Atopic eczema is a chronic relapsing inflammatory skin disease commonly associated with atopy. The disease is common in early childhood and is characterized by dryness of skin, itchiness and skin flexures. There has been no cure for the disease. Treatments of atopic eczema focus on relieving symptoms, maintaining skin integrity and preventing secondary infection. With good compliance to the treatment, most patients may obtain optimal control. Education is essential for good compliance to the treatment. In local public acute hospitals, the current service provided restricts the time for comprehensive patient education during follow-up by physicians. Some studies indicated that nurse-led programs are effective in managing chronic illness because patients have longer consultation time and more information. The effect of nurse-led program in managing common chronic disease like atopic eczema may be promising. However, there was no systematic review on the use of nurse-led education program in reducing pediatric eczema in the local setting. Against the above background, this dissertation aims to systematically evaluate the current evidences on the effectiveness of nurse-led education program for pediatric eczematous patients in reducing the severity of eczema, to develop an evidence-based guideline of the program, to assess the implementation potential and to develop implementation strategies and evaluation plan. A systemic review of the literature from Medline (Ovid SP), PubMed and CINAHL (EBSCOhost) was conducted. A total of 298 citations were retrieved after the database search. Finally, 5 studies were identified and included in the systemic review. Data were extracted and the quality of each included studies was assessed with the help of the appraisal instruments. In which, one study was methodologically strong, two studies were of moderate methodological qualities and two studies were of poor methodological qualities. Among the four studies with severity of eczema as outcome measures, three studies showed significant in reducing severity of eczema. Therefore, we considered sufficient evidence that supported the use of nurse-led education program in reducing pediatric eczema. An evidence-based guideline of the program was developed. The characteristics of the patients in the local setting are similar to those of the identified studies. The availability of the resources and the readiness of the staff towards the proposed innovation are supportive in the local setting. Thus the findings of the reviewed studies were transferable and the proposed innovation was feasible. Cost-benefit analysis showed that the proposed program could be able to generate a potential saving of about $ 550,000 in the local setting annually. In the implementation plan, a three-month pilot study on ten patients will be conducted before the implementation of the program. Evaluation will be made after the end of the pilot study and the end of the implementation program. Refining of final protocol will be done according to the evaluation and comments from the pilot study. The severity of eczema and the patient’s satisfaction are considered as primary and secondary patient outcomes respectively. The healthcare provider outcomes are the staff morale and the workload. Systematic outcomes are the admission rate of pediatric ward and the attendance rate of pediatric outpatient clinic, and the cost of innovation. Finally, patient outcomes, healthcare provider outcomes and systemic outcomes would be evaluated in order to identify the effectiveness of the program. / published_or_final_version / Nursing Studies / Master / Master of Nursing

According to the World Health Organization, life-threatening infectious diseases, even in remote and vulnerable locations, can be minimised through immunisation. Vaccines interact with the immune system to produce an immune response similar to that produced by natural infection. However, about 10% of the population avoid vaccination and other needle procedures because of “needle fear”. Because of the prevalence of injection pain and more concern about the adequacy of pain management, and with the steadily increasing number of recommended childhood immunisation, we identified a need for evidence-based guidelines on pain management to be developed in our local setting through translational nursing practice. After a critical appraisal of randomised controlled trials and systematic reviews, it is highly recommended that “topical anaesthetics are effective in reducing vaccination pain” (Grade A recommendation, based on level I evidence by SIGN). In order to facilitate practice from evidence, the implementation potential, transferability, feasibility and cost-benefit ratio - has been examined, and an evidence-based guideline has been developed simultaneously for the new practice. With the identification of stakeholders and the development of a communication plan, potential users of the guideline and pilot testing are discussed. Innovation outcomes and their effectiveness are examined and explored. It is expected that, through this translational nursing practice, vaccination induced pain and distress among healthy children can be managed well, according to the best evidence and up-to-date recommendations. / published_or_final_version / Nursing Studies / Master / Master of Nursing

The purpose of this report is to review critically research focused on oral motor based treatment for pediatric swallowing disorders with the aim of assisting speech-language pathologists in making informed clinical intervention decisions. Oral motor based treatment has become a popular intervention approach among some speech-language pathologists, but the evidence supporting the approach is limited. This report will discuss research studies and review articles with high levels of evidence of treatment efficacy and propose when to use oral motor based treatment approaches in clinical intervention for pediatric swallowing disorders. / text

No description available.

Rationale: Methodological quality of systematic reviews (SRs) remains an area of concern with no consensus on the optimal appraisal instrument to assess quality of published research. Hypothesis: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a feasible and useful methodology to assess quality of evidence in pediatric pharmacotherapy. Aim: To demonstrate the applicability of the GRADE to selected topics. Methods: To perform two SRs to illustrate the practical use of the GRADE, highlight methodological challenges encountered and compare the GRADE to the alternative appraisal tool. Results: the GRADE was implemented to conduct two SRs. Judgments on imprecision were challenging. Comparison of the GRADE to alternative tool demonstrated that GRADE may generate different conclusions on overall quality assessment. Conclusion: The GRADE is a valuable innovative tool for assessing quality of evidence, applicable to the field of pediatric pharmacotherapy, with a potential to impact inferences drawn after applying alternative instruments.

No description available.

No description available.

<p>The aim of the study was to determine the oral and debntal health status of pediatric cardiac patients, 12 years of age and younger, and compare them with non-cardiac patients. A total of 150 children, 75 with known cardiac condition (study group) and 75 no-cardiac (control group) were examined. No statistically significant differences were established in the study between the caries experience score for the cardiac and control groups. The study concludes that the cardiac group generally has a higher decay component and a lower missing component which may be an indication of the lack of dental intervention. The gingival inflammation was significantly higher in the cardiac group although the plaque scores were similar in the two groups.</p>

Rationale: Methodological quality of systematic reviews (SRs) remains an area of concern with no consensus on the optimal appraisal instrument to assess quality of published research. Hypothesis: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a feasible and useful methodology to assess quality of evidence in pediatric pharmacotherapy. Aim: To demonstrate the applicability of the GRADE to selected topics. Methods: To perform two SRs to illustrate the practical use of the GRADE, highlight methodological challenges encountered and compare the GRADE to the alternative appraisal tool. Results: the GRADE was implemented to conduct two SRs. Judgments on imprecision were challenging. Comparison of the GRADE to alternative tool demonstrated that GRADE may generate different conclusions on overall quality assessment. Conclusion: The GRADE is a valuable innovative tool for assessing quality of evidence, applicable to the field of pediatric pharmacotherapy, with a potential to impact inferences drawn after applying alternative instruments.

Introduction: The ideal timing to initiate orthodontic treatment is an important, yet controversial issue. The purpose of this study was to investigate the provision of orthodontic care for 7 types of skeletal dysplasia by paediatric dentists and orthodontists in Canada. Methods: A questionnaire was distributed to randomly selected orthodontists (N=140) and paediatric dentists (N=132) throughout Canada. Surveys returned within 8 weeks were included for c2 statistical analysis. Results: The response rate was 59% for orthodontists and 54% for pediatric dentists. Orthodontists and pediatric dentists differed significantly in the timing of their first orthodontic consultation (p < 0.01). More pediatric dentists used to the dental age to determine the appropriate time to initiate treatment (p < 0.01), whereas more orthodontists relied on the pubertal indicators (p < 0.01). More orthodontists would intervene in the early mixed dentition for moderate mandibular prognathia (p < 0.01); mid-mixed dentition for severe mandibular retrognathia (p < 0.01), late mixed dentition for moderate mandibular retrognathia (p < 0.01) and permanent dentition for skeletal openbite and severe mandibular prognathia (p < 0.01). Most pediatric dentists would intervene in the early and mid-mixed dentition for the specified cases of skeletal malocclusions (p < 0.05). Conclusions: The results of this investigation indicate both consistencies and variation between orthodontic and paediatric practitioners with regard to preference in treatment timing, and the factors that influence these decisions.