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Thesis (M.S.)--Boston University

Decision making could be defined as the ability to make a choice or a judgement before an individual takes action. How the individual works through the process of making a decision is influenced by a number of factors. It is acknowledged decision making is a complex process that involves cognitive and affective thought processing, together with interpretation, understanding, choosing between alternatives and taking action. The steps involved in this process are varied and range from a few to many depending on whose literature one is reading at the time. This descriptive cross sectional study aimed to determine what factors influenced a woman's decision when choosing the infant feeding method for her newborn. The information was gathered by means of a survey questionnaire and follow-up telephone interview. The factors identified as being important or influencing the decision were included on the survey. These factors were highlighted in previous studies and were considered part of the Theory of Reasoned Action (TRA) the framework on which this study was based. The one hundred and sixteen women who participated in this study had delivered term babies - that is babies over thirty-seven weeks gestation, in two hospitals in metropolitan Melbourne. A number of assumptions were tested. The descriptive statistics was generated using Statistical Package for Social Sciences (SPSS) Version 7. The qualitative data was analysed using thematic analysis. Eighty-five per cent (85%) of the women in this study made the decision to breastfeed and seventy-five per cent (75%) made this decision prior to their pregnancy being confirmed. Ninety-seven (83.6%) of the women stated their own values and beliefs had a major influence (i) on their infant feeding decision with just over twenty per cent (20.2%) of the women indicating the midwife had a major influence on their decision. Results of data supported or refuted the assumptions made at the beginning of the study and previous studies. These results also identified areas in midwifery practice that require change. This in itself will be a challenge for midwives. How they respond to this challenge may have an impact of the way women make the decision regarding their choice of infant feeding

Thesis (M.D.)—Boston University

Thesis (M.D.)--Boston University School of Medicine

Thesis (M.S.)--Boston University

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

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / RecÃm-nascidos (RN) que nÃo podem obter uma nutriÃÃo adequada atravÃs do trato gastrintestinal requerem nutriÃÃo parenteral total (NPT) como terapia exclusiva ou de apoio. A NPT fornece ao paciente debilitado os eletrÃlitos necessÃrios, uma reserva protÃica adequada, e energia para os processos metabÃlicos. As fases da terapia nutricional sÃo: indicaÃÃo de suporte nutricional; prescriÃÃo mÃdica; avaliaÃÃo farmacÃutica; manipulaÃÃo das soluÃÃes, transporte, conservaÃÃo, administraÃÃo, controle clinico, laboratorial e avaliaÃÃo final. Em virtude da complexidade das etapas envolvidas, à importante a integraÃÃo da equipe multidisciplinar, de modo que a terapia seja usada racionalmente, resultando em benefÃcios ao RN quanto à seguranÃa, efetividade e qualidade. O presente trabalho objetivou monitorar a terapia nutricional em RN, observando a indicaÃÃo, a prescriÃÃo, a manipulaÃÃo e a administraÃÃo da nutriÃÃo parenteral em uma maternidade pÃblica do municÃpio de Fortaleza â CE. Foi realizado um estudo observacional, descritivo e prospectivo, envolvendo as etapas da terapia de nutriÃÃo parenteral. Os dados foram coletados a partir de um formulÃrio estruturado de acordo com o roteiro de inspeÃÃo (Portaria 272/98, ANVISA). A anÃlise estatÃstica foi executada utilizando-se o programa Statistical Package for the Social Sciences versÃo 16.0 e foi considerada significÃncia de 5%. Entre os 73 RN avaliados, 97,3% apresentaram a prematuridade como diagnÃstico principal. Com relaÃÃo Ãs prescriÃÃes mÃdicas, 2,3% nÃo foram entregues ao serviÃo de farmÃcia, 16,7% e 9% foram enviadas fora do horÃrio de entrega estabelecido e com problemas na prescriÃÃo, respectivamente. Durante a manipulaÃÃo, 0,6 e 6,15% de erros ocorreram na aspiraÃÃo e na adiÃÃo das substÃncias, respectivamente. No momento da administraÃÃo, 99% dos RN nÃo possuÃam acesso exclusivo para a NPT; assim como, 98,7% das bolsas nem 99% dos rÃtulos foram adequadamente checados. Em 36% da inserÃÃo do cateter, nenhum procedimento de limpeza foi realizado. Dessa forma, conclui-se que um melhor controle do processo envolvido na terapia nutricional e uma equipe multidisciplinar mais atuante contribuirÃo para a correÃÃo dos desvios e erros, uma vez que a prescriÃÃo, a manipulaÃÃo e a administraÃÃo representam os passos crÃticos para uma terapia bem-sucedida. / Many newborns (NB) require total parenteral nutrition (TPN) as main or adjuvant therapy, once they can not obtain an adequate nutrition through gastrointestinal system. The TPN offers to the debilitated patient the necessary electrolytes, the required protein source and the energy for metabolic processes. The nutritional therapy phases are: indication for nutritional support; medical prescription; pharmaceutical evaluation; manipulation of the solutions; delivery; conservation; administration; clinical and laboratorial controlling; and, final evaluation. Due to the complexity of the steps involved, it is important the integration of the multidisciplinary team, so that the therapy is used rationally, resulting in benefits to the NB in terms of safety, effectiveness and quality. The present work aimed to monitor the nutritional therapy in NB, observing the indication, prescription, manipulation and administration of the parenteral nutrition in a public maternity in Fortaleza â CE. It was performed an observational, descriptive and prospective study involving all phases. The data were collected from a structured formulary according to the inspection rule (Portaria 272/98, ANVISA). The statistical analysis was executed using the program Statistical Package for the Social Sciences, version 16.0, and it was considered a significance level of 5%. Among the 73 NB evaluated, 97,3% presented as main diagnostic pre-term newborn. Related to the medical prescriptions, 2,3% were not delivered to the pharmacy, 16,7 and 9% were delivered out of the established time and with problems in the prescriptions, respectively. During the manipulation, 0,6 and 6,15% of errors occurred, respectively in the aspiration or in the addition of the substances. At the moment of the administration, 99% of the NB did not have exclusive access for the TPN; neither 98,7% of the bags nor 99% of the labels were adequately checked. In 36% of catheter placement, no cleaning procedure was performed. In conclusion, the controlling of process involved in nutritional therapy and a more active multidisciplinary team will assess the correction of deviations and errors, once the prescription, manipulation and administration represent the critic steps for a successful therapy.

Com a finalidade de avaliar um conjunto de curvas de ganho de peso de gestantes, foram tomadas, em dois grupos de mulheres, medidas antropométricas maternas como peso, estatura, peso habitual, peso no final da gravidez, perímetro cefálico, perímetro braquial, prega cutânea tricipital, bem como medidas antropométricas do recém-nascido ao nascer (peso, comprimento, perímetro cefálico), além de ter sido realizado estudo da dieta das gestantes. A comparação entre as curvas e as demais variáveis antropométricas, maternas ou fetais, mostrou que os resultados são semelhantes, mesmo em grupos diferentes entre si como os aqui estudados. As gestantes classificadas como desnutridas através das curvas de ganho de peso também o são quando outras técnicas são aplicadas. Os filhos de gestantes desnutridas têm peso, comprimento e perímetro cefálico significantemente menores que os filhos de gestantes normais ou obesas. Verificou-se ainda que não há relação entre a ingestão de calorias, proteínas e ferro e o estado nutricional materno. A estatura e a idade-gestacional maternas não interferiram nesse processo diagnóstico. Os resultados permitiram considerar as curvas estudadas como bons indicadores de desnutrição materna e fetal. / This study has been carried out with the purpose of evaluating curves of weight gain during pregnancy. Two gruups of women were selected and the following values were obtained for each them: maternal prepregnancy weight, weight at the end of pregnancy, height, cephalic circumference, arm circumference and triceps skinfold. Also some anthropometric measurements of tne newborn children were taken, such as weight, lenght and cephalic circumference. A dietary survey was aLso carried out. When the cuRves and the other measurements were compared, it was seen that the results were similar in both of the groups of mothers studied. Pregnant women classified as undernourished in terms of the weight gain curves are also classified in the same way when other tecniques are used. Babies born-to undernourished mothers have an impairment in intra-uterine growth, as compared to babies born to normal or obese mothers. There is no relation between caloric, protein and iron intake and maternal nutrition status. Maternal height and gestational age do not play any part in this diagnostic process. The results permit to consider the curves here studied as good indicators of maternal and fetal malnutrition.

Thesis advisor: Cherie McGill / Thesis advisor: Marius Stan / Seriously ill newborns are a part of a recent bioethical phenomenon that emerged during the late 1970s. With the rise of new, innovative medical technology, doctors can keep these seriously ill newborns alive, but at monumental financial and psychological costs. This thesis utilizes several economic and ethical frameworks to contextualize these newborns within our healthcare system. After all, our healthcare resources are limited. We must therefore discern between the continuation of an infant’s treatment and conversely, the withdrawal of treatment. / Thesis (BA) — Boston College, 2017. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Philosophy.