A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Computer tomography (CT) is commonly used to evaluate suspected acute appendicitis; however, ionizing radiation limits its use in children. This study assesses 3T magnetic resonance imaging (MRI) as an imaging modality in the evaluation of suspected acute appendicitis in the pediatric population. This study is a retrospective review of prospectively‐collected data from 155 pediatric subjects who underwent MRI and 197 pediatric subjects who underwent CT for suspected acute appendicitis. Sensitivity, specificity, appendix visualization rate, positive appendicitis rate, and alternative diagnosis rate are determined. Sensitivity and specificity of MRI are 100% and 98%, 99% and 97% for CT (p = 0.61 and 0.53), respectively. Appendix visualization rate is 77% for MRI, 90% for CT (p = 0.0002), positive appendicitis rate is 25% for MRI, 34% for CT (p = 0.175), and alternative diagnosis rate is 3% for MRI, 3% for CT (p = 0.175). This study supports 3T MRI as a comparable modality to CT in the evaluation of suspected acute appendicitis in the pediatric population. Although MRI visualizes the appendix at a lower rate than CT, our protocol maintains 100% sensitivity with no false negatives. Our appendix visualization rate with 3T MRI (77%) is an improvement from published data from both 1.5T and 3T MRI systems. The exam time differential is clinically insignificant and use of MRI spares the patient the ionizing radiation and intravenous contrast of CT.

Background: The rate of childhood cancer survivors has grown to nearly 80% in the past few decades. Current evidence reveals that primary care providers report feeling unprepared with inadequate knowledge about the variable types of late effects and diagnostic screenings recommended for childhood cancer survivors (Dulko et al., 2013; Potosky et al., 2011). However, the current evidence reflects data mainly from physicians. None of the current literature addresses the specific preparedness of primary care nurse practitioners. Such data would be helpful in better understanding how education and current resources affect nurse practitioner preparedness for such a narrow, but growingly prevalent, patient population.Purpose: To assess primary care nurse practitioner preparedness when caring for childhood cancer survivors.Methods: This descriptive study obtained data using a survey disseminated to primary care nurse practitioner members of the Puget Sound Nurse Practitioner Association in Seattle, WA. Analysis was conducted by calculating the means and modes for each survey item. Results: This sample (n=5) revealed that 50% of nurse practitioners identify as feeling adequately trained to care for childhood cancer survivors. Time and insurance coverage were not found to be barriers to care. Less than 50% of nurse practitioners utilized guidelines from the Children’s Oncology Group. The most wanted resources included the Children’s Oncology Group guidelines, survivor care plans, and electronic health record prompts. Discussion: According to the results of this study imply that nurse practitioners in the Seattle area feel adequately prepared to care for childhood cancer survivors. In addition, nurse practitioners identify that clinical practice guidelines may be beneficial in guiding their care. However, certain limitations, including small sample size, may affect the trustworthiness of the results. Thus, more research is warranted to gather more comprehensive knowledge and understanding regarding nurse practitioner preparedness when caring for childhood cancer survivors in the primary care setting.

Due to the early onset of caries in many children general anesthesia is often required in order to treat the dental disease. Unfortunately following dental treatment under GA, many children have caries relapse, which often requires a repeat GA in order to accomplish the new dental treatment. The objective of this study was to determine if recall frequency following treatment under general anesthesia affects the likelihood that children will require new dental treatment under a repeat GA. 674 charts were reviewed from a private Pediatric dental practice located in Winnipeg Manitoba Canada where patients who underwent a GA for dental treatment were investigated. It was found that those patients, who required new treatment following an initial treatment under GA, were less likely to receive a repeat GA for new dental treatment if they attended more frequently for a recall examination. / October 2016

INTRODUCTION: Psychiatric disorders are among the most common illnesses in children. Most psychiatric disorders begin in childhood but most children with psychiatric symptoms receive delayed or no treatment. A resilience-based strategy for at-risk children in primary care, such as enhancing childhood sports participation, could be an effective and feasible early intervention. Existing literature demonstrates an association between sports participation and mental health in adolescents and adults, and that exercise can improve depressive symptoms. There are few studies on the link between mental health and sports participation in children under twelve. OBJECTIVE: Since sports participation could be a simple and potentially available intervention for mental health, we investigated the association between sports participation in children ages 6-11 and measures of psychiatric impairment. METHODS: We performed linear regression analyses between measures of psychiatric symptoms (total number of CBCL/6-18 syndrome scale elevations and individual syndrome scale elevations) and sports participation as measured by the number of parent-reported sports, with demographic factors as covariates. RESULTS: The association between sport count and number of CBCL syndrome scale elevations was not significant (p = 0.638). However, we found a significant association between fewer numbers of sports reported and higher T-scores on the Withdrawn/Depressed CBCL syndrome scale (p = 0.019) and was also significant for age (p = 0.003) and ethnicity (p = 0.037). CONCLUSION: Playing one or fewer sports during childhood is associated with higher withdrawn/depressive symptoms in school-age children. This replicates earlier findings which suggest that sports participation may be protective for child mental health.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

A research report submitted to the Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Occupational Therapy Johannesburg, April 2017 / The study sought to compare the caregivers’ evaluation of the occupational performance and assistance needed by children with cerebral palsy (CP) to that of treating therapists to ascertain agreement about the children’s strengths/weaknesses so goals for intervention can be set. The Paediatric Evaluation of Disability Inventory (PEDI) parent/caregiver and therapist scores of 50 children with CP in Harare aged four to six and half years were analysed. The association between PEDI scores and the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels as well as the internal consistency of the PEDI for this sample were also determined. Correlations for the caregivers’ and therapists’ scores on the PEDI were strong to excellent. A marked decrease in functional skills on the PEDI was noted in relation to the GMFCS and MACS levels with a negative moderate correlation between the PEDI scores and the GMFCS levels for self care, a negative strong correlation for mobility but a negative weak correlation for social function. The similarity of scores indicates positive correlation that allows for collaborative goal setting and Family Centred Therapy with these children. Internal consistency was excellent for all functional skills domains and caregiver assistance. / MT2017

Existing literature has identified that health care providers significantly shape the experiences of parents at the end-of-life in the pediatric intensive care unit. However, there is a gap in the literature of the specific nursing influence on parental experiences of a child’s death in this context. Employing the interpretive descriptive methodology, this qualitative study was designed to explore parents’ moral experiences of nursing care at the end-of-life in the pediatric intensive care unit, and was analyzed through a lens of nursing ethics. Face-to-face, semi-structured interviews were conducted with eleven parents (six mothers and five fathers) of six children who died in a pediatric intensive care unit at a university-affiliated tertiary hospital in Eastern Canada. Study results revealed close connections between parents’ abilities to meaningfully parent a child through their death and the nursing care that they received at the end-of-life, and highlighted the varying helpful guiding roles that nurses adopted at different moments in parental experiences. Results also indicated that parents attributed immense value to feeling that nurses cared-for-and-about their child and the parents themselves, since this made parents feel that their child’s death mattered to the nurses whom they had formed relationships with. This study enhances our understanding of the individualized nature of parents’ moral experiences of nursing care at the end-of-life in the pediatric intensive care unit, and study results suggest implications for nursing practice, education, and research.

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University