Class of 2017 Abstract / Objectives: To assess the perceived confidence level of community pharmacists in utilizing weight-based dosing, dispensing prescriptions, counseling, and recommending over-the-counter medications for the pediatric population in rural and non-rural settings. Methods: A 33-item questionnaire generated through REDCap was distributed to 11,280 pharmacists registered with the Arizona State Board of Pharmacy via email from March 14 to April 4 of 2017. The survey collected information on the participants’ experiences in managing pediatric prescriptions and demographics. Results: Of the 11,280 surveys distributed, a total of 857 responses were submitted by the end of the survey period (7.6%) and 482 responses were included in the analysis; 49 (10.2%) were practicing in rural areas and 433 (89.8%) were practicing in non-rural areas (including urban and suburban) in Arizona. There was no significant difference in the rural group compared to the non-rural group regarding experiences with dispensing pediatric medications. In regards to the confidence level, there was a significant difference between the two groups in calculating and recommending weight-based dosing for prescription and OTC pediatric medications (p = 0.022 and 0.031, respectively) and identifying a dosing error in pediatric prescriptions (p = 0.016). Conclusions: Community pharmacists practicing in rural and non-rural settings in Arizona had similar experiences with dispensing pediatric medications and confidence levels in managing medications for pediatric patients.

Prior studies of immigrants to the United States show significant weight gain after 10 years of US residence. Pediatric refugees are a vulnerable population whose post-immigration weight trajectory has not been studied. We examined the longitudinal weight trajectory of 1067 pediatric refugees seen in a single university based refugee health program between the dates of September 3, 2012 and September 3, 2014 to determine how quickly significant weight gain occurs post-arrival. The most recent BMI was abstracted from the electronic health record and charts reviewed to obtain serial BMI measurements in 3 year increments after the date of US arrival. The mean arrival BMI percentile for all refugees was 47th percentile. This increased significantly to the 63rd percentile within 3 years of US arrival (p < 0.01). This rapid increase was largely attributable to African and South and Southeast Asian refugees. The overall prevalence of age and sex adjusted obesity rose from 7.4 % at arrival to 18.3 % within 9 years of US immigration exceeding the pediatric US national obesity prevalence of 16.9 %. Pediatric refugees are at increased risk of rapid weight gain after US immigration. Targeted interventions focused on prevention of weight gain in specific populations are warranted.

Purpose: The purpose of this study was to determine the relationship of the CYP2B6 genotype to the clinical response to meperidine in pediatric dental patients. Methods: Forty-nine patients, ASA I/ II, 41–101 months old, received an oral sedative regimen containing meperidine for dental treatment. The North Carolina Behavior Rating Scale (NCBRS) and Overall Effectiveness of Sedation Scale (OESS) were used to assess their behavior and sedation outcome. Saliva DNA samples were genotyped by PCR-RFLP. Results: We found the following genotype distributions: homozygous wild-type 1*1 (n = 19, 39%), heterozygous 1*6 (n = 25, 51%), and homozygous variant 6*6 (n = 5, 10%). The genotypes showed a significant difference in the North Carolina Behavior Rating Scores and a trend towards significance of the Overall Effectiveness of Sedation Scale during meperidine oral sedations. Conclusion: This research concludes that variations of the CYP2B6 enzyme can be used in the prediction of successful behaviors for oral sedations that include meperidine in the drug regimen. Future research regarding the enzyme kinetics of meperidine is needed to determine the exact enzymatic function of CYP2B6 and its variants.

Purpose: The purpose of this study is to describe children’s dental disease status and functional health literacy of families enrolled in the Child Health Investment Partnership program in Roanoke Valley. Methods: This was a prospective cohort study of children (n=166) enrolled in the Child Health Investment Partnership of Roanoke Valley, Virginia (CHIP). The parents of the 166 children completed the Life Skills Progression (LSP) survey at enrollment between September 2004 and September 2008 to assess their functional health literacy levels. Their LSP scores were used to determine their subsequent health care literacy (HCL), personal health literacy (PHL), and dental-child utilization (LSP22) scores. Descriptive statistics were recorded and a paired t-test was used to determine a relationship between the three measures of functional health literacy at baseline and at their most recent literacy assessment. Dental disease status was determined by an epidemiological dental exam and evaluated using d1d2-3f criteria. This was a visual exam that measured the presence of frank (d2-3) and non-cavitated carious lesions (d1), as well as filled teeth. Results: Descriptive analysis of the cohort reveals: 58% of the children enrolled had no carious teeth at the dental screening exam. The average mean of LSP scores for all three scales: HCL, PHL, and LSP22 were significantly different from baseline: p<.0001, p<.0009, and p<.0001, respectively. Conclusion: An improvement of parental functional health literacy has been documented in a low-income pediatric dental population when preventative efforts and education is delivered within the context of a home-visitation health program. The population of high-risk children had low levels of dental disease.

En av de största utmaningarna, inom folkhälsan, under 2000-talet beskrivs vara, övervikt och fetma hos barn. Sen år 1990 är ökningen alarmerande och detta främst i låg- och medelinkomstländerna. I Sverige har det främst varit en ökning av övervikt och fetma bland barn i en mer utsatt socioekonomisk bakgrund. Familjen och de levnadsvanor som följer barnet i uppväxten beskrivs vara avgörande, för om barnet utvecklar övervikt eller fetma. Sjuksköterskor har goda möjligheter, att komma i kontakt med hela familjen för att rådgöra samt stötta. Syftet med studien är att beskriva sjuksköterskors erfarenheter av att möta barn med övervikt samt deras familjer. En litteraturstudie genomfördes. Elva vetenskapliga artiklar, varav 9 med kvalitativ forskningsansats och 2 med kvantitativ forskningsansats, granskades och analyserades. Fyra teman och nio subteman identifierades. Resultatet visar att yrkesverksamma sjuksköterskor möter svårigheter, till dessa hör att övervikt tolereras och accepteras på ett annat sätt än tidigare, liksom livsstilsförändringar som innebär att vi idag är mer stillasittande. De ansåg sig väl positionerade för att ta hand om barnen med övervikt och fetma, men upplevde en osäkerhet för samtalet kring och med barnet, samt dess familj. Bristande riktlinjer på arbetsplatsen bidrog till färre antal samtal, med berörda föräldrar. Sjuksköterskorna upplevde en osäkerhet i den egna professionen, där mer utbildning önskades, dels i hur kommunikationen med barn och deras föräldrar kunde förbättras men även i ämnet övervikt. För att öka tryggheten hos sjuksköterskorna behövs tydlig arbetsbeskrivning och riktlinjer, mer utbildning, främst i kommunikation med barn och familj, men även ett förbättrat samarbete med andra yrkeskategorier.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2015 / Background: Despite the empirical evidence of the significance of weaning protocols in Intensive Care Units, variations still exist in the adoption of weaning protocols. Multidisciplinary teams hold the responsibility for the introduction and development of weaning protocols in PICU. Purpose: To explore and describe the opinions of multidisciplinary teams practicing in the paediatric and cardiothoracic ICU at an academic hospital in Johannesburg concerning weaning protocols from mechanical ventilation. Design: Qualitative descriptive. Method: Data was collected from multidisciplinary team comprising of registered nurses (n=8) and doctors (n=2) practicing in PICU and CTICU who were purposively selected using semi-structured interviews to obtain qualitative information on their opinions regarding weaning protocols. Data collected was analysed using a Braun and Clarke method of qualitative thematic analysis. Seven categories were identified in which three themes, which provided the fundamental structure of the findings for the discussion, emerged and included the following:  Unstructured weaning – the current practice.  Recognition of the need for weaning protocols.  Being not in favour of weaning. Results: The majority of the multidisciplinary team members recognise the need to develop weaning protocols in PICU for standardisation of practice. Currently there are no weaning protocols and a multidisciplinary approach was identified as an important strategy to develop the protocols. However, nurses practicing in PICU are not trained in Critical Care nursing which poses a challenge to the practice. Conclusion This study indicates that there is need for the development of weaning protocols in PICU. Although nurses are weaning patients in PICU, there are no standardised weaning protocols to guide the practice. The study therefore suggests the need to develop weaning protocols through multidisciplinary approach and training of nurses in critical care nursing to improve knowledge base and skills. Keywords: Mechanical ventilation, weaning, protocols, paediatric patients, opinions/perception and multidisciplinary team.

BACKGROUND: Inflammatory bowel disease (IBD) is a group of conditions characterized by chronic inflammation of the gastrointestinal (GI) tract. A new diagnosis of IBD in children and adolescents can have significant psychosocial effects on both the patient and the family. Child and parental coping strategies play a crucial role in the adjustment to IBD, especially within the first year of the diagnosis. AIMS: The primary aim of the study was to assess the stability of coping measures over time in children and parents following a new pediatric IBD diagnosis. The study also aimed to assess the impact of parental coping on parental healthcare resource utilization for children with newly diagnosed IBD, as well as the impact of parental coping on anxiety, depression, and quality of life in children with newly diagnosed IBD. METHODS: This was a prospective, longitudinal cohort study at Boston Children’s Hospital (BCH) that focused on children and adolescents with newly diagnosed IBD, as well as their parents. Patients and their parents were approached at the time they enrolled in the study and then again about 12 months later as part of a one-year follow-up. At both time points, they were asked to fill out various questionnaires about psychological functioning and answer other questions about medical care. RESULTS: The study identified and encountered 465 IBD patients, of which 126 were eligible for recruitment. There were 70 patients and families who signed a consent form for enrollment, 55 who fully or partially completed the questionnaires at baseline, and only 5 who also completed the questionnaires at follow-up. Due to the limited number of participants who completed the questionnaires at follow-up, no definitive conclusions could be drawn about the stability of coping measures over time. Parental anxiety, parental depression, frequent parental stress, and difficult parental stress were all found to be positively correlated with healthcare utilization and negatively correlated with the child’s quality of life. Parental anxiety, frequent parental stress, and difficult parental stress were all found to be positively correlated with the child’s anxiety. Parental depression, frequent parental stress, and difficult parental stress were all found to be positively correlated with the child’s depression. CONCLUSION: Preliminary findings suggest that poor parental coping leads to decreased child quality of life and increased healthcare utilization, child anxiety, and child depression. A larger sample size is needed to accurately evaluate the stability of coping measures over time. The next steps for this study involve further examination of the impact of parental coping and enrollment of more patients and families.

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

O objetivo deste estudo foi comparar o preparo de canais radiculares de dentes decíduos artificiais com o uso dos sistemas manual, rotatório e de rotação recíproca, no que diz respeito ao desgaste promovido após a instrumentação dos canais radiculares e o tempo necessário para a realização da instrumentação. Os fatores em estudo foram técnica de instrumentação em três níveis e área de avaliação no canal radicular em três níveis. Foram utilizados apenas os dentes multiradiculares (primeiro molar superior, segundo molar superior, primeiro molar inferior e segundo molar inferior), compondo 24 dentes os quais foram aleatoriamente divididos entre as três técnicas de instrumentação em estudo: manual, Sistema rotatório Mtwo e Sistema de rotação recíproca Reciproc. A unidade amostral foi conduto radicular (n=20). Os condutos radiculares foram escaneados no tomógrafo de TCFC (Accuitomo). Após a instrumentação dos dentes novas imagens foram realizadas, avaliações quantitativas foram feitas medindo-se nas imagens axiais dos canais radiculares, a espessura das paredes em três diferentes regiões: terços apical, médio e cervical. As variáveis de resposta analisadas foram cálculo do transporte do canal, cálculo da descentralização e tempo de instrumentação. Tanto para a avalição da descentralização, quanto para a avaliação do transporte, os dados foram transformados e analisados por ANOVA a 2 critérios e Teste de Tukey, para os dados da comparação dos tempos foi utilizado o teste de Kruskal-Wallis e Teste de Tukey (p<0,05). Para a avaliação do transporte do canal e da descentralização não foi encontrada diferença estatística significativa entre os tipos de instrumentação e terços radiculares (p>0,05). Na avaliação do tempo de preparo, o grupo do sistema reciprocante apresentou menor tempo de preparo em comparação com o sistema manual e rotatório (p<0,05). Desta forma conclui-se que os tipos de instrumentação avaliados promoveram um preparo similar dos canais, sem diferença entre os terços cervical, médio e apical, sendo que o sistema de rotação recíproca resultou em um menor tempo de instrumentação. / The objective of this study was to compare the preparation of root canals of artificial deciduous teeth with the use of the manual systems, rotational and reciprocal rotation, with regard the detrition promoted after instrumentation of root canals and the time necessary for the realization of instrumentation. The factors in study were the techniques of instrumentation in tree levels and the area of root canal in tree levels. Have been used only teeth multirooted (first molar, second molar, lower first molar and second molar), composing 24 teeth which were randomly divided among the three instrumentation techniques under study: manual, rotational system Mtwo and reciprocal rotation system Reciproc. The sample unit was root canal (n = 20). The root canals were scanned in tomographer CBCT (Accuitomo). After instrumentation of new images teeth were conducted quantitative evaluations were made by measuring the axial images of the root canals, the wall thickness at three different regions: apex, middle and cervical thirds. Response variables analyzed were calculating the channel transport, decentralization and calculation time instrumentation. Both for the evaluation of decentralization, as for the evaluation of transportation, data were processed and analyzed by ANOVA and Tukey 2 criteria test to the data comparing the times we used the Kruskal-Wallis test and Tukey test (p <0.05). For the evaluation of the channel transport and decentralization was no statistically significant difference between the types of instrumentation and root thirds (p> 0.05). In assessing the preparation time, the reciprocating system group showed less preparation time compared to the manual system and rotary (p <0.05). Thus it is concluded that the types of instrument reviews promoted a similar preparation of channels, no difference between the cervical, middle and apical thirds, and the reciprocal rotation resulted in a shorter time instrumentation.