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1
Sutton, Kathleen Rose Creagh, i res cand@acu edu au. "A Study of the Mater Children’s Hospital Tile Project". Australian Catholic University. School of Arts and Sciences, 2005. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp105.11092006.
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This thesis examined the relationship between children’s visual art and hospital contexts. It specifically focused on children’s art in the Tile Project within the Mater Children’s Hospital, Brisbane, Queensland, Australia. This ethnographic study consisted of interviews with the creators of the Tile Project as well as interviews and a survey with parents, staff, and children within the Mater Children’s Hospital. The interviews were informed by a review of literature in the areas of art in health settings. The study made observations of the community interacting with the tiles and collected images of the tiles used in the hospital and employed the framework of Bourdieu’s (1993) fields of cultural production and Abbs’s (1987) aesthetic field and dimensions, as well as the aesthetic dimensions of Beardsley (1982), Eisner (1985), and Csikszentmihalyi (1990). The study investigated the aesthetic characteristics of the tiles and their health outcomes in relation to the hospital community. This study is significant because the Mater Children’s Hospital Tile Project was a project that reflected art in healthcare settings involving Community Arts, art in design, and art in public buildings. The research identified the unique nature of the Tile Project which saw the hospital as a children’s space with artworks for children by children. The study reflected on the value of the tiles in having a healing and distracting quality for parents and children alike and that engagement with the tiles through touch, imagination, and playful games improved the atmosphere of the hospital.
2
Tchou, Michael J. M. D. "Patterns of Electrolyte Testing Utilization at Children’s Hospitals for Common Inpatient Conditions". University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1543839434925304.
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3
Johnson, Laverne Michelle. "Measurement of service quality and customer satisfaction at a children’s hospital in the Western Cape". Thesis, Cape Peninsula University of Technology, 2017. http://hdl.handle.net/20.500.11838/2658.
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Thesis (MTech (Office Management and Technology))--Cape Peninsula University of Technology, 2017.Healthcare facilities across South Africa are increasingly facing a myriad of societal, fiscal, political and cultural challenges associated with demands for greater quality in the provision of healthcare services. This study measures service quality and customer satisfaction at a Cape Town hospital (hereinafter referred to as Hospital X), with the aim of providing its management with information to enable them to enhance service quality and thus improve customer satisfaction. It is essential to note that the respondents in this study were the parents or guardians of patients. The views of the patients were not obtained directly from them as it would have been unethical for minors to have participated in the survey. Their parents or guardians were surveyed in order to obtain the requisite data. The problem investigated was that management at public hospitals does not regularly research what customers need from a service quality point of view, Therefore, Hospital X may be failing to provide a quality service to its customers, namely, parents and guardians. Against this background, the researcher set out to measure customer perceptions and expectations of service quality by making use of the SERVQUAL model. “Customer expectation” is what the customer can reasonably expect given the available resources and is likely to be influenced by personal needs and past experience. “Customer perceptions” are totally subjective and based on the customer’s interaction with the service provided at Hospital X. The SERVQUAL model (reliability, assurance, tangibles, empathy and responsiveness), is commonly known as the RATER model, RATER being an acronym formed from the first letter of each of the five dimensions of SERVQUAL. The study incorporates the SERVQUAL dimensions within a survey comprising a number of questions structured on a six-point Likert scale. The results of applying the SERVQUAL model will indicate whether or not Hospital X provides a quality service to their customers. The study seeks to demonstrate the importance of service quality and customer satisfaction to hospital management, as well as the impact that effective service quality can have on customers’ evaluation of their overall hospital experience. (The term customer will be used interchangeably with parent and/or guardian in this study.)
4
Carlson, Jacqueline Marie, i Hilda Mercedes Galan. "An Exploration Of Creative Arts Therapies In Pediatric Hospitals". Digital Commons at Loyola Marymount University and Loyola Law School, 2016. https://digitalcommons.lmu.edu/etd/293.
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This research paper explores the use of creative arts therapies with children and families in a pediatric hospital setting as experienced by the therapists who provide these services. The research investigates art therapy, music therapy and dance/movement therapy at Children’s Hospital Los Angeles (CHLA), with an in depth consideration of the role of art therapy services in this setting. The researchers reviewed general literature regarding hospitalization, specifically its effects on children and families, availability and role of psychosocial services and the intensive care units (ICU). Literature discussing creative arts therapies (art therapy, music therapy and dance/movement therapy) was also reviewed, with a focus on art therapy and its role in medical settings with children/families, with pediatric cancer patients and in psychosocial services. Based on information gleaned from the literature review, the researchers crafted an online survey utilized to gather information regarding the experience of providing creative arts therapies in a pediatric hospital setting. The researchers conducted in-depth interviews with three selected survey respondents to further explore these experiences through interview questions and art making. The qualitative data from survey/interview responses, including the art, was reviewed and analyzed by the researchers. Analysis of the data resulted in five prominent themes from the online survey data: being present, family, support, change and identity. Four prominent themes emerged from the interview data: empowerment, culture, being present and identity. The researchers then examined these themes in the context of the general and art therapy literature. The meanings derived from these findings demonstrate the importance of continued and expanded use of creative arts therapies in pediatric hospitals.
5
Karnas, Diana Maria Girardi. "The psychology of the environment in children's health care setting : James Whitcomb Riley Hospital for Children - Cancer Unit". Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/845987.
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Hospitals are constantly evolving to keep pace with the latest medical technologies. Whether it is a refurbishment of an existing facility or the addition of a new unit, the design process usually focuses on the technological requirements rather than the human elements of such an undertaking. The Riley Hospital for Children in Indianapolis presents an architectural opportunity to incorporate psychology of the environment into the design and construction of a new Cancer Unit. By balancing the technological requirements with the physical and psychological needs of the pediatric bone marrow transplant and hematology/oncology patients, one can create a healing environment more conducive to a rapid recovery.Department of Architecture
6
Bishop, Katherine G. "From their perspectives children and young people's experience of a paediatric hospital environment and its relationship to their feeling of well-being /". University of Sydney, 2008. http://hdl.handle.net/2123/3962.
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Doctor of Philosophy (PhD)This study was conducted to increase our understanding of children and young people’s experience of a hospital environment and to identify the salient attributes of the physical environment in their experience. There were three specific aims: to describe children and young people’s experience of a hospital environment and identify what constitutes a supportive paediatric environment; to examine the role of the physical environment in patients’ feeling of well-being; and to highlight the capacity of participatory research with children and young people to inform evidence-based paediatric design. At this stage, there has been very little healthcare design research carried out with populations of children and young people. Well-being research with children and young people in paediatric environments that identifies the potential supportive attributes in this environment is also very limited. Historically research on children’s health and well-being has been dominated by a focus on the prevalence of disorders, problems and disabilities. More recently, in response to the change to health promotion, positive attributes have been included in well-being and satisfaction measures. At this stage, there are still many fewer positive measures. Within the body of literature that exists in healthcare, healthcare design research, and well-being research, there are only a small number of participatory studies that focus on children and young people’s experience of hospitalisation, and an even smaller number that include children and young people’s experience of hospital environments. The picture that is created by the research that exists is patchy. There is a need for a more holistic understanding of children and young people’s experience of hospitalisation and of hospital environments from their own perspectives. Based on these gaps in current knowledge, two research questions were developed. The first was concerned with describing children and young people’s experience of the sociophysical environment of a paediatric hospital. The second question was concerned with understanding the role of the physical environment in children and young people’s feeling of well-being in a hospital environment. In addressing these questions, the intention was to identify attributes within the hospital setting which collectively comprise a supportive environment for children and young people and which contribute to children and young people’s feeling of well-being in a paediatric setting. The current study was conducted as an exploratory qualitative case study and carried out at the Children’s Hospital at Westmead, in Sydney, Australia. Using participatory research techniques, the sequence of the study included two pilot studies and the main study. The focus was on understanding the experiences of longer-term patients of a paediatric hospital environment. In the main study 25 children and young people, aged between 9-18 years, who had been in hospital for at least a week completed semi-structured interviews in which they talked about their response to the environment of the hospital and their experience of hospitalisation. Data analysis was completed using a combination of concept mapping and thematic analysis techniques. Preliminary findings were used as the basis of a further member-checking task carried out with a further six children and young people before conclusions were reached. The findings reveal that children and young people’s experience of a paediatric setting involves a number of major areas of influence including their personal situation, their social experience, their interaction with the physical environment, opportunities and characteristics of the organisation, and the effect of time. The findings also reveal that children’s feeling of well-being within this experience is linked to their ability to feel comfortable in the environment, to maintain a positive state of mind, and to remain positively engaged with the experience and the environment. This research reveals a dynamic relationship between children and young people and a paediatric environment that children and young people actively manage and shape. It reveals some of the key considerations in children and young people’s experience of hospitalisation. It also reveals why these considerations are important and what role they play in patients’ experience and feeling of well-being. These findings provide the basis for further research and they have implications for future design and research practice in paediatric healthcare settings.
7
Carvalho, Ana Rosa Rebelo Ferreira de. "A classe hospitalar sob o olhar de professores de um hospital público infantil". Pontifícia Universidade Católica de São Paulo, 2008. https://tede2.pucsp.br/handle/handle/15776.
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Previous issue date: 2008-12-15Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
This aim of this study was to understand the significance that teachers in a Hospital Class, at a children's hospital in São Paulo, give to their work. The term Hospital Class is recognized by the Ministry of Education and Sport s (MEC/ SEESP) Bureau for Special Education, and refers to pedagogic-educational care for children and young people, which takes place in health-care environments, whether in cases of hospitalization, daily or weekly outpatient services or full mental health treatment. Three teachers who have worked in Hospital Classes at a public children s hospital for at least a year took place in this research. Data were collected through semistructured interviews and analyzed from a qualitative approach perspective, by analyzing content. Data was collected at the hospital at a time and place chosen by the participants. After examining the data and the purpose of the study, three main themes were identified: the importance that the participants attach to their work; prospects for the future of the participants, and the participants educational background. The analysis showed that the teachers believe their work has a role that goes beyond that of a mere teacher. However, the participants reported feeling satisfied and recognized for the duties they perform, despite finding it difficult to cope with the socioeconomic status of patients and with possible deaths. The deaths of child patients affect their professional, personal and family lives, which probably occurs because of the lack of specific training, interdisciplinary work and psychological support. The results demonstrate that there is a need for specific preparation for working in a hospital environment and such individuals should be included in the health care team
O presente trabalho teve por objetivo compreender o significado que as professoras da Classe Hospitalar, de um hospital público infantil de São Paulo, atribuem ao seu trabalho. O termo Classe Hospitalar é reconhecido pela Secretaria de Educação Especial do Ministério da Educação e do Desporto (MEC/SEESP), e refere-se ao atendimento pedagógico-educacional a crianças e jovens, que ocorre em ambientes de tratamento de saúde, tanto em circunstância de internação como em atendimento em hospital-dia e hospital-semana ou em serviços de atenção integral à saúde mental. Participaram desta pesquisa três professoras que atuam em Classes Hospitalar de um hospital público infantil, a pelo menos um ano. Os dados foram coletados através de entrevistas semi-estruturadas e analisados a partir da perspectiva da abordagem qualitativa, por meio da análise de conteúdo. A coleta de dados foi realizada na instituição hospitalar em local e horário definidos pelas participantes. A partir dos dados coletados e do objetivo da pesquisa, foram definidos três núcleos temáticos: significado atribuídos ao trabalho pelas participantes; perspectivas de futuro das participantes; e contexto histórico de formação das participantes. A análise indicou que as professoras atribuem ao seu trabalho uma função que extrapola o papel de professor. Entretanto, as participantes relatam sentirem-se gratificadas e reconhecidas pela função que exercem, apesar de demonstrarem dificuldades em lidar com a situação socioeconômica dos pacientes e com possíveis óbitos. Em relação ao óbito de crianças, relatam afetá-las nas esferas profissionais, pessoais e familiares, o que provavelmente ocorre devido à falta de formação específica, à ausência de um trabalho interdisciplinar e de um serviço de apoio psicológico. Os resultados apontam para a necessidade de preparo específico para atuar no ambiente hospitalar e de incluir tais profissionais na equipe de saúde
8
O'Reilly, Glenda. "Families in today's health care system : the experience of families during pediatric admission". Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=78189.
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The purpose of this study was to explore the experiences and needs of families during the admission of a child to a paediatric ward in an acute care hospital. Qualitative research methods were used to access the caregivers' and professionals' perceptions of the culture that families experience in a paediatric in-patient setting. For this project, data collection methods included a review of the literature in the area, individual interviews with caregivers, and focus groups with paediatric health care professionals.In the study, both parents and paediatric professionals described a multitude of experiences and needs of families during a child's admission to a paediatric ward in an acute care setting. Understanding the experiences and needs of families is important for professionals. The information collected in this study provides some insight into the culture that families experience when their child is admitted to a paediatric ward in an acute care hospital.
9
Lindsay, Bruce. "Who cares? : the morphology of 'caring' in children's hospitals, 1852-1950, with special reference to the Jenny Lind Hospital for Sick Children, Norwich". Thesis, University of East Anglia, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.323466.
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10
Shah, Phalguni S. "Children's preventive health care center with aspect of play for a child". Virtual Press, 1994. http://liblink.bsu.edu/uhtbin/catkey/897516.
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Children are the most important asset for the society's future. They develop into maturity depending upon how they are moulded by their families, society, and the environment. They are very sensitive and could easily get influenced or affected by the slightest change. Therefore it is important to maintain a normal set-up for them under all of their routine and disturbed mental and physical conditions.Sickness and hospitals are one thing that affect a child's psychology. Children dread to get into the harsh technological environments of today's medical environments. Hospitals are constantly evolving to keep pace with the latest medical technologies. Additions or refurbishments or a totally new set-up usually focuses on the technological requirements rather than the human element of such an undertaking. The Riley Hospital for Children in Indianapolis presents an architectural opportunity to incorporate psychology of the environment into the design and construction of a new outpatient unit. By balancing the technological requirements with the physical and pschological needs of a child patient, one can create a healing environment more conducive to a rapid recovery. This thesis explores one of the possibilities of creating such an environment.Department of Architecture
11
Aniruth, Sunildutt. "Maxillofacial fractures in children attending the Red Cross War Memorial Children's Hospital". Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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The literature shows that maxillofacial fractures in children are uncommon. Although the Department of Oral and Maxillofacial Surgery of the Faculty of Dentistry, of the University of the Western Cape, has been providing a service to the Red Cross Children&rsquos Hospital (RXH) for the past twenty years, no study had been undertaken to determine the age, gender, number of patients per year, aetiology, patterns, and management of maxillofacial fractures at this institution. A retrospective records based study was undertaken to determine these features. This study accessed the records of patients seen at the trauma unit at RXH, from 1994 to 2003 inclusive, and referred for maxillofacial attention.
One-hundred-and-five patient records were obtained and analyzed using the SPSS statistic package. One-hundred-and-twenty-seven fractures were recorded in one hundred and five patients. The age of the patients ranged from one to thirteen. Sixty-five male and forty female patients were seen. Dentoalveolar fractures were the most common fracture seen in both the midface and mandible. Midface fractures were more common than mandibular fractures. Falls, followed by motor vehicle accidents, were the most common cause of facial fractures. Most fractures were successfully managed by closed procedures. At this institution, nasal and frontal fractures have surprisingly little or no input from the Department of Oral and Maxillofacial Surgery.
12
Gurria, Juan P. "Thrombocytosis Following Pancreatectomy with Islet Autotransplantation in Children: Cincinnati Children's Hospital Experience". University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1521191336859138.
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13
Barnes, Pamela Alice. "Hospitals and childhood : a case study of the The Royal Manchester Children's hospital, "Pendlebury" 1829-1999". Thesis, University of Manchester, 2001. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.508799.
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14
Lee, Wing-yee Wendy. "Hospital as playground". Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25948295.
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15
Neal, Kamilah J. "An exploratory study of children’s hospital social workers’ attitudes toward children with physical disabilities". DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2000. http://digitalcommons.auctr.edu/dissertations/3777.
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Social workers who interact with disabled children have developed unique attitudes and perceptions about physical disability in children and the disabling effects of material, social, and environmental components of society. Because of the unique problems associated with the care of physically disabled children, social workers are needed to provide ongoing services to help these children manage their disabilities and address their social and health concerns. This study was designed to elucidate the attitudes of social workers which may affect their interactions with disabled children. This information can be used to increase the effectiveness of social workers who plan to work with disabled children. This nationwide study is a preliminary investigation of the attitudes of social workers in children’s hospitals which are members of the National Association of Children’s Hospitals (NACH). Surveys were sent to seventeen social services departments in these hospitals and were distributed to full time social workers who interact with disabled children between the ages of 6 and 17. Sixteen surveys from 5 different hospitals were returned. All returned surveys were used in the study The survey consisted of three parts: 1) a demographic section; 2) the Attitudes Toward Disabled Children Scale; and 3) the Attitudes Towards Disablement Scale. The data were analyzed by using the Statistical Package for Social Sciences. Although the number of participating social workers was small, preliminary results indicate that social workers who serve physically disabled children have a positive attitude toward disabled children and feel that societal components are responsible for further disabling those children
16
Kennedy, Andrew. "The health of young children and the foundation of British children's hospitals, c.1830-1860". Thesis, University of Central Lancashire, 2014. http://clok.uclan.ac.uk/11158/.
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Between the years 1852 and 1860 six voluntary hospitals were opened in Great Britain to provide medical care for children who would previously have been considered too young to be admitted to hospital. This thesis argues that the process was shaped by the public health movement which was ascendant at that time. The literature review shows that while historians of nineteenth-century childhood have been aware that child health was a problem, especially for working-class children, they have tended to view this through the prism of industrial and urban history, and there is little work available relating specifically to the provision of health care for younger children. Chapters two and three demonstrate the emergence of a new understanding of the nature of childhood which came about as a result of the great inquiries into child labour, the health of towns, and the condition of the labouring classes, and the impact of the emerging science of statistics. At a time of crisis in traditional British medicine, the new approaches combined with French clinical and German laboratory techniques to open British physicians to the possibility of working with young children as a serious proposition for the first time. Chapters four to six follow the various ways in which six children’s hospitals were opened in London, Norwich, Liverpool, Manchester, and Edinburgh. Influences which are analysed include the desire to rectify the acknowledged ignorance among physicians concerning children’s diseases, the recognition of environmental management as a fruitful means for improving children’s health, and a new willingness to emulate Continental practices. This thesis departs from the existing historiography in challenging the underlying assumption as to the operating model of a hospital. Histories of children’s hospitals are written in terms of the extent to which they succeeded in applying the allopathic model of health, with the administration of medicines and surgical procedures at the centre, however ineffectually. What actually distinguished the new institutions was their emphasis on promoting healing not by manipulating children’s bodies but, drawing on the insights of the public health movement, by providing a therapeutic environment.
17
Lee, Wing-yee Wendy, i 李穎怡. "Hospital as playground". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31985294.
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18
Smith, Lara. "Neurocognitive outcome of HIV-infected children on antiretroviral therapy at Red Cross Children's Hospital". Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/11190.
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Includes bibliographical references (leaves 54-59).Central nervous system involvement contributes significantly to the morbidity and mortality of paediatric HIV infection. The spectrum of CNS morbidity varies from minor developmental disabilities to severe, progressive encephalopathy. Therefore regular developmental evaluation should be regarded as an essential component of the overall care of HIV-infected children. Antiretroviral therapy may arrest or even reverse neurocognitive and motor deficits associated with HIV infection.
19
Sfandyari, Fard E. "An investigation into the consideration of children and young peoples' preferences in children's hospital design". Thesis, University of Salford, 2013. http://usir.salford.ac.uk/30693/.
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This study was conducted to increase the understanding of the involvement of children in the design process of the children's hospitals environment from their perspectives. It was aimed to build rich picture of the process, methods, benefits and problems associated with engaging children during the design process of children’s hospital. It also provides a set of guidelines to apply for the process of involvement, which can be applied in future design projects conducted with children. This study was conducted to increase the understanding of the involvement of children in the design process of the children's hospitals environment from their perspectives. It was aimed to build rich picture of the process, methods, benefits and problems associated with engaging children during the design process of children’s hospital. It also provides a set of guidelines to apply for the process of involvement, which can be applied in future design projects conducted with children. The research methodology employed a case study approach, including two case studies: Royal Alexandra children’s Hospital and Royal Manchester Children’s Hospital. The process of identifying children’s preferences and considering them into the different stages of the design process is described. Different research techniques have been applied, including literature review and synthesis, interviews and content analysis. The contribution of this research is to address the gap identified in the literature and practice between the hospital design process and the needs of its users, i.e. children. It is intended to addresses the role of user perspective, the empowerment of the users, and the quality of the final outcome. These issues are examined from the points of view of hospital staff, designer, PFI. As a result, a better understanding of children and young people’s participation during the design process of hospital was achieved. The research has produced a set of guidelines for the process of involvement, which can be applied in future design projects to support project teams to define the process and tools for children’s participation.
20
Stewart, Moira Connell. "An examination of the factors associated with the presentation of children at the Royal Belfast Hospital for Sick Children and of the hospital resources used in their management". Thesis, Queen's University Belfast, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.357511.
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21
Moraes, Myrian Soares de. "Brincando e sendo feliz: a pedagogia hospitalar como proposta humanizadora no tratamento de crianças hospitalizadas". Pós-Graduação em Educação, 2013. https://ri.ufs.br/handle/riufs/4900.
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This essay intends to explore Hospital Pedagogy. Aspects related to how hospital humanization is carried out during this process of education is discussed. How humanization politics is dealt within the hospital and which of the health players are responsible for developing pedagogical practice capable of imputing humanizing impact on hospitalized children is an issue carried out in this work. The main goal is to analyze the legislation towards hospital humanization and its interfaces with pedagogical practice. More specific objectives were developed to reach out towards the main goal: analyze hospital humanization in the hospital humanization politics, analyze the pedagogical practice developed within such environment under the perspective of hospital humanization, discuss theoretic aspects related to sick students based on childhood sociology, identify which are the members of the health team responsible for developing pedagogical practice for the sick students. This research is classified as qualitative using a bibliographic, documental approach along with a set of interviews. The discussed documents are national politics of humanization and the program previous to this politics: the National Hospital Care Humanization Program. Laws that allow assistance to sick students were also examined seeking to explore their influence in developing social potentialities. The interviews were used to allow the professionals within the hospital to express their opinions on the pedagogical practice developed with the hospitalized children. It was possible to identify a brief legal support for educators on their pedagogical practice for sick students as well as to lay out a sick student's reality as a social agent bringing out his or her's potentialities. At the end of the project it was possible to notice a significant increase in the interest of the doctors interviewed towards the pedagogical activities present at the hospital.Este texto de dissertação tem como tema a Pedagogia Hospitalar. A partir deste, são discutidos aspectos abrangentes da humanização hospitalar: políticas, concepções da criança ativa, olhar dos profissionais, brinquedoteca. Trago a questão de como a política de humanização é imersa no hospital e quais as representações da equipe de saúde a respeito das atividades pedagógicas que acontecem no hospital com um viés humanizador. Apresento como objetivo geral analisar a perspectiva da humanização hospitalar no enfoque da legislação e suas interfaces com o trabalho pedagógico. Os objetivos específicos, a fim de responder tal questionamento são os seguintes: analisar a perspectiva da humanização hospitalar defendida na Política de Humanização Hospitalar; analisar a prática pedagógica sob o olhar da perspectiva da humanização hospitalar; discutir aspectos teóricos sobre a criança hospitalizada a partir da Sociologia da Infância; identificar as representações da equipe de saúde a respeito das atividades pedagógicas realizadas com o público infantil hospitalizado. Esta pesquisa é classificada como uma pesquisa qualitativa com caráter bibliográfico, documental e utilizando também entrevistas. Os documentos discutidos são a Política Nacional de Humanização e o programa que antecedeu tal política, o Programa Nacional de Humanização da Assistência Hospitalar, assim como leis que viabilizam o atendimento destinado à criança hospitalizada como sujeito de potencialidades sociais. As entrevistas serviram de suporte para que os profissionais da saúde expressassem seus pensamentos sobre o trabalho pedagógico realizado com as crianças hospitalizadas. O trabalho identificou um respaldo legal conciso para a atuação do pedagogo no hospital por meio de atividades pedagógicas, assim como situou a realidade da criança hospitalizada, como agente social, o que traz à tona suas potencialidades. Para concluir, as informações coletadas aproximaram os olhares dos médicos entrevistados com a perspectiva do trabalho pedagógico no hospital.
22
Omarjee, Zakiyya. "An audit of endocrine dysfunction in children with craniopharyngiomas at Red Cross Children's Hospital and Groote Schuur Hospital from 1976 to 2004". Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/26765.
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Background: Craniopharyngiomas account for 6-10% of childhood brain tumours and are the third most common intracranial tumours of childhood. Despite their benign histological appearance, they are often associated with a poor outcome and have significant associated morbidity. Aim: To analyse the data of children with craniopharyngiomas at Red Cross Children's Hospital and Groote Schuur Hospital from 1976 to 2004 with respect to age at presentation, presenting symptoms and preoperative and post-operative endocrine dysfunction. Patients and methods: The records of 45 children aged between 9 months and 13 years were reviewed. The majority of children in the study were aged between 5 and 10 years. There was a considerable delay in the diagnosis in most cases especially in areas outside of Cape Town. Pre-operative tests prior to 2000 were incomplete but have improved since then. Twenty nine percent of our patients had a near total excision of the craniopharyngioma and 29% had partial excisions necessitating adjuvant radiotherapy. The endocrinological, neuro imaging and presenting symptoms were analysed and post-operative tests were reviewed. Where possible neuropsychiatric assessments were accessed as well in order to assess long term neurocognitive deficits Results: The age of presentation of craniopharyngiomas in our group of patients was much younger than in other studies with the largest group of affected children being between 5 and 10 years of age. The most common presenting symptoms in this group were headaches (62%) and visual disturbances (57%). Sixty four percent of the children had preoperative endocrine testing for pituitary dysfunction of which 59% were ACTH and TSH deficient and only 38% were growth hormone deficient. After surgery multiple endocrinopathies were universal with 56% of children having pan hypopituitarism at follow up. There was no reversal of pre-existing hormone deficits after surgery. The management of craniopharyngiomas remains controversial. Twenty nine percent of our patients had a near total excision and 29 % had a partial excision combined with radiotherapy with a further 6 patients receiving intratumoral bleomycin for recurrences. Post operatively the majority of children were on replacement therapy but only 6 patients (14%) received human growth hormone or are receiving human growth hormone currently due to a lack of funds to provide human growth hormone for children with growth hormone deficiency. Seventy percent of the children had central diabetes insipidus post operatively reflecting posterior pituitary damage. Our overall survival rate from 1976 to 2004 was 91 % with a mortality rate of 13%. Most of the deaths were attributed to recurrences of the craniopharyngioma and the complications of bleomycin treatment. Conclusion: Craniopharyngiomas remain tumours associated with significant morbidity. Total excision of the tumour remains a favourable option but the proximity of the craniopharyngioma to the pituitary gland and optic tracts results in devastating sequelae. Although the medical and surgical management of craniopharyngiomas has improved, a significant number of patients had endocrine sequelae. The management of craniopharyngiomas in an African context compares favourably internationally but with limited resources especially with regard to growth hormone replacement, a large proportion of our children are not receiving optimal treatment.
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Tarrants, Marcy Lynnette Herman Robert D. "Pediatric versus non-pediatric hospital markets : determinants of operating margins". Diss., UMK access, 2007.
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Thesis (Ph. D.)--Henry W. Bloch School of Business and Public Administration and Dept. of Economics. University of Missouri--Kansas City, 2007."A dissertation in public affairs and administration and education." Advisor: Robert D. Herman. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed July 30, 2008 Includes bibliographical references (leaves 86-90). Online version of the print edition.
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Switala, Juli. "Evaluation of children with haemophagocytic lymphohistiocytosis (HLH) at Red Cross War Memorial Children's Hospital 1991-2010". Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11104.
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Includes bibliographical references.Haemophagocytic Lymphohistiocytosis (HLH) is a rare haematological disorder in children. However, this is probably an underestimation due to the difficulty in diagnosing the disease. HLH is characterized clinically by persistent fevers, organomegaly, cytopaenias and typical biochemical derangements viz. hypertriglyceridaemia, hyperferritinaemia and hypofibrinogenaemia. Other associated findings include decreased natural killer cell (NKC) function and raised soluble CD 25. The exact pathophysiology of HLH is not completely understood but involves a trigger (often an infection) which sets off an uncontrolled inflammatory cascade, characterized by an increase in hyperactivated macrophages and T lymphocytes which leads to increased production of cytokines, alongside reduced cellular cytotoxicity as a result of reduced or absent NKC function.
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Buys, Heloise. "Klebsiella pneumoniae bloodstream infections in hospitalised children at Red Cross War Memorial Children's Hospital : 2006 - 2011". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/19901.
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Background: Klebsiella pneumoniae (KP) is a significant paediatric bloodstream pathogen in children. There is little data about KP in South African children. The focus for the present study was to address this knowledge gap. Methods: This study addressed a retrospective case notes review on bloodstream Klebsiella pneumoniae infections at a children's hospital in Cape Town, South Africa 2006-2011 using conventional descriptive and comparative statistical methods. Results: Of 410 hospitalised children with laboratory confirmed KP bloodstream infection (KPBSI), 339 (83%) were presumed extended-spectrum β-lactamase (ESBL) producing isolates. The median age (interquartile range, IQR) was 5.0 (2-16) months, 212 (51.7%) were male, 82 (20%) were HIV-infected, and 241 (58.8%) were moderately or severely underweight. The infection was nosocomial or healthcare-associated in 389 (95%) children and community-acquired in 21 (5%) children. Significant risk factors for the acquisition of ESBL-KP bloodstream infection included cephalosporin exposure in the preceding 12 months prior to the KPBSI p=<0.0001: aRR 1.25 (95% CI: 1.15-1.36); and those who had intravenous infusions for more than 3 days prior to the KPBSI, p=0.004: aRR 1.18 (95% CI: 1.05-1.31).
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Mteshana, Phindile. "Use of the PCR technique to diagnose meningitis in children admitted to Red Cross War Memorial Children’s Hospital". Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30122.
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Introduction: Viral meningitis (VM) is more common than bacterial meningitis (BM) and is a self-limiting disease. Clinicians still tend to admit patients with VM and treat them for BM because they fear the morbidity and mortality that is associated with a delay in treating or not treating BM. Unnecessary admissions have huge cost implications and they separate children from their parents while exposing them to painful procedures and unnecessary antibiotics.
Methods: A structured literature review was undertaken to see whether clinical manifestation and examination findings and laboratory findings including viral PCR of cerebrospinal fluid can help to diagnose viral meningitis and avoid unnecessary admissions.
Results: Viral and bacterial meningitis have similar clinical findings. CSF examination is crucial in confirming the diagnosis of meningitis. Microscopy and culture remain the gold standard in making the diagnosis. The introduction of the Haemophilus influenzae type b and pneumococcal vaccines into the South African Expanded Programme on immunization (EPI) markedly reduced the incidence of invasive Haemophilus influenzae type b and pneumococcal disease in children under 5 years-of-age as in other countries where they are used. Viral meningitis is the leading cause of childhood meningitis however the clinical and CSF findings in viral meningitis and bacterial meningitis overlap. The sensitivity of CSF culture has been shown to be around 81.3%, but is very much affected by prior antibiotics. Traumatic/bloody CSF taps also make it difficult to interpret 10 results. Inflammatory markers have been used in conjunction with CSF results in differentiating between BM and VM however, the use of polymerase chain reaction technique in the diagnostic methodology improves the sensitivity to more than 95%.
Conclusion: Viral meningitis is common worldwide. Real-time multiplex PCR offers value in accurately detecting common viral and bacterial pathogens thus allowing for appropriate patient management. In order to avoid the risk of not identifying organisms not included in the PCR assay and further not being able to do susceptibility testing on those organisms, it important to realize that PCR testing would have to be done in addition to culture, and not as a replacement.
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Eke, Christopher Bismarck. "A Retrospective review of medical gastrointestinal endoscopy in children attending Red Cross War Memorial Children’s Hospital, Cape Town". Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31539.
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Background: Gastrointestinal endoscopy has evolved to become an important diagnostic, therapeutic as well as surveillance and follow-up modes of management in children with diverse gastrointestinal diseases. There is a paucity of data on gastrointestinal endoscopy in children in the sub- Saharan African region. The objectives of the study were to describe the socio-demographic characteristics; presenting symptoms; indications; endoscopic yield; impact of endoscopy on management; as well as its safety profile and complications. In addition algorithms for the indications of medical gastrointestinal endoscopy in children were designed using the results derived from the presenting symptoms and indications for gastrointestinal endoscopy among the patients. Methods: This was a cross sectional descriptive study. Subjects were children < 18 years attending Red Cross War Memorial Children’s Hospital (RCWMCH) who underwent medical gastrointestinal endoscopic procedures from 2007 to 2016. Study ethical approval was obtained from University of Cape Town while written permission from the RCWMCH Research and Management Committee prior to the commencement of the study. Data sheet was used in retrieving relevant patients variables from the hospital’s medical records and the Division of Paediatric Gastroenterology endoscopy and laboratory (histopathology) databases. Data was analysed using Stata 13.1. A p- value of less than 0.05 was considered statistically significant. Results: A total of 402 children were studied with 773 endoscopies performed comprising 670 oesophagogastroduodenoscopies (OGD) and 103 colonoscopies. For OGD: 179 (26.7%), 287(42.8%) and 204 (30.4%) procedures were for diagnostic, therapeutic and follow - up indications. A total of 78 (10.1%) combined OGD/colonoscopy were carried out. Out of 103 total colonoscopies performed, 67 (65.0%), 30(29.1%), and 6 (5.8%), were for diagnostic, follow - up and therapeutic indications respectively. vi Feeding difficulty 112 (25.4%) and rectal bleeding 11 (2.7%) were the main presenting symptoms for OGD and colonoscopy respectively. Main diagnostic indications for OGD, combined OGD/colonoscopy and colonoscopy alone respectively were chronic abdominal pain 51 (12.6%) and probable inflammatory bowel disease (IBD) 30 (7.5%) and IBD 30 (7.5%). Change 143 (35.6%)/ insertion 87(21.6%) of percutaneous gastrostomy were the most common therapeutic indications for OGD and polypectomy 8 (2.7%) for colonoscopy. Abnormal (positive) macroscopic findings on endoscopy were reported on 79/179(44.1%), 35/68(51.55%), and 46/67(53.7%) of OGD, combined OGD with lower scope, and colonoscopy alone respectively. Also, positive histological findings on OGD, combined OGD with colonoscopy, and colonoscopy alone were reported in 62/179(34.6%), 34/68(50.0%), and 32/67(47.8%) respectively. The overall normal endoscopic findings (both abnormal macroscopic findings on endoscopy and histological findings) were 63/179(35.3%) and 25/67(37.3%) for OGD and colonoscopy while overall diagnostic (endoscopic) yield was 116/179(64.8%) for OGD and 42/67(62.7%) for colonoscopy respectively. For OGD the main endoscopic yield reported were gastritis in 50(27.9%) and oesophageal varices 31(17.3%) while inflammatory bowel disease (Crohn’s disease 9(13.4%), ulcerative colitis 7(10.4%), juvenile polyps 9(13.4%) and intestinal tuberculosis 7(10.4%) were observed in colonoscopy respectively. A significant impact of endoscopy on the management of subjects were recorded in 298(74.1%) (p < 0.001) including diagnostic (change of medication, addition of new medication) and therapeutic (insertion/change of PEG; sclerotherapy 29 (9.8%) , band ligation of oesophageal varices 28 (9.4%), and polypectomy 8(2.7%)). The overall complication rate was 4.0% (16 patients). Conclusion: Feeding difficulty and rectal bleeding were the most common presenting symptoms for OGD and colonoscopy; with chronic abdominal pain and IBD being the most common indication for performing OGD and colonoscopy respectively. Therapeutic modalities of endoscopy performed were PEG insertion/change, polypectomy, sclerotherapy/band ligation for varices. vii Endoscopic yield was 116/179(64.8%) for OGD and 42/67(62.7%) for colonoscopy respectively a significant impact of endoscopy on the management of subjects were recorded in 298(74.1%) (p < 0.001). No mortalities were recorded following the procedures, however 16(4%) had some complications. Use of societal guidelines in selecting children with appropriate indications for gastrointestinal endoscopy will result in higher diagnostic yield and application of therapeutic modalities in children with gastrointestinal disorders resulting in significant impact on patient’s management and minimize complications.
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Mlotha-Mitole, Rachel. "A retrospective review of acute liver failure in children admitted at Red Cross War Memorial Children's Hospital". Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33863.
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Acute liver failure (ALF) describes a clinical syndrome resulting from severe liver damage and extensive loss of functional parenchymal liver mass triggered by various factors. Early recognition and initiation of specific therapy may improve outcomes and reduce the need for liver transplantation, a treatment modality not universally available in resource constraint areas. There is paucity of data describing this syndrome in Sub-Saharan Africa in children. Objective This study aims to retrospectively review and determine the clinical presentation, aetiology, complications & outcome of ALF in children admitted at the Red Cross War Memorial Children's Hospital (RCWMCH). Methods All records of children from 0 to 13 years admitted at the RCWMCH over the period from January 2005 to December 2016 with ALF were retrospectively reviewed, after obtaining ethical approval. Patients with pre-existing evidence of chronic liver disease were excluded. Demographic variables as well as clinical presentation and investigations were captured, with determination of outcomes at 3 weeks and 6 weeks of diagnosis. Results Study included 24 children., 16 females (66.7%) and 8 males (33.3%). Median Age was 15 months, with interquartile range from 5 to 28 months. Diarrhoea, jaundice, respiratory distress, hepatomegaly and encephalopathy were common clinical features. Aetiology was infection in 37.5 % of cases (n=9, 2 of whom had autoimmune hepatitis comorbidity) and hepatitis A was most common infectious cause (n=4, 44%). Causes were indeterminate in 29.2%. Two patients had autoimmune hepatitis without co-morbidity; Reye syndrome 12.5% and 17% had miscellaneous causes. Transaminases were raised to thousands in viral causes of hepatitis, with a low C reactive protein. INR >4 and Total Bilirubin>210umol/L were associated with death outcome (p=0.04 and p=0.03 respectively. Conclusion Viral hepatitis A is the leading infective cause of acute liver failure in this study cohort and 29.2% of cases were indeterminable. INR >4 and Bilirubin > 210umol/l were predictors of poor outcome. Follow up study is recommended to better understand clinical spectrum and outcomes of children with acute liver failure in this low resource setting.
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Rutledge, M. Hannah. "Patient Family and Hospital Staff Information Needs at a Pediatric Hospital: an Analysis of Information Requests Received by the Family Resource Libraries". Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc801947/.
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This research explored the information needs of patient families and hospital staff at a pediatric hospital system in Dallas, Texas. Library statistics recorded in four hospital libraries from 2011 - 2013 were used to analyze the information requests from patient families and hospital staff. Crosstabulations revealed the extent to which patient families and hospital staff used the libraries to satisfy their information needs. The data showed that patient families used the libraries very differently than hospital staff. Chi-square tests for independence were performed to identify the relationships between the Classification (Patient Family, Hospital Staff) and two descriptors of information needs (Request Type, Resources Used). There were a total of 1,406 information requests analyzed. The data showed that patient families and hospital staff information requests differed greatly in the number of information requests, the type of information requested, the resources used and the time the library staff spent on the requests. Chi-square analyses revealed relationships statistically significant at the p < .05 level; however, the strength of the relationships varied.
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Page, Jacqueline. "Parent and physician decision making in children with suspected ear infection presenting to a children's hospital emergency department". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0017/MQ48175.pdf.
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Kija, Edward Nkingwa. "Bone metabolism abnormalities in children with epilepsy at Red Cross War Memorial Children's Hospital, Cape Town, South Africa". Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27013.
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Introduction: Epilepsy is the most common neurological condition worldwide. Literature on the antiepileptic medications and biochemical markers of bone metabolism has revealed inconsistent results. Most of these studies were undertaken in Europe and America where the burden and the associated comorbidities are different to the ones in Africa. Methods: A hospital based case control study was undertaken at Red Cross War Memorial Children's Hospital where children were recruited from a dedicated Epilepsy clinic and controls were obtained from a day surgical ward. Blood and urine samples were taken for the assessment of markers of bone metabolism. Results: Seventy-five cases and 75 controls were recruited. The median age for the children with epilepsy was 9 years with a range of 1 to 17 and controls 3 years with a range of 1 to 12. Vitamin D deficiency was present in 11(16.2%) of children with epilepsy compared to 6(8.8%) in the control group. Vitamin D insufficiency was present in 30(44.1%) in children with epilepsy compared to 27(39.7%) in the control group. Children with epilepsy on enzyme inducing AEDs had lower mean Vitamin D levels (24.67±11.4 vs 30.72±7.4, p=0.08), lower mean Vitamin D2 (0.25±0.07 vs 0.4±0.17,p=0.0018),lower mean Vitamin D3 (1.61±1.06 vs 2.58±0.86,p=0.004), lower mean serum phosphate levels (1.39±0.2 vs 1.76±0.7,p=0.000) and a higher mean parathyroid hormone levels (4.47±2.33 vs 2.7±0.97, p=0.03) compared to the control group. Children with Epilepsy on enzyme inhibitors had higher mean Vitamin D2 (0.44±0.37 vs 0.25±0.07,p=0.000004) and mean Vitamin D3 (2.26±0.86 vs 1.61±1.06,p=0.028) compared to children on enzyme inducers. Dietary intake and ancestry did not influence Vitamin D levels between the cases and controls. Conclusion and Recommendations: Vitamin D deficiency is common in children with epilepsy on AEDs. Children on enzyme inducing AEDs should be investigated for vitamin D deficiency and managed accordingly.
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Cavota, João Joaquim Gunza. "Primary health care facilities for street children : a study of the street children's requirements in designing community hospitals in Angola". Master's thesis, University of Cape Town, 1997. http://hdl.handle.net/11427/28254.
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Summary in English.Bibliography: pages 122-126.
This dissertation studies the delivery of health care to street children. ft investigates the existing street children's facilities and the health system in Ang of a in order to determine an appropriate type of health facilities for the special health needs of these children. The study was based on a review of bibliographic material on street children and related subjects. The findings from this review were tested through a series of interviews with professionals working with street children in Angola and with ~treet children randomly selected from shelters and on the streets in Luanda. The questionnaires were designed for evaluation of the street children's facilities, the health system and to determine street children's preferences and attitudes towards formal institutions in a context where th'e main cause of family disintegration was war. The study concluded that street children's health needs in Angola would be better catered for through independent primary health centres provided with partial in-patient services (temporary sf eeping and eating facilities for children under medical care). These centres would serve mainly children with no access to shelters and those living in shelters without health centres. The study formulates guidelines and presents a design example of the type offacifity proposed.
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Stowers, Louisa Lockhart Lau Tin-Man. "An approach to improve children's hospital facilities by incorporating a play system with stimuli that allows for imaginative play to aid in children's development". Auburn, Ala, 2009. http://hdl.handle.net/10415/1744.
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Maree, Leana. "Investigating the aetiology of respiratory tract infections in children admitted to Tygerberg Children’s Hospital using molecular methods and viral culture". Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71902.
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Thesis (MMed)--Stellenbosch University, 2012.Includes bibliography
ENGLISH ABSTRACT: Introduction Acute respiratory tract infections cause significant morbidity and mortality worldwide, and are the main reason for the utilisation of health care services. Identifying the aetiological cause of lower respiratory tract infections (LRTIs) is difficult at the best of times, and more than 20 viruses and bacteria have been associated with LRTIs, which cannot be distinguished with clinical examination alone. Viruses can be detected in respiratory samples by a variety of methods, and without exception molecular methods have proven to be more sensitive than non-molecular-based tests. The increased sensitivity of molecular methods may assist in expanding our knowledge of the pathogenesis of severe respiratory tract infections, and could have a positive influence on patient management, infection control, vaccination strategies and public health. Aims and objectives 1. Determine the viral causes of lower respiratory tract infections requiring admission in using shell vial culture with immunofluorescent staining and two multiplex PCR assays, the Seeplex® RV15 ACE Detection system (Seeplex® RV15 ACE) and the Respiratory Multiplex Real-Time RT-PCR LightMix® Customised Kit (Resp Multiplex RT-PCR). 2. Compare the Seeplex® RV15 ACE and the Resp Multiplex RT-PCR with shell vial culture for the detection of respiratory viruses in routine diagnostic respiratory samples. 3. Examine the demographic and clinical characteristics associated with each respiratory viral pathogen. Materials and Methods One hundred and thirty-eight paediatric patients, admitted to Tygerberg Children’s Hospital from May 2010 to August 2010 with a presumptive diagnosis of an acute respiratory tract infection were included in the study. Nasopharyngeal or tracheal aspirates were collected, and all samples were tested by all three diagnostic methods. Clinical, demographic and laboratory data were collected through a systematic review of medical and laboratory records and subsequently anonymised Results Thirty-seven viruses were detected in 36 samples (26.1%) by shell vial culture with immunofluorescent staining; 169 viruses in 102 samples (73.9%) with the Seeplex® RV15 ACE; and 90 viruses in 73 samples (52.9%) with the Resp Multiplex RT-PCR. Shell vial culture had excellent specificity, but low sensitivity for all of the respiratory viruses. Conversely, the Seeplex® RV15 ACE had excellent sensitivity for all viruses, but slightly lower specificity. This was due to the detection of additional viruses, which may have been true positives due to the increased sensitivity of this assay. The Resp Multiplex RTPCR had excellent sensitivity and specificity. At least one respiratory pathogen could be identified in 80% of the patients. At least one virus was detected in 57% of patients, bacterial micro-organisms in 6%, and both viral and bacterial pathogens in 17%. Viral-bacterial co-infections were associated with increased severity compared to other infections, as these children were more likely to receive steroids and a blood transfusion (p = 0.002), and more likely to require mechanical ventilation (p < 0.001) and admission to the intensive care unit (p = 0.04). Conclusions We confirmed that molecular techniques are significantly more sensitive than shell vial culture for the detection of respiratory viruses in children. Due to their highly specific nature and the genetic variability observed in viruses, an excellent, continuous quality control programme is essential to ensure the continued superiority of these assays. Viral-bacterial co-infection is associated with increased severity of LRTIs in children. Further research is needed to elucidate the precise pathogenic and immunologic mechanism of this interaction.
AFRIKAANSE OPSOMMING: Inleiding Akute lugweg infeksies is verantwoordelik vir beduidende morbiditeit en mortaliteit wêreldwyd en is die hoofrede vir die benutting van gesondheidsdienste. Identifisering van die oorsaak van laer lugweg infeksies is baie moeilik en meer as 20 virusse en bakterieë word hiermee geassosieer. Ongelukkig kan kliniese ondersoek alleen nie onderskei tussen die verskillende organismes nie. Respiratoriese virusse kan deur ‘n wye verskeidenheid van toets metodes aangetoon word. Molekulêre metodes is sonder uitsondering meer sensitief as nie-molekulêre metodes. Hul verhoogde sensitiwiteit mag help om ons kennis oor die patogenese van erge lugweg infeksies te verbreed en kan ’n positiewe invloed op pasiëntbehandeling, infeksiebeheer, immunisasie strategieë en publieke gesondheidsorg hê. Doel van die Ondersoek 1. Bevestig die virale oorsake van laer lugweg infeksies deur gebruik te maak van “shell vial” kultuur met immunofluoressensie en twee veelvoudige molekulêre toetse, die Seeplex® RV15 ACE en die Resp Multiplex RT-PCR. 2. Vergelyk die Seeplex® RV15 ACE en die Resp Multiplex RT-PCR met “shell vial” kultuur vir die aantoning van respiratoriese virusse in roetine diagnostiese monsters. 3. Ondersoek die demografiese en kliniese eienskappe wat met elke respiratoriese patogeen geassosieer word. Metodiek en Materiaal Een honderd agt-en-dertig kinders wat toegelaat is tot Tygerberg Kinderhopitaal vanaf Mei 2010 tot Augustus 2010 met ’n voorlopige diagnose van ’n akute lugweg infeksie is in die studie ingesluit. Nasofaringeale of trageale aspirate is van elke pasiënt gekollekteer en met al drie diagnostiese metodes ondersoek. Kliniese, demografiese en laboratorium data is gekollekteer deur ’n sistematiese ondersoek van mediese en laboratorium rekords en daarna anoniem gemaak. Resultate Sewe-en-dertig virusse is in 36 monsters (26.1%) aangetoon deur “shell vial” kultuur met immunofluoressensie; 169 virusse in 102 monsters (73.9%) deur die Seeplex® RV15 ACE; en 90 virusse in 73 monsters (52.9%) deur die Resp Multiplex RT-PCR. “Shell vial” kultuur het uitstekende spesifisiteit gehad, maar sensitiwiteit was laag vir al die virusse. Teenoorgesteld hiermee het die Seeplex® RV15 ACE hoë sensitiwiteit vir al die viruses gehad, maar effe laer spesifisiteit. Dit was as gevolg van die aantoning van addisionele virusse, wat moontlik ware positiewe resultate kon wees as gevolg van die verhoogde sensitiwiteit van hierdie toets metode. Die Resp Multiplex RT-PCR het uitstekende sensitiwiteit en spesifisiteit gehad. Ten minste een respiratoriese patogeen is in 80% van die pasiënte geidentifiseer. Een of meer virusse was in 57% van die pasiënte aangetoon, bakterieë in 6% en beide virale en bateriële patogene in 17%. Virale-bakteriële ko-infeksies, in vergelyking met ander infeksies, was geassosieer met meer ernstige lugweg infeksies aangesien hierdie kinders meer geneig was om steroïede en ’n bloedtransfusie te ontvang (p = 0.002). Hulle het ook meer waarskynlik meganiese ventilasie (p < 0.001) en toegang tot die intensiewe sorg eenheid benodig (p = 0.04). Gevolgtrekkings Ons het bevesitg dat molekulêre tegnieke aansienlik meer sensitief is as “shell vial” kultuur vir die aantoning van respiratoriese virusse in kinders. As gevolg van hul hoogs spesifieke aard en die genetiese variasie waargeneem in virusse, is ’n uitstekende deurlopende kwaliteitsbeheer program noodsaaklik vir die voortgesette uitneemendheid van hierdie metodes. Virale-bakteriële ko-infeksies word geassosieer met meer ernstige laer lugweg infeksies in kinders. Verdere navorsing is nodig om die presiese patogenetiese en immunologiese meganisme van hierdie interaksie toe te lig.
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Tavares, Alan Ferreira Pinheiro 1989. "Projeto, construção e teste de protótipo de maca para transporte de crianças de um até dez anos de idades". [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/265781.
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Orientador: Antonio Celso Fonseca de ArrudaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecânica
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Resumo: No transporte, por ambulâncias, as crianças estão expostas a riscos fatais ao serem transportadas em macas de adultos as quais não atendem a antropometria infantil. A situação é agravada ao considerar o fato das ambulâncias se locomoverem em altas velocidades e necessitarem frequentemente reduzi-las de modo abrupto. Neste cenário, buscou-se projetar, construir e testar um protótipo de maca com um sistema de retenção eficaz para transportes emergenciais de crianças. O diferencial do projeto em relação às outras macas infantis, existentes no mercado internacional, está na versatilidade de realizar transportes tanto em ambulâncias quanto em áreas de resgate de difícil acesso veicular. O projeto de maca infantil possibilita atender uma ampla gama de pacientes de pequeno porte desde crianças na faixa etária de 1 (um) ano até 10 (dez) anos de idade. Trata-se de uma maca desenvolvida para rápido manuseio e armazenagem por ser dobrável e de fácil instalação sobre qualquer maca de adulto normatizada pela ABNT. O principal fator de segurança está vinculado ao sistema de retenção regulável, com facilidade de rápida fixação e remoção da criança. Foram realizados testes de impacto, com velocidade aproximada de 18 (dezoito) km/h, utilizando a maca de adulto e a maca infantil. O manequim com massa de 22 kg, representativo de uma criança de 6 (seis) anos de idade, foi instalado nas posições sentado e deitado. Os dados coletados, via um programa computacional Kinovea adequado para análise de biomecânica, permitiram estimar o deslocamento do manequim com grande precisão. Utilizou-se um aplicativo instalado em um celular com sistema operacional Android para registrar as desacelerações ocorridas no momento do impacto. A maca infantil apresentou uma retenção significativamente superior à obtida com a maca de adulto, tanto no deslocamento da cabeça quanto do tronco do manequim. Na posição deitado, o manequim chegou a ser ejetado para fora da maca, o que nunca ocorreu utilizando a maca infantil. Os testes realizados com o protótipo da maca validaram o projeto e a solução construtiva que estão vinculados a uma patente a ser depositada no Brasil
Abstract: In transportation, for ambulances, children are exposed to fatal risks by transported in adult gurneys that are not adapted to child anthropometry. The situation is escalated when considering the fact that the ambulances move up in high speeds and with frequently need to reduce abruptly velocity. In this field, we tried to design, build and test a prototype gurney with an effective restraint system for emergency transport children. The differential of the project regards to other children gurneys that exist in the international market; its versatility to perform both transport in ambulances and possible land rescue. Child gurney enables a wide range of small patients from children with one (1) until ten (10) years old, designed for fast handling and storage by be foldable and easy to install on any adult gurney standardized by ABNT. The main safety factor is linked to the adjustable retention system with facility for rapid attachment and the child's removal. Impact tests were performed, with an approximate speed of 18 (twenty) km / h, using the adult gurney and child gurney. The dummy with mass 22 kg, representing a child with 6 (six) years old, was installed in sitting and lying positions. Data collected via a computer program Kinovea suitable for biomechanical analysis, allowed to estimate displacement of the dummy with great precision. It was used a smartphone based on Android operational system to register decelerations occurred on impact. Child gurney had a higher retention regarding to adult gurney both the displacement of the head when the dummy torso restraint. In two teste with lying position, the dummy was ejected out of the gurney, fact that had never happened with child gurney. Tests conducted with the prototype gurney validated the project and the constructive solution that are bind to a patent to will be implanted in Brazil
Mestrado
Materiais e Processos de Fabricação
Mestre em Engenharia Mecânica
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Dosier, Sharla June. "Satisfaction Determinants: Parents with Children Admitted to an Adult Inpatient Surgical Unit". Thesis, Montana State University, 2006. http://etd.lib.montana.edu/etd/2006/dosier/DosierS0506.pdf.
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With the recent movement in healthcare to view the patient as a consumer, it has been recognized that patient satisfaction is an essential measurement of high quality healthcare. For populations of patients that have difficulty speaking for themselves, such as pediatrics, assessing the parent guardian satisfaction becomes essential. Rural areas face unique challenges with pediatric care including long distances from home to a healthcare facility and lack of specialized care. The causal model is used for the theoretical framework, which states that there are two factors that directly influence patient satisfaction. These are process quality and clinical quality. Demographic factors are also included because there is conflicting information of the correlation between demographics and satisfaction. There is little known about the factors that contribute to high levels of satisfaction in the pediatric population. The purpose of this study is to understand what factors play the greatest role in directly influence satisfaction of parents whose children are hospitalized. Specifically, the relationship between overall satisfaction and parent demographics, process quality and clinical quality were explored. The study is a descriptive correlational study with a non-random, convenience sample of parents whose children are admitted to adult in-patient surgical unit during an eight week period of time. The parents filled out a Pediatric Family Satisfaction Questionnaire (PFSQ) at the time of discharge. The total sample size was 13 with a 77% response rate. Overall, the satisfaction scores were very high. Correlations could not be established due to the lack of variability in certain factors. The study did reveal trends that are consistent with findings of previous studies. These trends include the reluctance to be critical of healthcare, higher satisfaction scores with lower levels of education and higher satisfaction with process quality.
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Mostert, Colin. "The diversity of malignant rhabdoid tumours : a morphological, immunohistochemical and ultrastructural review of cases from the Red Cross Children's Hospital and Groote Schuur Hospitals". Master's thesis, University of Cape Town, 1997. http://hdl.handle.net/11427/26788.
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Malignant rhabdoid tumours of the kidney are rare childhood neoplasms. Extra-renal rhabdoid tumours are known to have a distinctive biological behaviour and do not always occur in the paediatric age group. As the histogenesis of rhabdoid tumours, and their apparent relationship to nephroblastoma is still unclear, careful assessment of new cases is required. This investigation illustrates diverse ultrastructural, light microscopic and immunohistochemical findings. These features are related to each other and to the biological behaviour of renal rhabdoid tumours, and six extra-renal lesions with rhabdoid features obtained from the Pathology Archives of the Red Cross Children's Hospital and Groote Schuur Hospital. In this series primitive epithelial elements are a dominant feature, but ultrastructural features of one renal rumour suggest diverse differentiation. The extra-renal lesions investigated include three undifferentiated rhabdoid lesions, a primitive neuro-ectodermal tumour, a malignant epithelioid Schwannoma and a possible undifferentiated hepatocellular carcinoma; all showing areas of extensive rhabdoid differentiation. Pseudo-rhabdoid cells in an additional two cases were also examined. These particular tumours were a nephroblastoma and a fibro-lamellar carcinoma of the liver. These rhabdoid tumour mimics were ultrastructurally different from true rhabdoid cells. Strong immunohistochemical co-expression of Vimentin and cytokeratin in rhabdoid tumour cell inclusions has been noted by previous investigators. (Vogel, 1984) (Gansler, 1991), (Berry, 1992). We speculate that the predominant line of differentiation in renal rhabdoid tumours is epithelial although, as in nephroblastoma multiple lines of differentiation may occur. The extra-renal lesions appear to represent more than one entity, but once again epithelial or neuro-epithelial differentiation appears to be present. Ultrastructural examination is a more useful investigation than immunohistochemistry because of inherent non-specific uptake of antibodies by the filamentous cytoplasmic inclusions.
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Meyer, Sarah. "Children's preferences for color schematics of hospital rooms". Connect to resource, 2007. http://hdl.handle.net/1811/28522.
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Thesis (Honors)--Ohio State University, 2007.Title from first page of PDF file. Document formatted into pages: contains 29 p. Includes bibliographical references (p. 27-29). Available online via Ohio State University's Knowledge Bank.
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Soo, Yan Ho Michelle. "Coping with hospital admission in children /". St. Lucia, Qld, 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17815.pdf.
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Schondelmeyer, Amanda C. M. D. "The Frequency of Physiologic Monitor Alarms in a Children’s Hospital". University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428064830.
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Wege, Martha Helena. "A retrospective review of the prevalence and management of anaemia in children in at Red Cross War Memorial Children's Hospital". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/19898.
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Includes bibliographical referencesIntroduction Childhood anaemia is a major public health problem, iron deficiency being most common. WHO estimates anaemia to occur in 24.1% of pre-school South African children. Our study describes prevalence and management of anaemia in children aged 6 - 36 months presenting to a children's hospital. Methods In a retrospective cross-sectional study, laboratory data were used to estimate prevalence of anaemia in children aged 6 - 36 month presenting to medical emergency or ambulatory services of Red Cross Children's Hospital in 2012. A random sample of 50% of anaemic children was sampled for detailed review. Results 2661 subjects were included. Anaemia (H b < 10.5) was found in 40.8 % (1088/2661. Children presenting to medical emergency had a higher prevalence of anaemia compared to those presenting to ambulatory services ( 42.7% vs. 34.9 % ; p=0.001 ). Anaemia prevalence increased with decreasing age with RR 1.25 (95% CI 1.10 - 1.43) and RR 1.15 (95% CI 1.02 - 1.31) in children aged 6 - 11 months and 12 - 23 months respectively compared to children aged 24 - 36 months. Microcytosis was found in 51.3% (558/1088) of anaemic children and in 19.3% (n=303/1573) of children without anaemia ; p<0.001 Folders were reviewed i n 502 children with anaemia , 36.1% had mild anaemia (Hb 10 - 10.5g/dl), while moderate ( Hb 8 - 10 g/dl ) and severe ( Hb < 8 g/dl ) anaemia was found in 52.5% and 11.4% respectively. Breastfeeding for longer than six months was associated with higher risk of microcytic anaemia [RR 1.26 (95%CI 1.08 - 1.47)]. Only 12.2 % (31 /254) of children with microcytic anaemia received adequate iron therapy, 50.0 % (127/254) received no iron therapy. Conclusions Prevalence of anaemia in children presenting to hospital is higher than predicted for well children in South Africa. The risk is higher in younger and acutely sick children. Prolonged breasting is associated with increased risk of microcytosis. Most children with suspected iron deficiency anaemia did not receive appropriate treatment.
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Fitzwanga, Kaiser. "Transfusion practices among children undergoing cardiac surgery admitted to the Red Cross War Memorial Children's Hospital Paediatrics Intensive Care Unit". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29879.
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Objective- We aimed to describe the use of blood products following cardiac surgery, as well as the outcomes and factors associated with post-operative blood product use
Design- Prospective, single centre observational study
Setting- Paediatric intensive care unit (PICU) in Cape Town, South Africa
Patients- One hundred and twenty-six children <18 years old admitted to the PICU following cardiac surgery between July 2017 and January 2018
Interventions- None
Measurements and Main Results- The data was prospectively obtained from blood bank charts, intraoperative and PICU observation charts. Demographic data, intraoperative details and post-operative blood product use were extracted from patient records and entered in a standardised case record form. Fifty three percent of children received blood products following cardiac surgery. The blood products transfused included cryoprecipitate (30.9%), packed red cells (22.2%), albumin (18.3%), fresh frozen plasma FFP (15.9%) and platelet concentrate (15.1%). Low haemoglobin level was commonest indication (86%) for red cell use. Bleeding was the commonest indication for FFP (70%) and cryoprecipitate (67%) use. Thrombocytopenia was the commonest indication (84%) for platelet use while hypotension episodes were predominant (95%) in those who received albumin. The standardized mortality ratio was 3.1 vs 0, respectively, among transfused versus non-transfused patients (p<0.0001). The median (IQR) duration of PICU stay was 5 (3-11) vs 2 (2-5) days, respectively in those transfused versus non-transfused (p<0.0001). The median (IQR) ventilation duration was 47(22-132) hours vs 20 (6-27) hours, respectively among the transfused versus non-transfused (p=<0.0001). The factors associated with blood-product use post cardiac surgery include previous cardiac surgery, younger age, lower weights, and prolonged coagulation parameters (p=<0.05).
Conclusion- There is high usage of blood products among children post cardiac surgery. The children transfused had a longer ICU stay, ventilation duration, and higher standardized mortality ratio compared to the non-transfused.
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Shi, Zuoming. "Little Garden: A Postmortem for an Interactive Project for Children's Hospitals". Thesis, The University of Arizona, 2015. http://hdl.handle.net/10150/577320.
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Little Garden is an endless survival game that utilizes the Microsoft Kinect as its only input method. The game started near the end of the Spring 2014 semester as an interactive display to be installed at University of Arizona Medical Center, Children's Ward. Currently, an instance of the game is installed in the ward. Among the unique challenges facing this project is its intension as a public display, the unique location of the Children's Hospital, and utilization of Microsoft Kinect as the input method. This paper details the design process behind the game, obstacles encountered during production, the result of the project, and lessons learned during the process.
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Hedlund, Jannica. "En litteraturstudie om barns upplevelser av att möta sällskapsdjur på sjukhus". Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-26101.
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Bakgrund och problemformulering Barn som vårdas på sjukhus kan uppleva det som skrämmande och obehagligt. De känner oro, ångest och det kanske blir en skräckfylld upplevelse. Rädsla för smärtsamma ingrepp som procedurer med nålar är vanliga. Många studier har visat att djurassisterad terapi/aktivitet har en positiv effekt som kompletterande behandling för barnens hälsa. Hur upplever barn sällskapsdjur vid sjukhusvården? Vad ger sällskapsdjur för effekt hos barn som vårdas på sjukhus? Studien är en litteraturstudie som handlar om att undersöka detta. Syfte Beskriva barns upplevelser av sällskapsdjur vid sjukhusvård Metod Studien utfördes som en litteraturöversikt av både kvantitativa och kvalitativa artiklar enligt Friberg (2018). Sökning gjordes i databaserna CHINAHL, MEDLINE, PUDMED samt även manuell sökning. En kombination av sökbegrepp användes för att skapa ett avgränsat urval av artiklarna som svarade mot syftet. Resultat 10 artiklar granskades som gällde djurassisterad terapi, djurassisterad aktivitet och djurassisterad innervation inom sjukhusvården. Analysen av artiklarna visade hur barn upplevde en reducerad ångest, oro, smärta och ökade sin sociala kommunikation. Analysen visade även att det gav en positiv effekt som distraktion mot smärta, exempel vid blodprovstagning. Barnen beskriver att deras sjukhusminnen blev mer positiva med hunden som interaktion. Diskussion Sällskapsdjur som omvårdnadsalternativ på sjukhus har visat sig ha en positiv effekt för barnen. Resultaten visade att djurassisterad terapi, djurassisterad aktivitet och djurassisterad innervation kan underlätta kommunikation, ge positiva känslor, fysisk avkoppling och motivation för aktivering. Dessa resultat är värdefulla för framtida forskning för att kunna framhålla sällskapsdjur som en kompletterande behandling för barn på sjukhus.
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Nilsson, Maria, i Cecilia Johnsson. "Parents`experiences when their children are tended at hospitals". Thesis, Kristianstad University College, Department of Health Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-3851.
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Background: In Sweden the healthcare has moved from the homes to the hospitals, as the system has developed. Parents were not allowed to visit their children when they were hospitalised in the past. It was noticed in the beginning of the 20th century that it might be harmful for the children to be left without parents at the hospital. Today it is considered a fact that the parents should stay with their hospitalised children and the healthcare is based on a family-centered care.
Aim: The aim of this literature study was to elucidate parents experience when having hospitalised children.
Method: Eleven scientific articles were analysed on the basis of qualitative content analysis. Units of meaning were selected and divided in main and sub categories.
Results: The result shows that it is stressing to have hospitalised children. Parents experience need of information and support. The parents experience a need to be close to their children and to attend the healthcare on own conditions in order to be able to cope with the situation.
Discussion: It is not a common situation for parents to have their child hospitalised. Nurses should therefore get information about each specific family in order to support the family in their situation.
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Rocha, Simone Maria da. "Narrativas infantis: o que nos contam as crian?as de suas experi?ncias no hospital e na classe hospitalar". Universidade Federal do Rio Grande do Norte, 2012. http://repositorio.ufrn.br:8080/jspui/handle/123456789/14533.
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Previous issue date: 2012-02-29Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior
This dissertation focuses on the narratives of children hospitalized with chronic diseases. The overall goal is to deduce, from the look of the child health care, hospital class contributions to the process of school inclusion. The research is part of the qualitative ethnographical approach and is based on the principles and research methods (auto)biographical in education and schooling in hospital. Participated in the investigation 05(five) children, aged between 06 (six) and 12 (twelve) years of age, treated at the Center for Children s Onco-Hematology, Varela Santiago Children s Hospital in Natal-RN. The corpus used for the analysis comprises five (05) narrative interviews, 03 (three) drawings made by children as well as records in the researcher s field diary. The sources were collected during the months of August 2010 to February 2011. The analysis revealed that the inclusion of the hospital class, and ensure the right to education, contributes to the construction of strategies for coping with illness and hospitalization, as it promotes autonomy, comfort, playfulness and self-knowledge, the rand the world, easing the stress of hospitalization. The figure of the teacher took the class hospital in the voices of children, a reliever and minimizing the role of double exclusion that cause illness and hospitalization, showing the contributions to (re) construction of identity and subjectivity constitution strengthened. The children interviewed said that the hospital class leave the hospital more cheerful. The playfulness and learning experiences in the hospital are seen by children as actions that go beyond the physical treatment of the disease, since it provides them with acceptance and understanding of hospitalization and illness, to give them affective security and emotional. In conclusion, the narratives of children confirm that the service class hospital ensures continuity of schooling, but they reveal, namely, that this service provides them socialization among peers and with adults, strengthening the emotional, social and cognitive biopsychosocial perspective of attention
Esta disserta??o tem como foco as narrativas de crian?as hospitalizadas com doen?as cr?nicas. O objetivo geral ? depreender, a partir do olhar da crian?a em tratamento de sa?de, as contribui??es da classe hospitalar para seu processo de inclus?o escolar. A pesquisa se insere na abordagem qualitativa de cunho etnogr?fico e fundamenta-se nos princ?pios e m?todos da pesquisa (auto)biogr?fica em educa??o e nas teorias da escolariza??o hospitalar. Participaram da investiga??o 05 (cinco) crian?as, entre 06 (seis) e 12 (doze) anos de idade, em tratamento no Centro de Onco-Hematologia Infantil, do Hospital Infantil Varela Santiago, em Natal-RN. O corpus utilizado para a an?lise compreende 05 (cinco) entrevistas narrativas, 03 (tr?s) desenhos, realizados pelas crian?as, al?m dos registros no di?rio de campo da pesquisadora. As fontes foram recolhidas durante os meses de agosto de 2010 a fevereiro de 2011. A an?lise revelou que a inclus?o pela classe hospitalar, al?m de assegurar o direito ? educa??o, contribui para a constru??o de estrat?gias de enfretamento ao adoecimento e ? hospitaliza??o, na medida em que promove autonomia, conforto, ludicidade e o conhecimento de si mesmo, do outro e do mundo, amenizando o estresse decorrente da interna??o hospitalar. A figura da professora da classe hospitalar assumiu, nas vozes das crian?as, um papel apaziguador e minimizador da dupla exclus?o que o adoecimento e a hospitaliza??o provocam, evidenciando as contribui??es para a (re)constru??o de identidades fortalecidas e a constitui??o de subjetividades. As crian?as entrevistadas afirmam que as classes hospitalares deixa o hospital mais alegre. A ludicidade e as aprendizagens experienciadas no hospital s?o vistas pelas crian?as como a??es que v?o al?m do tratamento f?sico da doen?a, uma vez que lhes proporciona a aceita??o e a compreens?o da hospitaliza??o e do adoecimento, ao transmitir-lhes seguran?a afetiva e emocional. Em conclus?o, as narrativas das crian?as ratificam que o servi?o da classe hospitalar assegura a continuidade da escolariza??o, mas elas revelam, notadamente, que esse servi?o proporciona-lhes a socializa??o entre pares e com os adultos, fortalecendo os aspectos emocionais, sociais e cognitivos, numa perspectiva de aten??o
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Lachman, Peter Irwin. "Referral patterns to the Red Cross War Memorial Children's Hospital". Master's thesis, University of Cape Town, 1989. http://hdl.handle.net/11427/26634.
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This prospective descriptive study describes the referral patterns to the Red Cross War Memorial Children's Hospital. The study was conducted from 1st July to 31st December 1987 and entailed the collection of all referral letters presented (9288) to the hospital and the analysis of a sample of these letters (4702). The results indicated: * The patients are similar in terms of age and sex to those attending the Outpatients Department except that relatively fewer referred patients are Black. * The private sector, i.e. general practitioners, is the largest referral agency followed by Day Hospitals. * Most patients were ref erred to the Outpatients Department without an appointment. * Of the specialist clinics, the surgical clinics, i.e. Ophthalmology and Ear, Nose and Throat Clinics, were utilised the most. * The majority of patients (84,90%) were not admitted. * The contact made by the hospital with referral agents was poor (only in 30,30%). * The quality of information in referral letters was generally poor and did not contribute to patient care. Recommendations are made to the hospital and relevant health authorities.
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Davidson, Alan. "Wilms' tumour outcomes at Red Cross Children's Hospital 1979-2003". Master's thesis, University of Cape Town, 2007. http://hdl.handle.net/11427/14308.
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Includes bibliographical references (leaves 78-96).BACKGROUND: In Africa Wilms' tumour frequently presents with advanced disease. This study reports our results over 25 years using the National Wilms' Tumor Study Group approach of primary surgery, in the form of nephrectomy, followed by chemotherapy. A small number of these tumours are bilateral and here surgery has evolved from simple nephrectomy into the use of nephron-sparing techniques. METHODS: A retrospective analysis was performed on all patients diagnosed with Wilms' tumour between January 1979 and December 2003. Treatment was according to National Wilms' Tumor Study Group protocols. For unilateral Wilms' tumour primary surgery, where possible, was followed by adjuvant chemotherapy with vincristine and dactinomycin. Doxorubicin was added for stage III and IV tumours. Other drugs were used for unfavourable histology, and radiotherapy was reserved for local stage III tumours and pulmonary metastases. Patients with bilateral Wilms' tumours underwent initial bilateral biopsy, neoadjuvant chemotherapy and tumourectomy. Where indicated, nephrectomy (partial or complete) involved using ice dam topical cooling and vascular control, and in one case bench surgery and extensive renal reconstruction with orthotopic autotransplantation. Revision tumourectomy was utilized on three occasions for recurrence in areas of nephroblastomatosis. Radiotherapy was reserved for pulmonary metastases and palliation. RESULTS: There were 188 children with unilateral Wilms' tumour and 20 with bilateral Wilms' tumour. Among those with unilateral Wilms' tumour fifty seven (30.3%) were stage I, 33 (17.6%) were stage II, 60 (31.9%) were stage III and 38 (20.2%) were stage IV. Twenty-four patients (12.8%) had unfavourable histology. Fifteen of the bilateral Wilms' tumours had a synchronous presentation, one with liver metastases at diagnosis, and five were metachronous. Nephroblastomatosis was identified in 18 of the 20 patients (90%) with bilateral Wilms' tumour. One hundred and forty five patients are alive and disease free, 23 to 318 months from diagnosis. The estimated 5-year overall survival for all unilateral Wilms' tumours was 78.3%; 82.8% for favourable histology and 47.3% for unfavourable histology. Among those with favourable histology, estimated 5-year overall survival was 94.6% for stage I, 96.2% for stage II, 78.4% for stage III and 54.2% for stage IV. There was no difference in overall survival between those favourable histology stage III tumours that were operable and those deemed inoperable. Intra-operative spillage was uncommon (8%), and did not increase local relapse rate. Survival of stage IV disease has not improved over the last decade. mong those with bilateral Wilms' tumours, 11 are alive free of disease one to fifteen years after completing treatment, all with well-preserved renal function. Nine have died (two of unrelated disease), including six of the seven with spread outside the kidney. All three with unfavourable histology are alive, as are four of the five with a metachronous presentation. Survival for bilateral Wilms' tumour has improved markedly in the last decade. CONCLUSIONS AND RECOMMENDATIONS" National Wilms' Tumor Study Group protocols employed in a South African setting with highly competent and experienced surgical care, produced results for non-metastatic favourable histology unilateral Wilms' tumour comparable to those of the National Wilms' Tumor Study Group. For bilateral Wilms' tumours appropriate chemotherapy together with conservative (nephron-sparing) and innovative surgery produced good results with preservation of adequate renal function in nearly all cases. We can seek to improve outcomes via better risk stratification with molecular markers, new adjuvant chemotherapy regimes for high risk tumours and novel surgical approaches to improve nephron-sparing in bilateral Wilms' tumour. Improving results in Stage IV patients may depend as much on earlier diagnosis, as on advances in therapeutics.
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Moore, David Paul. "Aspect of tuberculosis case management at Red Cross Children's Hospital". Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/10863.
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Includes abstract.Includes bibliographical references (leaves 151-165).
Aim: To describe the spectrum of tuberculosis in children <15 years of age attending Red Cross War Memorial Children's Hospital between January 2006 and December 2008. Methods: A retrospective review of a paper-based Notifications Register and a database of culture-confirmed tuberculosis were undertaken. Laboratory and clinical data were analysed. Results: 1,314 episodes of tuberculosis were identified amongst 1,300 children. 433 (33%) of all cases were culture-confirmed; however, 120 (27.7%) of all culture-confirmed cases were not recorded in the paper-based Notifications Register. Conclusions: To improve the clinical service, detection of HIV co-infection in children undergoing evaluation for tuberculosis should be enhanced and strategies adopted to ensure that all children with culture- confirmed disease are notified and access antituberculosis therapy.
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Livesley, Joan. "Children's experiences as hospital in-patients : voice, competence and work". Thesis, University of Salford, 2010. http://usir.salford.ac.uk/26780/.
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There is growing evidence that children's subjective interpretations of events may differ significantly from those of adults; yet children's voices and children's knowledge regarding hospital care remain largely unexplored. This study was undertaken to determine what counted as voice in work with hospitalised children, and explore children's subjective interpretations and knowledge as in-patients. Influenced by critical ethnographic methods, the study was undertaken in two phases with children who had been in-patients in one English tertiary referral children's ward. Phase one involved reconnaissance with 6 children to explore what mattered most to them regarding their in-patient experience. Phase two involved field work undertaken over six months, on a nephro-urology ward, and included in-depth work with nine children. Voice became manifest in what the children said but also through the non-verbal mechanisms of resisting and being silent. In this study, the children chose which voice to present when they participated in the study and that voice was accepted without question. Inductive analysis revealed that the children shared the experience of being in trouble. While they were in-patients, recognition of their competence was fluid=and contingent on structural and material factors. When their competence was denied, some of the children fought hard to re-establish their claim as authentic and knowledgeable individuals. However, while all of the children who participated in this study, regardless of ability, were capable commentators on their experiences, their capacity to work in their own best interests was sometimes challenged. During these episodes, they relied heavily on supportive adults. In the absence of supportive adults they often became marooned and subject to routinised care.