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Inflammatory Bowel Disease (IBD), divided into Crohn’s disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC), is a chronic, crippling autoimmune condition characterized by gastrointestinal (GI) inflammation. The methods used to diagnose IBD and assess its activity can be invasive and costly and typically include a combination of histologic, endoscopic, radiologic, clinical, and biochemical measures. Currently, there is an increasing need for the development of noninvasive assessment measures to detect an interval response to prescribed therapy. Previous studies have found serial and fecal biomarkers to be reliable, but non-specific indicators of GI tract inflammation. At present, they cannot be used to distinguish between inflammation resulting from infection and that caused by chronic inflammation in patients with IBD. The aim of this study is to measure changes in serum and fecal biomarkers over time in individual children and adolescents with CD, UC, and IC initiating infliximab therapy while investigating any parallels between fluctuations in biomarker levels and endoscopic, clinical, and biochemical outcomes. The inflammatory biomarkers evaluated in this study include fecal and serum anti-Saccharomyces-Cerevisiae Antibody (ASCA), fecal and serum lactoferrin, fecal hemoglobin, fecal calprotectin, fecal IL1-α, fecal IL1-β, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The data for this study was collected from a multicenter longitudinal prospective cohort study following pediatric patients over the course of six consecutive infliximab infusion appointments. Study sites include Boston Children’s Hospital and Riley Children’s Hospital in Indianapolis. Participants were recruited from a pool of CD, UC, and IC patients who were either new to infliximab, had been receiving infliximab for less than six months, or had been receiving infliximab for more than one year. Patients brought in stool samples at each of their scheduled infliximab infusions, biochemical labs (ESR and CRP) were obtained, and patients completed a health-related quality of life survey (IMPACT-III Questionnaire). Forty-three patients (26 with CD, 16 with UC, and one with IC) completed this study. There was no significant difference in mean serum or fecal ASCA levels between participants with CD and those with UC. However, average serum and fecal ASCA were higher in patients with CD than those with UC at almost every infusion. The baseline mean CRP level in patients with CD was significantly higher than that observed in patients with UC (p<0.05). In patients with CD, the mean IMPACT-III score was significantly higher (improved quality of life) at Infusion 5 than at baseline. The data collected in this study suggest serial biomarker measurements may be useful in monitoring a patient’s response to infliximab therapy. This study is not yet complete and requires further data analysis to more definitively conclude if a single or a composite metric including several fecal and/or serum inflammatory biomarkers would provide a more robust assessment of disease activity in children and young adults with IBD.

Thesis advisor: Judith A. Vessey / Purpose: The purpose of this study is to investigate staff nurses’ clinical decision making (CDM) regarding pediatric oncology patients’ nutritional status. Background: Malnutrition, both under- and over-nutrition, in children can lead to significant morbidity and even mortality. Pediatric cancer patients are at high risk for malnutrition secondary to the disease process and treatment side effects; malnutrition in pediatric oncology patients is associated with poorer outcomes. Pediatric oncology nurses, with frequent and consistent contact with patients, are in an ideal position to assess nutritional status. Early identification and intervention for nutritional concerns in patients has been shown to improve outcomes. However, research on the quality of pediatric oncology nurses’ CDM regarding nutritional status does not exist. Methods: A web-based survey was distributed to members of the Association of Pediatric Hematology Oncology Nurses; it was comprised of three sections: a demographic data collection form, pediatric oncology nutrition related vignettes, and the New General Self-Efficacy Scale. The vignettes were rated on a one to five scale with one being under-nourished and 5 being over-nourished. Participants were asked to report their confidence in their rating and select cues in the vignette supporting the rating. A multi-level regression analysis was utilized to assess the quality of nurses’ CDM, the confidence of the nurses’ CDM, and the factors associated with CDM. Results: No nurse or organizational factors could be identified as useful in predicting the accuracy of the participants’ nutritional rating; however, nurses were significantly likely to under-rate the vignette when comparted with the expert panel’s rating. Nurses were significantly likely to select fewer cues supportive of nutritional rating than the expert panel. Conclusions: Further research regarding nutritional assessment and nurses’ clinical decision making is warranted. Evidence-based guidelines for nutritional assessment of pediatric oncology patients should be developed and implemented to ensure this patient population receives the highest quality of care. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

This resource list is a starting point before working with a mentor in the specialized area of neonatal physical therapy practice.

Background: We characterized B-cell non-Hodgkin lymphoma (NHL) cases over ten years at a tertiary children's hospital to contribute to the body of knowledge on pediatric lymphoma in developing countries with a high human immunodeficiency virus (HIV) burden. Methods: A retrospective cohort study using clinical and laboratory records of children newly diagnosed with B-cell NHL from January 2005 to December 2014. Results: Seventy-five children ≤ 15 years were included. The majority had Burkitt lymphoma (n = 61). Twenty-five percent (n = 19) were HIV positive and 16% (n = 12) had concurrent active tuberculosis. Bulky disease was present in 65.7% (n = 46) and 30.1% (n = 22) were classified as Lymphomes Malins B (LMB) risk group C. The five year survival estimates for HIV-negative and HIV-positive children were similar in our cohort: 81% vs. 79% for eventfree survival and 85% vs. 83.9% for overall survival. Of three children with Burkitt lymphoma, HIV and LMB group C, two died within one year. Conclusions: Irrespective of HIV status, the survival of children in our B-cell NHL cohort compares favorably with cure rates in developed nations, although advanced disease remains associated with a poor prognosis. Characterization of childhood NHL cases contributes to accurate risk stratification and tailored treatment.

The purpose of this qualitative study was to explore the process of complex healthcare decision-making by parents for their children within the milieu of a pediatric palliative care team. As healthcare has advanced, the number of children living with complex chronic conditions has increased. Decision-making by parents for their children referred to palliative care has not, up to this point, been widely explored by nursing. A purposeful sample of 22 participants, parents of children in life-limiting or life-threatening situations were asked: What matters most during the process of complex healthcare decision-making? A constant comparative method was used to analyze data collected from semistructured interviews and the theory of embodying parenting in the midst of conflicting complexity emerged. J. Watson’s (2020) theory of human caring grounded the researcher in living caritas processes throughout the study. All participants experienced a disruption of their expected parenting and family normal. Through constant comparative data analysis, the core category of embodying parenting was identified. Feeling respected as the parent, thoughtfully making right decisions, and maintaining presence support embodying parenting. The basic social process identified was finding a unique path. The process of finding a unique path included connecting with a supportive community, claiming decisional authority, moderating negative thoughts and feelings, and adjusting expectations. Living in peace was achieved by finding a unique path to embodying parenting in the midst of conflicting complexity. For the participants in this study, accepting circumstances, feeling gratitude, and perceiving life differently led to living in peace. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2020. / FAU Electronic Theses and Dissertations Collection

Thesis (M.Sc.D.)--Boston University School of Graduate Dentistry, 1973. Pedodontics. / Bibliography included.

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Over the last couple of decades changes to pediatric inflammatory bowel disease (IBD) care may have altered health services use among these children. I used a retrospective matched cohort design and population-based health administrative data to first quantify trends in IBD health services and surgical outcomes in Ontario IBD children diagnosed between 1994-2012. I then used these results to validate the distributed network analysis method – a method being increasingly used in Canadian multi-province studies where privacy regulations prevent sharing of individual-level data across provincial borders - using Ontario’s Local Health Integration Networks. I found (1) decreasing hospitalizations and surgical outcomes but increasing outpatient visit rates, suggesting changing patterns of health care use in Ontario children with IBD, and, (2) distributed network analyses is a satisfactory privacy-preserving alternative to individual-level analysis under the conditions tested in my study, providing a tested analysis method for researchers using multi-jurisdictional data.