population consisted of 69 nurses whom participated in the drug administration via IV process that was in work schedules during the study period in the investigated unit. The sample of professionals was composed by 36 licensed practice nurses and 2 nurses. For the number of observations, it was considered the calculation for finite population with a total of 327 observations of intravenous medication delivery process. Interviews were carried out for data collection with the nursing staff and systematic observation of drug delivery process in children via IV. For data collection interviews were performed with the nursing staff and systematic observation by IV drug delivery process in children, considering seven stages, namely: medical prescription reading, hand hygiene, preparation of material and medication , guidance on the procedure, puncture technique and administration of the drug. Such steps have the total 47 shares. The data was stored in a database produced on the Windows Excel 2010 and analyzed according to the literature. The study was approved by the Ethics Committee under CAAE protocol 34651314.7.0000.5054. It was found that in 15% of the observations nursing professionals did not understand the prescription due to illegible handwriting professional. In 78.0% of the time there was no hand hygiene. It was found that all professionals used personal protective equipment (cap and mask), but none used gloves. Among the 327 observations included: peripheral intravenous device most commonly used was the scalp 21 (63.3%); selection of dorsal hand veins arc (83.9%); success on the first attempt of venipuncture (82.6%); explains the procedure for child and /or guardian (5.5%); calms the child (82.6%); performs antisepsis of the skin at the site to be punctured with a swab with 70% alcohol (100%); awaits antiseptic evaporation to then continue the procedure (45.6%); proper disposal of the materials used during the procedure (89.3%); checks the prescription immediately after drug administration (86.8%). It was found unsatisfactory performance in 23 actions by IV drug administration process. Therefore, we suggest the development of training for nursing professionals about medication delivery process.
O processo de administraÃÃo de medicamento por via intravenosa (IV), uma das atividades mais importante da equipe de Enfermagem, possui alta incidÃncia na assistÃncia Ã crianÃa em situaÃÃo de urgÃncia e emergÃncia. Tal processo Ã considerado de alta complexidade e, quando nÃo planejado, controlado e monitorado por meio de indicadores, fica exposto Ã imprevisibilidade de seus resultados, interferindo na qualidade da assistÃncia. Objetivou-se avaliar a prÃtica de enfermagem no processo de administraÃÃo de medicamento por via IV na crianÃa. Trata-se de um estudo exploratÃrio, descritivo, observacional, de natureza quantitativa, desenvolvido no setor de urgÃncia e emergÃncia de um hospital pediÃtrico de referÃncia da esfera municipal de Fortaleza-CE. A populaÃÃo do estudo foi constituÃda por 69 profissionais de enfermagem que participaram do processo de administraÃÃo de medicamento pela via IV e que estavam nas escalas de trabalho durante o perÃodo do estudo na unidade investigada. A amostra dos profissionais foi composta por 36 tÃcnicos de enfermagem e 2 enfermeiros. Para o nÃmero de observaÃÃes, considerou-se o cÃlculo para populaÃÃo finita, com um total de 327 observaÃÃes do processo de administraÃÃo de medicamento por via IV. Para a coleta de dados realizou-se entrevista com a equipe de enfermagem e observaÃÃo sistemÃtica do processo de administraÃÃo de medicamento por via IV na crianÃa, considerando sete etapas, quais sejam: leitura da prescriÃÃo mÃdica, higienizaÃÃo das mÃos, preparo do material e medicaÃÃo, orientaÃÃo acerca do procedimento, tÃcnica de punÃÃo e administraÃÃo do medicamento. Tais etapas possuem ao total 47 aÃÃes. Os dados foram armazenados em um banco de dados produzidos no Excel do Windows 2010, analisados estatisticamente e de acordo com a literatura pertinente. O estudo foi aprovado pelo ComitÃ de Ãtica sob parecer N0 805.953. Constatou-se que em 15% das observaÃÃes o profissional de enfermagem nÃo compreendeu a prescriÃÃo mÃdica devido Ã letra ilegÃvel do profissional. Em 78,0% das observaÃÃes nÃo houve a higienizaÃÃo das mÃos. Identificou-se que todos os profissionais utilizaram equipamento de proteÃÃo individual (gorro e mÃscara), entretanto nenhum utilizou luvas. Dentre as 327 observaÃÃes destacaram-se como dispositivo intravenoso perifÃrico mais utilizado o scalp nÂ 21 (63,3%); escolha das veias do arco dorsal da mÃo (83,9%); Ãxito na primeira tentativa da punÃÃo venosa (82,6%); orientaÃÃo sobre o procedimento para crianÃa e/ou responsÃvel (5,5%); acalma a crianÃa (82,6%); realizaÃÃo de antissepsia da pele no local a ser puncionado com algodÃo embebido com Ãlcool a 70% (100%); aguarda a evaporaÃÃo do antissÃptico para em seguida dar prosseguimento ao procedimento (45,6%); descarte adequado dos materiais utilizados durante o procedimento (89,3%); checou a prescriÃÃo imediatamente apÃs a administraÃÃo do medicamento (86,8%). Concluiu-se desempenho insatisfatÃrio em 23 aÃÃes do processo de administraÃÃo de medicamento por via IV. Portanto, sugere-se o desenvolvimento de capacitaÃÃo para os profissionais de enfermagem acerca do processo de administraÃÃo de medicamento.

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15

Jaishankar, Gayatri Bala, Jodi Polaha Jones, Deborah Thibeault, Robert Matthew Tolliver, V. Morris, A. Johnson e Karen E. Schetzina. "A Team Care Screening Tool to Address Social Determinants of Health in a Pediatric Primary Care Clinic". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5034.

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16

MacKay, Lyndsay Jerusha, e University of Lethbridge Faculty of Health Sciences. "Exploring family-centered care among pediatric oncology nurses". Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Health Sciences, c2009, 2009. http://hdl.handle.net/10133/2483.

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Family-centered care (FCC) is important within the practice of pediatric oncology nurses. Such nurses face challenges and barriers when attempting to provide FCC. The purpose of this study was to understand the experiences of pediatric oncology nurses in relation to FCC; identify how pediatric oncology nurses implemented FCC into their practice; identify what facilitated and enabled pediatric oncology nurses to implement FCC; and discern the barriers and challenges that were present in their setting when implementing FCC. A qualitative approach utilizing person-centered interviewing was used to collect data. Nurses (N=20) from the Alberta Children‟s Hospital were recruited through purposeful convenience sampling and were then interviewed. Five major themes were identified from the data set: ACH support f FCC, How participants defined FCC, Establishing FCC, Enhancing FCC, and Barriers and Challenges to providing FCC. Recommendations for future research and implications for practice and education are offered.
xii, 191 leaves ; 29 cm

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17

Koontz, Victoria S. "Parental satisfaction in a pediatric intensive care unit". Huntington, WV : [Marshall University Libraries], 2003. http://www.marshall.edu/etd/descript.asp?ref=346.

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18

Mattila, Marja-Leena. "Quality-related outcome of pediatric dental health care". Turku : Turun Yliopisto, 2001. http://catalog.hathitrust.org/api/volumes/oclc/48714198.html.

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19

Kallio, M. (Merja). "Neurally adjusted ventilatory assist in pediatric intensive care". Doctoral thesis, Oulun yliopisto, 2014. http://urn.fi/urn:isbn:9789526206349.

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Abstract Guidelines and instructions derived from adult randomized controlled trials are generally followed in pediatric ventilation, as there have been no large trials of this kind in children. Current treatment strategies aim at preventing ventilator-induced lung injury by avoiding too large tidal volumes, supporting patient's spontaneous breathing and preventing lung collapse with positive end-expiratory airway pressure. Neurally adjusted ventilatory assist (NAVA) is a novel ventilation mode that provides respiratory support proportional to the electrical activity of the diaphragm (Edi). The aims of this thesis were to assess daily practices in pediatric ventilation in Finland and to compare NAVA with conventional ventilation in terms of safety and quality of care. Current treatment practices were studied with a preliminary enquiry and a 3-month prospective survey that was offered to all hospital units providing ventilatory care for children <16 years of age. NAVA was compared with current standard ventilation in a crossover trial involving 18 pediatric patients and in a larger controlled trial in which 170 patients were randomized to receive either NAVA or conventional ventilation. Respiratory distress was the most common indication for invasive ventilation in neonates, and postoperative care in older children. The principles of lung-protective ventilation were generally accepted and the goals were achieved in the majority of treatment episodes. The low incidence of pediatric invasive ventilation favours centralization. NAVA proved to be a safe and feasible primary ventilation mode in pediatric intensive care. It improved patient-ventilator synchrony and led to lower peak inspiratory pressures and oxygen requirements. It also reduced the need for sedation during longer treatment periods. Information derived from the Edi-signal could be used to optimize the level of sedation and to identify patients with a potential risk of extubation failure
Tiivistelmä Nykyisin käytössä olevat menetelmät lasten hengityskonehoidossa perustuvat suurelta osin aikuisilla tehtyihin tutkimuksiin ja totuttuihin tapoihin, sillä lasten hengityskonehoidosta on olemassa vain vähän tutkittua tietoa. Hengityskonehoidon aiheuttamaa keuhkovauriota pyritään ehkäisemään välttämällä suuria kertahengitystilavuuksia, tukemalla potilaan omia hengityksiä ja säilyttämällä ilmateissä positiivinen paine uloshengityksen aikanakin. Neuraalisesti ohjattu ventilaatio (NAVA) on uusi hengityskonehoitomuoto, joka tukee potilaan omia hengityksiä ohjaamalla koneen antamaa tukea pallealihaksen sähköisen signaalin avulla. Tämän tutkimuksen tavoitteena oli selvittää lasten hengityskonehoidon nykytilaa Suomessa sekä tutkia, voidaanko NAVAa käyttämällä parantaa hoidon laatua ja turvallisuutta. Nykyisiä hoitokäytäntöjä selvitettiin vuonna 2010 kysely- ja seurantatutkimuksella, johon kutsuttiin mukaan kaikki Suomessa lapsia ja vastasyntyneitä hoitavat tehohoito-osastot. NAVAa verrattiin nykyiseen hengityskonehoitoon 18 potilaan vaihtovuoroisessa tutkimuksessa sekä suuremmassa 170 lapsipotilaan satunnaistetussa kontrolloidussa tutkimuksessa. Eri syistä johtuvat hengitysvaikeudet ovat yleisin syy hengityskonehoitoon vastasyntyneillä ja suurten leikkausten jälkeinen hoito isommilla lapsilla. Keuhkoja säästävän hoidon periaatteet ovat Suomessa yleisesti hyväksyttyjä ja toteutuvat valtaosassa hoitojaksoja. Hengityskonehoitojaksojen määrän vähäisyys puoltaa hoidon keskittämistä suuriin sairaaloihin. NAVAa käyttämällä hengityskoneen antama tuki ajoittuu paremmin potilaan omien hengitysten mukaan ja sen avulla saavutetaan matalammat ilmatiepaineet sekä vähäisempi lisähapen tarve. Pitkissä hoitojaksoissa NAVA vähentää rauhoittavan lääkityksen tarvetta, ja pallealihaksen signaalia seuraamalla on mahdollista optimoida sedaatioaste aikaisempaa tarkemmin. Palleasignaalia voidaan myös hyödyntää arvioitaessa potilaan valmiutta hengitystuesta vieroittamiseen

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Rashotte, Judith Mary. "Pediatric intensive care nurses and their grief experiences". Thesis, University of Ottawa (Canada), 1996. http://hdl.handle.net/10393/10425.

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While the phenomenon of grief has received considerable attention and has been researched at length, there is a paucity of literature that has focused on health care professionals' experience of grief. The purpose of this study was to investigate the grief experience of pediatric intensive care nurses when their patients die. A phenomenological method was used in this study in order to obtain rich descriptions of nurses' experience of grief within their workplace. The purposive sample consisted of six registered nurses employed in an intensive care unit in a university-teaching pediatric hospital. In-depth, semi-structured interviews were conducted with the study participants in order to generate the data base. The audio-taped interviews were transcribed and analyzed for recurring themes emerging from the data according to the procedure outlined by Colaizzi. These nurses acknowledged they suffered multiple exposures to children's deaths and experienced grief. The interviews revealed eight themes that included one about their grief responses--hurting; two that described the influencing contextual factors--nurse-family unit relationship and dissonance, and five that related to coping strategies employed to manage their feelings of grief--self-expression, self-nurturance, termination of relationship activities, engaging in control taking activities and self-reflection. Further analysis revealed that managing grief effectively was an experiential learning process for the participants. The resultant themes were compared with the broader literature on grieving the loss of a significant other, grief and the health care professional, and the literature that addressed issues of occupational stress in the care of the critically ill, the dying, and the bereaved. The findings of this study could encourage further research that examines interventions designed to enhance the type of education and support needed in relation to the grief experience of nurses.

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21

Haidar, Samer. "The pediatric neurofeedback therapy center". Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10105253.

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This business plan proposes a neurofeedback therapy clinic to treat children diagnosed with Attention-deficit/hyperactivity disorder (ADHD) and are in search of a non-pharmaceutical intervention. ADHD is the most commonly diagnosed disorder among children between the ages 4-18. By stimulating arousal in the frontal portion of the brain through neurofeedback therapy, the symptoms of ADHD can be regulated. This proposal includes a market analysis, a feasibility and SWOT analysis, a review of legal and regulatory issues, and finally, a financial analysis.

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22

Shellhorn, Wendy Lauran Struchen. "Maternal interaction style, reported experiences of care, and pediatric health care utilization". [Tampa, Fla] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0001478.

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23

Whitted, Briana, Victoria Morris, Victoria Wells, Byron Brooks, Deborah Thibeault, Matthew Tolliver, Gayatri Jaishankar, Jodi Polaha e Karen Schetzina. "A Team Care Screener to Address Social Determinants of Health in Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6618.

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Health encompasses our lives in various ways; where we live, how we work, and how we play. These differentiating factors, or “social determinants”, may impact physical and mental health in a prominent manner. Screening for social determinants of health in pediatric primary care may help to identify important areas to intervene with families to address barriers to receiving care and improve health outcomes. East Tennessee State University (ETSU) Pediatrics aimed to find the prevalence of varying social determinants in their patient population through a 6-item screening tool—the Team Care screener. A Team Care screener was administered to the caregiver(s) of every child that came into the clinic for a newborn appointment, six month appointment, or one year well child examination. Caregivers responded with Yes or No to the screener's six items concerning the following: (1) ability to understand written and spoken English; (2) experiencing financial stress related to housing, food, and utilities; (3) stress around substance use; (4) incidents of domestic abuse; (5) feelings of depression and possible suicidal ideation; and (6) if transportation has been a barrier to attending medical appointments. After the screener was collected, if any social determinants were marked as Yes on the screener, a needs assessment was completed with the caregiver(s). The family then received resources to address needs at the appointment or by phone follow up, if applicable. This procedure is ongoing at the clinic. Results indicated that of the 1,009 Team Care screeners administered over a four-month period, 15% (n=153) of patients' caregivers reported a deficit in at least one social determinant. More specifically, 8% (n=79) endorsed experiencing financial stress, 5% (n=49) reported strain from acquiring transportation to appointments, 4% (n=17) expressed concerns related to substance use, 1% (n=14) noted difficulties with comprehending English, and less than 1% (n=6) reported possible incidents of domestic abuse. After discussion with caregivers, the most frequently reported stressors were determined to be access to adequate food, housing, and utilities as well as distress concerning transportation to medical appointments. Overall, our results suggest that a large portion of the patient population demonstrates varying social needs which have the potential to influence health outcomes. The Team Care screener has elucidated which patients are at particular risk, which allows clinic staff to provide more efficient patient-centered care.

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Smith, S. C., Jodi Polaha, Deborah A. Thibeault, Debra Q. Mills e Gayatri Jaishankar. "Team-Based Care for Postpartum Depression in a Pediatric Clinic". Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6572.

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The aim of this presentation is to describe the development, implementation, and one-year outcomes of a team-delivered, evidence-based protocol to identify and address postpartum depression in a pediatric primary care clinic. The presentation will include: 1) a description of the development process based on implementation science, 2) engaging activities for the audience such as a video illustration of the protocol itself, and providing an opportunity to learn and practice administering the Ecomap, an evidence-based assessment for social determinants of health, and 3) data from a records review showing outcomes. Additionally, this presentation will illuminate barriers and facilitators at varying levels to team-based healthcare in general and within this specific clinic. At the conclusion of this presentation, participants will be able to: Explain the inception and development of a stepped-care protocol set within a pediatric primary care clinic as conceptualized by the Consolidated Framework for Implementation Research. Describe the function and utility of an Ecomap to understand a family's social determinants of health. Apply the RE-AIM model to evaluate a clinical intervention implemented within an interdisciplinary pediatric primary care clinic.

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Tolliver, Sarah, Sara Reed, Robert Matthew Tolliver, Jodi Polaha Jones e Karen E. Schetzina. "Assessing For and Treating Postpartum Depression in a Pediatric Primary Care Setting Using a Stepped-Care Model: Is It Feasible?" Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/5073.

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Postpartum Depression (PPD) occurs in 10-20% of new mothers. PPD can lead to serious health risks to both the mother and infant, increase the risk of complications during birth, and cause lasting effects on the development and wellbeing of the child. Many mothers suffering from PPD do not receive treatment due to fear of being stigmatized, lack of education, or not being able to access mental health services. High prevalence of PPD, along with the negative and lasting effects it can cause point to the importance of developing an effective and feasible method of assessing and treating this disorder. A pediatric primary care office may be an opportune setting to screen for PPD since mothers often accompany their children to regularly scheduled well child visits. While some studies have examined PPD screening within the pediatric primary care setting, few have explored the addition of an on-site Behavioral Health Consultant to provide brief interventions for depressed mothers as part of a stepped care model. The primary aim of the current study is assess the feasibility of implementing a stepped care protocol that assesses PPD and provides brief interventions and referrals for depressed mothers within a pediatric primary care clinic. The protocol consists of several phases including: 1) distribution of the Edinburgh Postpartum Depression Screener to every mother arriving for a well child visit during the first six months of their child’s life; 2) appropriate documentation in the clinic’s electronic health record (EHR) of the Edinburgh score and resulting plan of action; 3) a brief same day intervention by the on-site Behavioral Health Consultant and referral to outside provider, if applicable; and 4) phone call follow up with the mother and referred provider, if applicable. Research assistants will monitor the EHR to determine the clinic’s fidelity to the protocol (e.g., if the Edinburgh is being administered properly). Data will also be collected from the EHR to determine if a correlation exists between Edinburgh scores and number of Emergency Room visits made by the child, immunizations administered to the child, and number of well child checks the child attended. Data collected throughout the month of March showing the Edinburgh uptake, consistency with protocol, and any correlation between Edinburgh scores and other variables will be presented.

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Ratliff, Jeremy. "Pediatric ICU Nurses' Suggestions forImproving End-of-Life Care". BYU ScholarsArchive, 2016. https://scholarsarchive.byu.edu/etd/6438.

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Of the 34,000 children who die annually, over 28,000 are four years old or younger. Nurses working in pediatric intensive care units (PICU) provide end of life (EOL) care before, during, and after death of these children. The purpose of this study was to determine thesuggestions PICU nurses have for improving EOL care for dying pediatric patients and their families. A sample of 1047 PICU nurses, who were members of the American Association of Critical-Care Nurses (AACN), were sent a 70-item questionnaire. One open ended item asked nurses to offer a suggestion for improving EOL care for dying PICU patients. Responses were received from 235 of the 474 (49.6%) nurses who returned the questionnaire. Eight themes were identified: (1) providing a better environment; (2) physician honesty about prognosis; (3) having a plan for dying; (4) ending futile care; (5) physicians on "same page;" (6)having more staff; (7) receiving more EOL education; and, (8) providing better pain control. Patient centered principles begin with creating an environment that allows the dying process to be centered on the family while fostering dignity. Fostering dignity includes providing an environment that is conducive to supporting quality EOL care. The importance of providing privacy and an appropriate place for the patient and family to feel more comfortable during the dying process was suggested. The need for better communication between providers and families, ending suffering, and having enough staff to support a "good death," were also high priorities. PICU nurses overwhelmingly suggested that the environment in which health care workers monitor, care for, and support patients and families during death is thegreatest area for improvement. Unit design teams need to assure that care areas for dying pediatric children are created to accommodate a dignified and peaceful passing to improve pediatric End-of-Life Care.

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Polaha, Jodi, Karen Schetzina e Katie Baker. "A Collaborative Practice Training Model for Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/ijhse/vol3/iss2/6.

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Santos, Kristopher B. dos. "The Huggable : a socially assistive robot for pediatric care". Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/78205.

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Thesis (S.M.)--Massachusetts Institute of Technology, School of Architecture and Planning, Program in Media Arts and Sciences, 2012.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 79-81).
The purpose of this thesis is to present the design and evaluation of a new type of socially assistive robot, one that can interact with people and collect various types of sensory input while being small enough to hold in one's arms. This project is a completely new revision of the Huggable project created by Dan Stiehl and Cynthia Breazeal, which features a new mechanical design, a revamped electronics structure, and a polished control system based off of its sister project, DragonBot (developed by Adam Setapen). This thesis describes the process of how this new design came to be, and provides extensive content on how it was designed, along with all major components that were included. An evaluation is also presented as a test run for the new Huggable, in the form of an online survey. The results, along with much of the work done with the initial prototype, showed that there is still much work to be done to be convincing as a robust research robot. Improvements are listed, as well as its future work with Boston Children's Hospital. This new design hopes to finally bring the Huggable project out into the field for actual use with people.
by Kristopher B. Dos Santos.
S.M.

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Mansky, Nicole Rae. "Enhancing Comfort Care Techniques in the Pediatric Inpatient Setting". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6612.

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The benefits of pharmacological and nonpharmacological interventions for children undergoing painful medical procedures are well documented in extant nursing literature; however, such techniques continue to be underused in practice. Improving comfort during medical procedures is necessary to enhance the patient and family experience. The purpose of this project was to provide education to nursing staff about pediatric pain theories and evidence-based practice recommendations that support the use comfort interventions for pediatric patients of all ages. The practice-focused question addressed the development of an educational program designed to enhance staff knowledge of comfort intervention options and the benefits provided to patients. The Kirkpatrick model of evaluation was used to guide the educational design and evaluation process. Data analysis demonstrated statistically significant improvement in test scores following the educational intervention. A total of 32 staff members of a unit at the project site participated in the project. Participant pretest scores averaged 61.6% and posttest scores averaged 97.8%, with all but 6 participants having scored 100% on the posttest. The nonparametric test Wilcoxon signed-ranks test was used, and statistical significance was seen (z = -4.969, p = .000). Implications of this project to promote social change include opportunities to expand the use of the educational module to other departments within the organization to promote a culture of comfort through a fact-based understanding of the theories and evidence that support the consistent implementation of comfort techniques.

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Polaha, Jodi, W. T. III Dalton, S. Allen, A. Enlow, N. Bagwell e S. Cumpston. "Pediatric Wellness and Integrated Health Care in Rural Appalachia". Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/6610.

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Calloway, J., e Jodi Polaha. "Training Pediatric Residents in ADHD Management in Primary Care". Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/6637.

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32

Quizhpi, Cristian, Karen Schetzina e David Wood. "Breaking the Cycle of Childhood Adversity Through Pediatric Primary Care Screening and Interventions: A Pilot Study". Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7660.

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Polaha, Jodi, Karen E. Schetzina, Katie Baker e Diana Morelen. "Adoption and Reach of Parent Management Interventions in Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2018. https://doi.org/10.1037/fsh0000380.

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Introduction: The field of implementation science provides the variables adoption and reach, which can be used to evaluate aspects to access, a primary incitement for integrated care. This study compared two integrated models: In Year 1, behavioral health consultants worked collaboratively with pediatricians to provide brief on-the-spot consultations to patients with behavioral concerns, and in Year 2, a structured, evidence-based treatment (EBT), the Family Check-Up, was developed to be delivered in conjunction with the existing collaborative model. Method: A chart review revealed the number of children who (a) attended a 4- to 5-year-old well-visit, (B) were screened, (c) were identified as having behavior problems, (d) were referred, and (e) accessed the services. Outcomes were calculated as percentages of children with behavioral concerns who were referred to (adoption) and received (reach) the services in each year. Results: Key findings were that (a) physician referrals increased when an EBT was added, but (b) patients had better first-session contact with the brief approach than the EBT, which few patients completed. Discussion: Results underscore the utility of measuring adoption and reach as partial indicators of access to services. These are accessible variables, collected in every practice that can be measured routinely in the context of quality improvement and, ideally, reported in studies as a way to disseminate knowledge about how to build behavioral health technology into primary care. Future research should strive for more rigor in measuring adoption and reach, and consider including a number of other implementation outcomes.

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Ygge, Britt Marie. "Parental Involvement in Pediatric Hospital Care-Implications for Clinical Practice and Quality of Care". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4010.

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Smith, Sarah C. "Evaluating a Stepped Care Protocol for Postpartum Depression in a Pediatric Primary Care Clinic". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etd/3277.

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Postpartum depression (PPD) is a prevalent, complex illness impacting 10% to 20% of mothers and their families. Treatments for PPD, such as medication and psychotherapy, are effective at reducing the severity of symptoms and generally improving quality of life for new mothers and their families. Unfortunately, many mothers with PPD go unrecognized due to a lack of standardized screening methods. Further, mothers regularly encounter barriers to accessible, evidence-based follow-up care to treatment even when symptoms of PPD are detected. The use of a stepped care protocol, set in a pediatric primary care clinic, is one proposed strategy to address the insufficient rates of screening, detection, and maternal contact with treatment. This study examines the feasibility of implementing a stepped care protocol to screen and provide brief therapeutic treatment to mothers reporting symptoms of PPD in one pediatric primary care clinic. The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework was used to evaluate implementation outcomes. Results suggest this stepped care protocol was feasibly implemented in one pediatric primary care clinic. The protocol was largely successful in screening mothers at a majority of well child checks (83.76%) for PPD and connecting them with resources based on the severity of symptoms reported. Future studies should further evaluate the impact brief onsite mental health treatments have on reports of PPD symptoms, longitudinal maternal and child outcomes as a result of the protocol, as well as the protocol’s replicability to pediatric practices elsewhere.

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Conte, Tania. "The influence of a pediatric palliative care program on health care utilization and costs". Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/51351.

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Pediatric palliative care program (PPCP) is believed to increase system efficiency. British Columbia (BC) relies on a free-standing hospice-based PPCP, and its effects on health care utilization and costs remain an outstanding question. This study aimed to gather evidence in a combined analysis of data from literature and BC PPCP. A systematic review was conducted through an electronic search of Medline, Embase, CINAHL, LILACS, and grey literature. Comparative studies reporting admissions, length of stay, and health care costs between PPCP users and usual care were included. Additionally, a similar comparison was applied to the data from BC PPCP using a retrospective matched-pairs cohort design (matched by ICD code and age at death) with a 3-year observational period prior to death. Data were obtained from Canuck Place Children’s Hospice and BC Children’s Hospital databases, and complemented by estimates from Canadian Institute for Health Information. A cost impact of the overall inpatient care provided by the hospice was presented. The review did not demonstrate a decrease in utilization by PPCP users yet suggested a shift to other health care settings, and potential cost saving in the Canadian context (1 article). The cohort study (n=11 pairs), suggests that children in both groups had similar upward trends in inpatient utilization and cost. However, PPCP users showed more inpatient care in the last year of life (especially critical care in the last 2 months), compared to their controls and to the period prior to referral. Post-referral, a shift in health care setting utilization from hospital to hospice was observed, representing approximately 50% of the costs. Without this shift PPCP users would have cost 32% more with a median monthly increment of $7,163 per child. All inpatient care provided by the hospice in the fiscal year 2011-2012 represented a potential cost saving ranging from approximately $1.1M to $4.3M. The findings of this study suggest that PPCP users may present higher health care needs, and that the shift of inpatient care to the hospice optimized resource use, offering a more holistic approach to EOL care, relieving hospital resources to meet other demands.
Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate

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Tolliver, Robert Matthew, Deborah Thibeault, Gayatri Bala Jaishankar, Karen E. Schetzina e Jodi Polaha. "Linking Families to Resources: Assessing Social Determinants of Health in Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5033.

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Background/Rationale: The American Academy of Pediatrics recommends universal surveillance of social determinants of health in primary care. Addressing these determinants is likely crucial to reducing extant health disparities. Such screening in urban pediatric primary care has been shown to increase access to relevant resources for families when combined with provider training in using a community resource binder (Garg et al., 2007). However, resources in more rural areas are often scarce and helping families navigate a complex resource system often requires a more individualized approach. Additionally, in an increasingly screener heavy pediatric environment, social determinant screeners that are comprehensive but brief are needed to reduce the burden on both patients and providers. Methods/Results: A brief TEAM Care social determinants screener protocol was developed to meet the needs of families presenting to ETSU Pediatrics. Our clinic serves primarily low income families, many of which live in ruralareas. During the first eight months of data collection, 2043 TEAM Care screeners were administered at annual well child checks. The prevalence of caregiver endorsed concerns was as follows: financial concerns impacting ability to pay for food, housing, or utilities (7%), transportation problems (4%), caregiver depression (4%), concerns about caregiver drug/alcohol use (2%), domestic violence (1%), and literacy problems (1%). 13.4% of caregivers endorsed at least one concern on the screener. Caregivers who endorsed a concern were provided individualized resources via a warm handoff or phone call by integrated social work interns. Interns were available on an ongoing basis to check in with families, adjust resource recommendations as needed, and coordinate care with the child’s primary care physician. Our poster will report on an anticipated 3000 TEAM Care screeners collected during the first year of administration. Conclusion: Last year at CFHA, we reported the initiation of the TEAM Care Screener, modeled after the WE CARE Screener (Garg et al., 2007) and designed to screen for social determinants of health in pediatric primary care via six items. Previous preliminary reports of this study included data from approximately 1000 screeners. A one year report of the TEAM Care screener will be completed in September 2017, making it ideal timing to present at CFHA in October 2017. We anticipate reporting prevalence data from 3000 screeners and incorporating results from a provider satisfaction survey of the screener process. The TEAM Care screener process was designed to maximize efficiency for families and providers, and the addition of social work interns ensures that families who endorse needs receive individualized help. A future goal is to more systematically follow up with families to determine how many were connected to recommended resources.

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Johnson, Kiana. "Pediatric Lupus Transitional Care: An Interactive Experience. A Fly on the Wall: Youth and Young Adult Perspectives". Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/7019.

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Quizhpi, Cristian, Karen Schetzina, Gayatri Jaishankar, Robert Tolliver, Deborah Thibeault, Hakyong Gloria Kwak, Olushola Fapo, J. Gibson, Katie Duvall e David Wood. "Breaking the Cycle of Childhood Adversity Through Pediatric Primary Care Screening and Interventions: A Pilot Study". Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/7687.

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Menchaca, Renajia LaShea'. "The effect of early dental care on pediatric patient behavior". The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1469195794.

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Palmer, Lydia Helmick. "Prevention of Skin Breakdown in the Pediatric Intensive Care Unit". Thesis, University of South Carolina, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3561837.

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Abstract (sommario):

Skin breakdown occurs when one or more layers of the skin have been disrupted (McLane et al., 2004; National Pressure Ulcer Advisory Panel, 2007). While some literature uses the terms skin breakdown and pressure ulcer interchangeably, these are actually two distinct conditions and pressure ulcers are encompassed in the definition of skin breakdown (Kuller, 2001; Lund, 1999; Suddaby et al., 2006). The consequences of skin breakdown in the pediatric population can include increased cost of treatment, infection, increased morbidity and mortality as well as psychological consequences from resulting alopecia or scarring (Schindler, 2010; Willock & Maylor, 2004). Development of skin breakdown has also been associated with increased morbidity, increased length of stay, and higher costs of care (McCord et al., 2004).

Prevention of skin breakdown can be accomplished by the use of barriers and specialty surfaces. Barrier protection is achieved by the use of preparations, such as zinc oxide, petrolatum-containing compounds, and alcohol-free barrier films, and also by the application of transparent film and hydrogel dressings (Atherton, 2004; Atherton, 2005; Baharestani, 2007; Campbell et al., 2000; Lund et al., 2001). Surfaces can be useful in the prevention of skin breakdown by aiding in the distribution of pressure and decreasing moisture, and can also be used to aid in temperature control for some patients (Norton, Coutts, & Sibbald, 2011). The PICO format question used to guide this project is: For patients in Pediatric Intensive Care Units, is barrier protection or use of specialty surfaces more effective at preventing skin breakdown?

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Kvederienė, Rūta. "The impact of emergency care on severe pediatric trauma outcomes". Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2012. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2012~D_20121227_085948-00813.

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Trauma is the main cause of death in paediatric population worldwide. Lithuania has the highest trauma-related mortality in the European Union (EU). Lithuanian standardised injury death rate is 150.9 per 100000 inhabitants while in comparison the mean standardised injury death rate in the EU is 41.4, and the lowest one is in the Netherlands (26.4 injury death rate per 100000 inhabitants). The aim of this study was to analyze the impact of pre-hospital and in-hospital emergent trauma care on severe pediatric trauma outcomes, performing a prospective observational clinical trial in the Vilnius University Children’s Hospital and Vilnius Pre-hospital Emergency Service Center. Trauma registry fields were defined in details and validated during this study. The recommended quality indicators were defined and used for pre-hospital pediatric trauma care and in-hospital emergent management evaluation. The study results showed that the level of pre-hospital care is associated statistically significantly with trauma outcomes: higher pre-hospital care level caused better trauma outcome assessed according to the Glasgow Outcome Scale. The longer time until the first key emergency intervention in hospital was associated statistically significantly with the worse trauma outcomes. Calculation of the Probability of survival (Ps) according to Trauma Score Injury Severity Score model (TRISS) revealed unexpected death (Ps > 50 %) rate 74%. The reasons for fatal outcome in the patient group with... [to full text]
Traumos yra pagrindinė vaikų, paauglių ir jaunų suaugusiųjų mirties priežastis. Stebimas didžiulis skirtumas Europos Sąjungos (ES) šalyse lyginant mirštamumą nuo traumų. Lietuvoje didžiausias ES standartizuotas traumų mirčių dažnis (150.9 mirtys dėl traumų 100.000 gyventojų). Palyginimui: ES šalių vidurkis yra 41.4 mirtys dėl traumos 100.000 gyventojų, mažiausias standartizuotas traumų mirčių dažnis yra Olandijoje – 26.4 mirtys 100.000 gyventojų. Toks skirtumas nurodo potencialią galimybę sumažinti mirčių dėl traumų skaičių, naudojant visas priemones: tiek traumų prevenciją, tiek skubios pagalbos prieinamumą ir kokybę. Darbo tikslas – išanalizuoti vaikų, patyrusių sunkias traumas, ikihospitalinės pagalbos ir skubiosios pagalbos ligoninėje laiko bei apimties įtaką traumų išeitims, atliekant perspektyvinį tyrimą Vilniaus Universiteto Santariškių klinikų Vaikų ligoninėje bei Vilniaus Greitosios medicinos pagalbos stotyje. Rezultatai parodė, kad pagalbos lygis ikihospitaliniu laikotarpiu susijęs su išeitimi: pacientams, gavusiems aukštesnio lygio pagalbą traumos išeitys pagal Glazgo išeičių skalę buvo geresnės. Ilgesnis laikas nuo paciento atvežimo į ligoninę iki pirmos skubiosios intervencijos statistiškai patikimai koreliavo su blogesne traumos išeitimi. Apskaičiavus išgyvenamumo tikimybę (Ps) pagal traumos skalės pažeidimų sunkumo modelį (TRISS), 74 proc. mirčių dėl traumų pateko į netikėtų mirčių (Ps > 50 proc.) kategoriją. Kiekviena netikėta mirtis, identifikuota naudojant... [toliau žr. visą tekstą]

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Petrosino, Mina Kay. "Implementing a Developmental Screening Tool in Pediatric Primary Care Practice". Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/556811.

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The American Academy of Pediatrics (AAP) released a statement recommending that primary care providers perform developmental screening with a standardized instrument for all 9-, 18-, 24-, or 30-month well-child visits. Despite evidence-based recommendations by the AAP, numerous pediatric practices do not currently use a standardized instrument for well-child visits. This quality improvement project aimed to determine the feasibility of implementing the Ages and Stages Questionnaire (ASQ), a validated developmental screening tool, at a pediatric primary care practice. In order to accurately assess implementation barriers and benefits, this feasibility study would have determined if the ASQ was the right fit for this pediatric practice. The first phase of implementation would have begun with the 9-month well-child visits and using the same process, later expanded to include the 18- and 24-month visits. The Plan-Do-Study-Act (PDSA) method would have provided the implementation framework for this project and the project would have been written utilizing the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines. However, due to unforeseen complications, this project was unable to be completed as planned. Instead, this project discusses outcomes of the DNP project without data, and provides guidance and points of consideration for future implementation in pediatric primary care settings.

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Alamu, Josiah Olusegun Herwaldt Loreen A. "Evaluation of antimicrobial use in a pediatric intensive care unit". Iowa City : University of Iowa, 2009. http://ir.uiowa.edu/etd/277.

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Erikson, Alyssa Erin. "Maintaining integrity: How nurses navigate boundaries in pediatric palliative care". Diss., Search in ProQuest Dissertations & Theses. UC Only, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3324708.

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Alamu, Josiah Olusegun. "Evaluation of antimicrobial use in a pediatric intensive care unit". Diss., University of Iowa, 2009. https://ir.uiowa.edu/etd/277.

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A pediatric intensivist in the University of Iowa Hospitals and Clinic's (UIHC) Pediatric Intensive Care Unit (PICU) was concerned about antimicrobial use in the unit. However, no one had quantified antimicrobial use in the UIHC's PICU or described the patterns of antimicrobial use in this unit. To address the intensivist's concern, the principal investigator (PI) conducted a retrospective study to determine the percentage of patients who received antimicrobial treatments, to determine the indications for antimicrobial use, and to identify antimicrobial agents used most frequently in the unit. On basis of our data, we hypothesized that empiric antimicrobial use, particularly the duration of therapy, could be decreased. We implemented a six-month intervention during which we asked the pediatric intensivists to complete an antimicrobial assessment form (AA) to document their rationale for starting antimicrobial treatments. We postulated that this documentation process might remind physicians to review antimicrobial therapies, especially empiric therapies, when the microbiologic data became available. In addition, we utilized the AA form to identify factors pediatric intensivists considered when deciding to prescribe empiric antimicrobial treatments. Data from the AA forms suggested that pediatric intensivists in the UIHC's PICU often considered elevated C-reactive protein, elevated white blood cell counts, and elevated temperatures when deciding to start empiric antimicrobial therapy. Data from the three nested periods showed that the median duration of empiric and targeted treatments decreased during the intervention and remained stable during the post-intervention period. The PI estimated that 193 days of empiric antimicrobial therapy and 59 days of targeted antimicrobial therapy, respectively, may have been saved by the decreased durations of therapy. Time series analysis assessing the trend in use of piperacillin-tazobactam, cefepime, and ceftriaxone (measured in mg/wk) did not reveal a significant change over time. On the basis of our results, an intervention strategy using an AA form alone may not be an effective strategy for antimicrobial stewardship in PICUs. Additional measures such as automatic stop orders and computer decision support may be useful for reducing the duration of empiric therapy in PICUs.

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Owens, K., D. Bumgarner, B. Lund, W. T. III Dalton e Jodi Polaha. "Behavioral Health Consulting in Pediatric Primary Care in Southern Appalachia". Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6596.

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Petgrave, Dannel K., Kayla McCarter, Courtney Lilly, Natasha Gouge e Jodi Polaha. "Managing Multiple Concerns in Pediatric Primary Care: Impact on Time". Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6632.

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Abstract (sommario):

Behavioral problems in children are common concerns in pediatric primary care. Time is an important factor for primary care providers (PCP) and it has been shown that pediatricians spend approximately five minutes longer providing care when behavioral concerns are presented, reducing the number of patients for which they can provide care. To date, no research has looked at the relationship between the quantity of behavioral concerns and PCP time demands, which is the aim of the present study. Using a sample of 516 children at a pediatric setting in rural southwest Virginia, data was recoded to classify children in one of two groups: those with behavioral concerns and those without. Using descriptive statistics, it was found that 96 children (18.6%) presented with at least one behavioral concern (with a range of 1 to 6 total behavioral concerns). Children with behavioral concerns were compared to children with medical-only concerns (with a range of 1-7 total medical concerns). When one concern was presented and it was behavioral, it took longer to address than when patients presented with up to four medical-only concerns. Regardless of the total number of concerns presented, PCPs spent 6.57 minutes longer with children presenting with at least one behavioral concern when compared to children in the medical-only group. More specifically, PCPs spent 5.07 additional minutes when one behavioral concern was presented and 9.03 additional minutes when two behavioral concerns were presented. Despite the quantity of behavioral concerns presented and the impact such concerns have on PCP’s time, results show that 100% of concerns raised were addressed at all times by PCPs within this clinic. Although from a consumer’s prospective, this is a desirable approach, such a model is not an especially time or cost efficient way for pediatricians to spend their time. As PCPs continue to address behavioral concerns, it is critical to develop and implement strategies (e.g., prioritizing concerns, identifying less time consuming concerns, scheduling follow up appointments) to address behavioral concerns more efficiently. Furthermore, incorporation of a full time on-site behavioral health provider might be an especially efficient way to maximize patient care while also relieving providers from the additional time burdens associated with the high prevalence of behavioral concerns within pediatric practices.

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Owens, K., D. Bumgarner, B. Lund, William W. T. Dalton e Jodi Polaha. "Behavioral Health Consulting In Pediatric Primary Care in Southern Appalachia". Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6765.

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50

Evans, J. H., R. J. Valleley e Jodi Polaha. "Integrating Pediatric Behavioral Health Into Rural Primary Care: Research Findings". Digital Commons @ East Tennessee State University, 2006. https://dc.etsu.edu/etsu-works/6617.

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