Advances in hearing instrument technology have permitted the development of non-linear prescriptive methods to prescribe amplification characteristics for the hearing- impaired individual. The dispenser’s task in selecting the most appropriate prescriptive procedure for the young child is of utmost importance to ensure optimum hearing aid benefit for communication development. It was the aim of this study to compare and describe the effect of the two most widely used methods, DSL (i/o) and NAL-NL1, on speech recognition and loudness perception. An exploratory, descriptive research design was selected to realise this goal. Ten participants were selected using a convenient non-probability method of sampling. Articulation index calculations and a closed set speech recognition test were utilised in the evaluation of speech recognition, whereas functional gain results and loudness rating measurements provided an opportunity to describe loudness perception. The obtained results were analysed using the SAS (Statistical Analysis System). The study concluded that, although significant statistical differences existed in loudness perception, no statistical difference was observed in actual speech recognition measures. This effect may contribute to the individual amplification approaches of the two methods, which seem to reflect the uncertainties expressed by researchers as to the contribution of high frequency amplification to speech recognition in young children. / Dissertation (M (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / Unrestricted

Introduction: Nausea and vomiting are the most common and distressing side effects of chemotherapy because they negatively impact on quality of life and treatment compliance. Adequate control of nausea and vomiting in children receiving chemotherapy is imperative. Currently, the first-line drug for the prophylaxis and treatment of chemotherapy-induced nausea and vomiting (CINV) in paediatric patients is the serotonin (5HT3) receptor antagonist, ondansetron, administered intravenously. However, the parenteral route of administration of this drug is now being questioned as it is inconvenient for children and there is pressure to switch to an available oral formulation. The aim of this study was to evaluate the ease of administration, efficacy and cost-effectiveness of intravenous (IV) and oral tablet (OT) formulations of ondansetron in paediatric cancer patients receiving moderately emetogenic chemotherapy at the Steve Biko Academic Hospital in Pretoria, Gauteng (South Africa).Methods: It was an open-label, parallel, randomized trial. Thirty (30) patients scheduled to receive moderately emetogenic chemotherapy were recruited from the paediatric oncology department of the hospital. These patients were randomized to receive the same dose of either IV or OT ondansetron for the prophylaxis of CINV for one chemotherapy cycle. The efficacy of the agents was determined using a visual analogue scale (VAS) completed by the paediatric patients, which was compared to a one page questionnaire completed by the parents of the patients. Both questionnaires were completed at the end of chemotherapy (treatment period) as well as after a week without chemotherapy treatment (follow-up period). The patients’ plasma concentrations of ondansetron at four different time points were quantified by liquid chromatography tandem mass spectrometry (LC-MS/MS). The ondansetron plasma concentrations obtained in the IV group were compared to those obtained in the OT group. The cost-effectiveness calculations included the direct costs of antiemetic prophylaxis and treatment, the use of any rescue medication and the length of hospital stay. Results: The VAS revealed that patients who were given antiemetic prophylaxis with OT ondansetron experienced less acute and delayed nausea than the patients in the IV ondansetron group; however, these differences were not statistically significant (p=0.538). Vomiting was similar in the two groups (p=1). There was a statistically significant difference between the patients and their parents in the perception of acute nausea (p=0.018), with parents overstating the level of acute nausea felt by their children. The plasma concentrations of ondansetron in patients on the IV formulation were higher than the ones in patients on the OT formulation at all the time points investigated. At 30 minutes post-dosing the mean plasma concentration of ondansetron in the IV group was significantly higher than in the OT group (p=0.0015), but the differences in plasma concentrations between the two groups from 2 hours were fairly comparable. The cost of antiemetic prophylaxis for IV ondansetron was significantly higher than the cost of antiemetic prophylaxis using the equivalent OT dose (p=0.0351). Conclusion: For the prevention of CINV, OT ondansetron, a 5HT3 receptor antagonist, proved to be an easy to use and cost-effective alternative to IV ondansetron in paediatric cancer patients receiving moderately emetogenic chemotherapy treatment. / Dissertation (MSc)--University of Pretoria / Pharmacology / unrestricted

Brain tumours account for the most frequent type of solid tumours among children. Despite advances in surgery and chemotherapy, brain tumours are still the main cause of cancer deaths in children. Furthermore, little is known about DNA methylation changes in paediatric astrocytoma. Recent investigations suggest that many tumours are initiated not only by genetic abnormalities, but also caused by epigenetic changes. DNA methylation is a key epigenetic mechanism that controls the regulation of gene expression. Interestingly, unlike DNA mutations, epigenetic abnormalities are reversible. The reversibility of epigenetic abnormalities upon pharmacological unmasking has prompted interest in developing epigenetic therapy with the crucial goal of restoring the expression of aberrantly silenced genes. The focus of this study was to utilise a combination of different microarray strategies to develop an integrative candidate gene approach to identify several novel frequently methylated genes in a cohort of paediatric HGA (High grade glioma) samples. In addition, to investigate the potential of therapeutic efficacy of a DNA methyltransferase inhibitor, 5-Aza-dC in paediatric HGA. There were 147 genes commonly identified to be potentially methylated in IN699 cells using the two different array strategies integration; re-expression array and Illumina Infinium Human Methylation 450k array. Furthermore, using two complementary microarray strategies including methylation 450k array and expression array, this work identified 55 genes that were both methylated and under-expressed in these HGA cultures. Following validation with CoBRA and RT-PCR coupled with the response of hypermethylated promoters to the demethylating agent 5-Aza-dC, six novel genes (CXCL14, PRR5L, ELTD1, ITGA2, KRT8 and NTM) that are frequently silenced in paediatric astrocytoma were identified. This study suggests that re-expression of ii CXCL14 inhibited the colony formation and cell growth and reduces the migration rate significantly in IN699 short term culture and likely have functional significance in the development of paediatric HGA and an excellent candidate gene for further analysis. In parallel, the efficacy of 5-Aza-dC treatment was examined in paediatric HGA aiming to introduce this epigenetic therapy as a potential mechanism in management of this tumours. This study demonstrated that, relatively low dose of 5-Aza-dC sharply reduced the colony formation and inhibited proliferation and not through the apoptotic effect. It is likely that this reduction in proliferation without cell death is due to using relatively low doses that do not acutely kill cells, thus, allow the sustained alterations in both gene expression patterns and appearance of a new phenotype to emerge. Taken together, this work contributes to a more detailed understanding of the effect of epigenetic silencing on paediatric HGA. This investigation also demonstrated the use of epigenetic drug, 5-aza-dC to reverse the gene silencing for the potential treatment of paediatric HGA.

Paediatric high grade glioma (HGG), including diffuse intrinsic pontine glioma (DIPG) are highly aggressive tumours with no effective cures. Lack of understanding of the molecular biology of these tumours, in part due to lack of well-characterised pre-clinical models, is a great challenge in the development of novel therapies. Analysis of paired cell culture/biopsy samples in this study revealed that paediatric HGG short-term cell cultures retain many of the tumour characteristics in vivo. Using a genome-wide approach, copy number, gene and miRNA expression, and methylation changes were characterised in 17 paediatric HGG-derived short-term cell cultures including 3 from DIPG. The majority of the genomic changes were unique from those arising in adult HGG. Approximately 65% (11/17) of paediatric HGG short-term cell cultures had balanced genetic profiles resembling normal karyotypes. The most frequent copy number gain and loss were detected at 14q11.2 (94%) and 8p11.23-p11.22 (59%), respectively. H3F3A (K27M) mutation was present in 2/17 (12%) cases and concurrent loss of CDKN2A and BRAFV600E in 1/17 (6%) case. Genes involved in reelin/PI3K signaling (DAB1), RTK signaling (PTPRE), and arginine biosynthesis (ASS1 and ASL) were frequently deregulated by methylation in these tumours. The anti-growth and anti-migratory properties of DAB1 and PTPRE were demonstrated in vitro. Preliminary investigations validated the therapeutic potential of ADI-PEG20 (arginine depletion), and PI-103 (PI3K/mTOR inhibition) in a subset of paediatric HGG short-term cell cultures. This study has identified novel genetic and epigenetic changes in paediatric HGG that may, following further validation, be translated into potential biomarkers and/or therapeutic targets.

BACKGROUND: Inadequate information from health professionals to parents is an issue in the Swedish paediatric care today. Paediatric nurses have an important role in making parents more involved in their child's care. Promoting co-care, communication and information is essential, which can be possible when nurses are working together with other health professionals and the child's parents. PURPOSE: To explore parents' experiences of information given to them at a neonatal care unit. METHOD: This studies design is qualitative explorative and based on survey's collected from two different neonatal care units in Sweden. The material was analysed according to a content analysis based on codes, meaningful units and categories. RESULT: Parents' needs of information varies depending on the situation and their emotional condition. The way health professionals communicate affects the information given to the parents. Adherence, continuity and honesty were elements parents found essential to be able to understand and process the information that was given at the neonatal care unit. CONCLUSION: The paediatric nurse's knowledge can help and calm parents by informing them about what is happening and why. It is important that as a health professionals use a language that the parents understand and give information continuously. The parents' also find it meaningful to get information from the paediatric nurse regarding details about nursing and routines on the ward. / BAKGRUND: Bristfällig information från vårdpersonal till föräldrar är idag ett problem inom svensk barnsjukvård. Barnsjuksköterskan har en viktigt del i att göra föräldrar involverade i sitt barns vård genom att informera dem om händelser och omvårdnad. Tillsammans med annan vårdpersonal och föräldrar kan en samskapande omvårdnad främjas där kommunikation och information är nyckeln. SYFTE: Att utforska föräldrars upplevelser av information som ges på neonatalvårdsavdelning METOD: Studien är av kvalitativ explorativ design, baserad på insamlade enkäter från föräldrar som haft barn inlagda på två olika neonatalvårdsavdelningar i Sverige. Analysen av materialet gjordes enligt en innehållsanalys baserad på koder, meningsbärande enheter och kategorier. RESULTAT: Föräldrars behov av information varierade beroende på situationen och deras emotionella tillstånd. Hur vårdpersonalen kommunicerade påverkade den information som gavs till föräldrarna. Följsamhet, kontinuitet och ärlighet ansåg föräldrar vara viktigt för att kunna förstå och ta till sig information kring sitt barn då de var på neonatalvårdsavdelningen. SLUTSATS: Barnsjuksköterskans kunskap kan lugna föräldrar genom att informera om vad som händer och varför. Det är viktigt att som vårdpersonal använda sig av ett språk som föräldrarna förstår och att ge kontinuerlig information. Betydelsefullt för föräldrar är att få information av barnsjuksköterskan kring omvårdnadsdetaljer och fasta rutiner.

Purpose: Young adolescent females are at the highest risk of sustaining an ACL injury, which may alter their movement and muscle activation patterns yet there is a lack sex- and age- specific guidelines for ACL injury management. The purpose of this study was to (1) evaluate the effects of limb dominance in a healthy uninjured population to serve as a baseline for the ACL-deficient cohort and (2) provide evidence of the neuromuscular patterns and biomechanical loading of uninjured and ACL-deficient knee joints in a female paediatric population. Methods: Eighteen active female adolescents with ACL rupture (ACLd) and 21 uninjured female adolescent controls matched for limb dominance (CON) participated in this study. Participants completed bilateral squats and drop vertical jumps (DVJ) while lower limb electromyography, kinetics and kinematics data were collected. Muscle synergies were extracted using a concatenated non-negative matrix factorization (CNMF) framework and compared between limbs, (CON dominant vs CON non-dominant and CON vs ACLd) across tasks and between limbs within tasks using intraclass correlation coefficients and statistical paramedic mapping. Results: ACLd participants took significantly longer to perform the squat relative to their uninjured peers. No significant differences were found for hip, knee and ankle peak joint flexion angles and moments between populations for the squat. Squat and DVJ muscle synergies were equivalent for dominant and non-dominant uninjured control limbs. ACL injured (ACL deficient and contralateral limbs) exhibited greater variability in DVJ synergy vectors than for the squat task. When comparing across tasks, scaling coefficients were consistently higher for the DVJ for all populations. Conclusion: Differences in lower limb kinematics, muscle activity and muscle activation patterns between dominant and non-dominant limbs indicate that limb symmetry, a clinical tool commonly used to assess rehabilitation and return to play may not provide relevant results. DVJ scaling factors were larger than those of the squat for all groups, likely due to the increased demand of that task. ACLd and CON participants completed squats and DVJ with similar lower limb joint angle patterns and muscle activity. ACL injured groups had fewer consistent vectors across tasks demonstrating greater variability in muscle activation patterns. This increased variability may be due to the ACL injury however, as injured participants were not studied pre- injury it cannot be confirmed.

On a daily basis critically ill paediatric patients are admitted in the Paediatric Critical Care Unit (PCCU). Some of these paediatric patients require cardiothoracic surgery and is mechanically ventilated post-operatively. Chapter one of this study gives an orientation to this research and explains that in order to prevent ventilator associated complications and high hospitalisation costs, the mechanically ventilated paediatric patient following cardiothoracic surgery should be extubated as soon as he/she is ready. Chapter two is dedicated to the available literature on this topic and indicates that literature on extubation criteria for the mechanically ventilated paediatric patient is minimal. The methodology of this study is discussed in detail in Chapter three. Chapter four gives a detailed explanation of the research findings and the researcher included the developed clinical pathway for the extubation of the paediatric patient following cardiothoracic surgery in a private hospital in Gauteng. The relevant clinical pathway functions as a guideline and evidence-based tool in the PCCU. Lastly Chapter five gives a summary of this study and a few recommendations are made. The researcher has included a personal reflection in this Chapter. / Dissertation (MCur)--University of Pretoria, 2014. / tm2015 / Nursing Science / MCur / Unrestricted

Cancer affects everyone; it does not distinguish between age, race, gender or social background. When a child is diagnosed with cancer, it does not only affect the child, but also the family system as a whole. The focus of this study was on the psychosocial aspects that are affected in the family system once a child diagnosed with cancer. These psychosocial aspects included the emotional impact, the spousal impact, the role changes that occur in the family system, the financial impact, the impact on siblings as well as the impact on religion and spirituality. These aspects were investigated by the researcher during the applied study. This applied study used a qualitative approach with a collective case study research design. The research population of this study included families who have a child diagnosed with cancer, who was treated at Nicus Lodge Cancer Treatment Centre in Pretoria which is a CANSA affiliate. The staff at Nicus Lodge selected participants who met the criteria based on purposive sampling, on behalf of the researcher. The researcher used semi-structured interviews and an interview schedule in order to obtain the participants’ experiences of their child diagnosed with cancer and the psychosocial effects it had on them as a family system. Nine participants participated in the study. The interviews were recorded with the permission of the participants and then later transcribed. Creswell’s steps for qualitative data analysis were implemented. By utilizing these measures and tools, the researcher was able to formulate findings from which conclusions and recommendations could be made. From the findings, the following themes and sub-themes were identified, demonstrating the psychosocial effect that a child diagnosed with cancer has on the family system and answering the research question: Theme 1: Protective measures with the sub-themes of religion, support structures and personality. Theme 2: Restrictive measures with the sub-themes of role changes, single parent, multiple children and date of diagnosis. Theme 3: Financial related aspects with the sub-themes of employment/unemployment, supportive employer, transport and medical aid. The findings demonstrated that many different aspects of a family system are affected when a child is diagnosed with cancer. It also demonstrated that a family system that had the necessary protective measures, were able to cope more effectively and maintain their quality of life when their child was diagnosed with cancer. The findings furthermore showed specific focus areas that a social worker in the health care setting, specifically in the oncology field, should focus on which hinder family systems from coping effectively. These focus areas enable the social workers to provide adequate supportive services to the families of a child diagnosed with cancer. Supportive services are imperative when dealing with a family of a child diagnosed with cancer, and this is one of the recommendations of the study and a focus area for future studies. Recommendations from this study can be used by social workers in the health care field to better understand the challenges that families of a child diagnosed with cancer experience and how to effectively address their needs. Social workers can also utilize the recommendations to find ways to make their services known to the communities and improve their intervention and supportive services to these families. It is important for social workers to improve awareness in the community and to provide them with the necessary resources to cope better with the situation. To better understand this paper, certain key terms were used by the researcher. / Dissertation (MSW)--University of Pretoria, 2014. / tm2015 / Social Work and Criminology / MSW / Unrestricted

Bakgrund: Den palliativa vården som finns i all hälso- och sjukvård syftar till att stödja livskvalitén hos patienter som har en progressiv och livshotande sjukdom eller skada. Föräldrars mest traumatiska erfarenhet är när deras barns kurativa behandling mot cancer övergår till palliativ vård. Peplaus interaktionsteori kan användas för att sjuksköterskan ska kunna etablera en relation med föräldrar vars barn får palliativ vård. Relationen är viktig för att sjuksköterskan ska kunna ge det stöd som föräldrar är i behov av. Syfte: Syftet var att belysa sjuksköterskans perspektiv av att ge stöd till föräldrar vars barn får palliativ vård inom onkologin. Metod: En systematisk litteraturstudie med en konventionell innehållsanalys gjordes utifrån 10 artiklar. Resultat: Två huvudkategorier, Sjuksköterskans stöd till föräldrar och Sjuksköterskans svårigheter med att ge stöd till föräldrar. Stödet som sjuksköterskan gav gjorde att föräldrarnas kapacitet ökade, vilket gjorde att de dagliga påfrestningarna i föräldraskapet blev hanterbara. Sjuksköterskorna kunde uppleva att det fanns faktorer som hindrade att ge det stöd föräldrarna förväntade sig. Dessa faktorer grundade sig i föräldrarnas emotionella agerande som ledde till konflikter. Konklusion: I studien framgår det att mer forskning behövs om stödet till föräldrarna inom pediatrisk palliativ vård i onkologin eftersom det inte finns tillräcklig evidens inom ämnet. / Background: In all healthcare, the palliative care aims to support the quality of life with patients who has a progressive and life threatening illness or injury. Parents mort traumatic experience is when their child’s curative treatment against cancer devolve to palliative care. Peplaus interaction theory could be used by the nurse to establish a relationship with parents whose child is receiving palliative care. The relationship is important for the nurse to be able to give the support that parents are in need of. Aim: The study´s aim was to illustrate the nurses’ perspective to give support to parents whose child is receiving palliative care within the oncology. Method: A systematic literature study with a conventional content analysis was made from 10 articles. Result: Two main categories, Nurses support to parents and The nurses’ difficulties to give support to parents. The support that the nurses gave made parents capacity increased, which made the daily stresses in parenthood manageable. The nurses could experience that there were factors that obstructed to give the support the parents expected. These factors were based on the parents emotional acting which led to conflicts. Conclusion: In the study it appears that more research is needed about the support to the parents within the paediatric palliative care in oncology because of insufficient evidence within the subject.

Magister Psychologiae - MPsych / Burns are a major problem in Low-Income Countries (LIC) and Low-Middle Income Countries (LMIC). Children in LIC have been identified as a burn injury at-risk group. Individuals experience severe psychological and physical distress as a result of burn injuries. However, burns are a systemic problem and their impact is not limited to the individual but impacts the family system as a whole. Therefore, effective post burn interventions for families of child burn survivors are key in order to assist the child burn survivor’s well-being and recovery. The present study hopes to 1) address some of the gaps in knowledge in burn interventions for families of child burn survivors and 2) identify promising psychosocial interventions. A systematic review of literature was conducted that focused on identifying burn interventions for families of child burn survivors. These interventions were evaluated in order to establish which interventions showed promise. This systematic review was conducted following the guidelines of the PRISMA Statement for Systematic Reviews. An integrated quantitative and qualitative appraisal tool was used to review the identified studies. All the available English-medium literature between 1990 and 2019 was reviewed for this study. A literature search was performed in EBSCOhost, Academic Search Complete, PsychArticles, CINAHL plus, Medline, ERIC, SocIndex and Health Source: Nursing/Academic edition. Five studies were identified which included psychosocial interventions for families of child burn survivors. Of these studies only two were of quantitative nature and indicated sufficient evidence with regards to outcomes and efficacy. Three studies were of qualitative nature and indicated subjective evaluation measures to assess efficacy. Interventions identified included a family burns camp, a support group for parents, a support website, a parent participation program during acute paediatric burns management, and a teaching manual. All five studies indicated a degree of efficacy however, support groups in conjunction with psycho-education groups with systemic focus appeared to show the most promise. It is recommended that researchers focus on using quantitative measures in future intervention studies to assist in measuring efficacy. Furthermore, context specific interventions for LIC should be considered.