Thesis. / Includes vita. Includes bibliographical references (leaves 110-125)

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Introduction The problem at hand is understanding if pediatric acute lymphoblastic leukemia (ALL) treatment affects neurocognitive function or development. As the children battle ALL and are given treatments such as cranial radiation therapy and chemotherapy, they are having issues later on in life because the treatment regimens are very strong and are given during a crucial period of development. Purpose Statement and Question Does one pediatric treatment option affect neurocognitive development more than another later in life? Literature Review Research was conducted online via Google Scholar and East Tennessee State University Library database. Key terms used were pediatric ALL and neurocognitive effects of chemotherapy and radiation. Five studies were collected all pertaining to the question at hand. Findings The findings from the research collected was that certain demographics have a stronger effect on the development of a child post-ALL treatment. The treatment regimen and the strength of the treatment affect cognitive development. Cognitive impairment related to attention occurs with all children treated for ALL. Conclusion Nurses see first-hand the effects treatment have on children as the grow. We have to provide resources to help with attention deficits among other cognitive issues that result from treatment. The literature gave a great insight to what effects are to be expected post-treatment.

Hearing loss in pediatric populations is the most common Chronic congenital condition of American children.1 The complicated link between disease, socioeconomics, and race has been established thoroughly by previous studies. This study aims to evaluate the relationship between low socioeconomic and racial minority status in the United States and whether that influences the relative rates of hearing loss in pediatric populations using multivariate logistic regression to control for potential confounding variables. The goal is to better expand the current body of literature documenting the systemic barriers minorities face when accessing the healthcare system. Additionally, our goal is that this study will better raise awareness for children diagnosed with hearing loss and will spur action to improve access to intervention both medical and educational. / 2022-12-14T00:00:00Z

Rasmussen's encephalitis is a rare neurological disease first described in 1958 that is characterized by medico-refractory seizures, focal unilateral cerebral inflammation, and deficits such as hemiparesis. While we still do not have a full understanding of this disease, proposed theories behind its etiology include auto-immune manifestations, immune attack by T cells, and malfunctional alterations in genetic expression. It is classically considered a rare childhood malady with a median age of onset of six years, and cases in adolescents and adults are even rarer, representing up to 10% of all cases to date. In this report, we would like to share a rare case of Rasmussen's encephalitis that occurred in an adolescent. Our 17-year-old male patient presented with signs and symptoms beginning at age 14 and was initially diagnosed with cerebral palsy only to later present with additional symptoms and characteristic EEG and MRI findings that ultimately led to a diagnosis of Rasmussen's encephalitis. Thus, with this case report, our intent is twofold: to shed light on an atypical presentation of an already rare disease, even rarer in adolescents and adults, and to underscore the importance of keeping a broad differential when it comes to evaluating a patient with seizures.

Importance: Evidence from randomized controlled trials (RCTs) is required to guide treatment of critically ill children. Unfortunately such evidence is not always available. Objectives: To describe the RCT research enterprise in pediatric critical care — the evidence and the process of creating it, along with problems and some solutions. Methods: To meet these objectives I undertook a series of 5 related studies. First a scoping review to describe the output of the research enterprise. Second, a social network analysis of coauthorship patterns to describe the community of researchers who produce this evidence. Third, a survey to investigate the importance of RCTs in clinicians’ decision-making. Fourth, a survey of trialists to identify barriers and facilitators of high quality RCTs. Fifth, a qualitative interview study to identify acceptable, feasible and effective strategies to improve the evidence available from RCTs in pediatric critical care. Results and conclusions: The number of RCTs in pediatric critical care is increasing but there is a preponderance of small, single-centred RCTs focusing on laboratory or physiological outcomes that are often stopped early because of feasibility problems or futility. The research community is highly fragmented and highly clustered. Experienced trialists identified approaches to improve the pediatric critical care research enterprise, including building a sense of community and ensuring key training and relevant practical experiences for new investigators. Because of the barriers that researchers face and their ethical obligation to undertake trials that are feasible and make a meaningful contribution to advancing the care of critically ill children, individuals and groups must take an active role in building a healthy research community. Only by changing how we function as a research community can we train the next generation of investigators and undertake the type of trials needed to improve the care of critically ill children. / Thesis / Doctor of Philosophy (PhD) / Evidence from randomized controlled trials (RCTs) is required to guide treatment of critically ill children. Unfortunately such evidence is not always available. My objectives in this thesis are to describe the RCT research enterprise in pediatric critical care — the evidence and the process of creating it, along with problems and some solutions. To meet these objectives I undertook a series of 5 related studies: to identify and describe the RCTs, describe how researchers collaborate, understand how clinicians use RCTs, identify barriers and facilitators of conducting high quality RCTs, and understand how we can improve the evidence available from RCTs in pediatric critical care. We found that the number of RCTs is increasing but there are opportunities to improve the methods, outcome measures, and quality of reporting. We identified strategies that researchers can adopt to facilitate the rigorous RCTs that are needed to improve the care of critically ill children.

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Obesity is a growing concern in North America and current research suggests that for addressing childhood obesity, family-based behavioural interventions targeting children are the treatment of choice. Due to the lack of clinics that offer face to face treatment, the Internet may serve as a viable method for the delivery of such interventions. Three studies are presented in order to explore the viability of the internet as a treatment modality for delivering family-based interventions for children who are overweight. The first study attempted to deliver a family-based behavioural intervention via the internet - the Healthy Eating and Active Living Throughout Youth (HEALTHY) - for children aged 8 to 14 (M = 10.5). The initial goal was to evaluate the effectiveness of the internet as a treatment modality for childhood obesity. A total of 20 families consisting of 25 child-parent dyads consented to the intervention. However, adherence and attrition were significant issues throughout the 3-month intervention and only two child-parent dyads (8%) completed the 3-month intervention. Therefore the goals of this study changed to become primarily exploratory, with the aims of identifying factors related to treatment adherence and attrition. For the second study, the parents of the 20 families who consented to the HEALTHY intervention were invited to participate in a telephone interview around their impressions of the study, barriers to participation, and their needs in seeking services for their children. Sixteen families (80%) provided consent and thematic analyses were conducted. Four categories of themes emerged from the data and included: 'Knowledge and Education', 'Social Supports', 'Tools for Success', and 'Program Goals'. These categories, and the themes embedded within each category are presented and discussed. For the third study a systematic review of exclusively web-based studies for paediatric obesity was conducted. Five health and social sciences databases were search between 1995 and March 2012 (including an initial and updated search). A total of 2432 bibliographic records were identified (following de-duplication) and were subjected to title and abstract screening, and a further 120 records were subject to full-text screening. Two reviewers independently assessed the eligibility of each bibliographic record at these multiple levels and conflicts were resolved by third party. Three records were included in the review, and a further three records were identified as noteworthy in that they reported on one larger web-based study with a minimal face-to-face component (i.e., 4 sessions over 2 years). Data regarding attrition, adherence, and body composition changes were extracted by two independent reviewers. Attrition rates from the included studies ranged from 43% to 85%. The noteworthy study reported 18% overall attrition at six months (following randomization: 18% from the intervention group) and 34% overall attrition at two years (following randomization: 36% from the intervention group). Adherence measures were varied, but suggested low adherence to study components. Body composition changes were marginal in the short-term, but then lost in the longer-term. Implications for research and practice will be discussed. The contributions of this thesis include examining whether family-based interventions for pediatric obesity delivered over the internet are feasible. This question will be answered by exploring baseline characteristics that are related to treatment adherence and attrition, investigating barriers that interfere with adherence and contribute to attrition, and reviewing other research conducted in the field. Following from this thesis, and other relevant research, implications and recommendations for future research and clinical practice will be discussed

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