Browsing by Subject "pediatric"

Now showing 1 - 7 of 7
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    Don’t Leave Without Them: Dispensing asthma medications to pediatric patients upon discharge is associated with decreased hospital readmissions
    (University of Minnesota, College of Pharmacy, 2012-12) Hiteshew, Kelly J.; Franz, Thaddeus; Lamberjack, Kristen; Chen, Aleda M.H.
    Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution’s outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During the intervention phase, pharmacists promoted use of the outpatient pharmacy by patients admitted for these conditions using multiple methods. In each chart review, the patients readmitted for asthma or wheezing within thirty days were classified as either outpatient pharmacy users (OPP users) or non-OPP users. Differences in readmission rates between OPP users and non-OPP users, as well as differences in overall OPP utilization, were analyzed before and during the intervention phase using a Chi-square test. Results: The initial chart review found no significant difference in thirty day readmission rates between OPP users and non-OPP users (6.2% and 7.5%, respectively; χ2 = 1.15; p = 0.274). The number of OPP users increased significantly from the first chart review to the second (11.8% and 45.9%, respectively; χ2 = 929.04, p < 0.001). The second chart review revealed that OPP users had a significantly lower readmission rate than non-OPP users during the intervention phase (2.3% and 10.9%, respectively; χ2 = 52.5; p < 0.001). Conclusion: Obtaining discharge medications from the OPP was associated with a lower thirty-day readmission rate in children with asthma. Promoting use of the OPP for transitional care should continue to be part of future efforts to decrease hospital readmissions.
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    Family Stress in Long-Term Pediatric Critical Care: A Mixed Methods Study
    (2015-08) Hagstrom, Sandra
    Hospitalization in the pediatric intensive care unit (PICU) is stressful for families and disruptive for their normal lives. As new technology has become available, the number of children requiring prolonged stays in the PICU has increased. This mixed methods study explored stress in families whose children were hospitalized in the PICU for more than one week, collecting data one to two weeks after admission, then four to five weeks later. The purpose was to describe sources of stress for families whose children require extended hospitalization in the PICU and explore how sources of stress change over time. Data collection included semi-structured interviews and completion of the Family Inventory of Life Events (McCubbin, Thompson & McCubbin, 1996) and Family System Stressor Strength Inventory (Berkey & Hanson, 1991) at each time point. Nine parents of eight children participated in the first phase of data collection; two mothers participated in the second phase. Data analysis revealed the following themes related to Aim 1 (sources of stress): separation, not knowing, child’s illness and distress, care and caring, emotional stress, physical stress, job and financial stress, and what we’ve been through before. Themes related to Aim 2 (change over time) were: stress builds, and stress decreases as the unknowns become known. Analysis of Time 2 data revealed similarities in sources of stress compared to Time 1, but there was a shift in the relative priority and contribution that each stressor made to the overall perception of stress as hospitalization became prolonged and the child’s condition improved; participants reported aspects of care and caring as most important at this point. A new subtheme in the original care and caring theme was also identified: considering the child’s entire picture. Findings demonstrated sources of stress directly related to the child’s acute illness as well as stress resulting from the child’s hospitalization and ongoing healthcare needs, all of which contributed to the perception of family stress. Over time, stress was compounded and there was a shift from the primary stressors of unknowns and separation of the family to stressors related to the care and caring provided by the team.
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    Identifying parasite virulence factors and host genetic and immunologic factors that contribute to severe malarial outcomes in Ugandan children
    (2016-10) Shabani, Estela
    Cerebral malaria (CM) and severe malarial anemia (SMA) remain drivers of morbidity and mortality due to Plasmodium falciparum infection in children in Sub-Saharan Africa. There are currently no adjunctive therapies for severe malaria (SM), suggesting that we need a better understanding of both host and pathogen factors that contribute to SM. This dissertation attempted to identify both host and parasite factors that contribute to disease severity in malaria, factors that differentiate between CM and SMA, and those associated with mortality and neurocognitive outcomes in CM. Children between 18 months and 12 years of age, meeting the WHO definition for CM (n=269) or SMA (n=232), were recruited from the Acute Care Unit at Mulago Hospital in Kampala, Uganda. Healthy community children (CC, n=213) in the same age-range were recruited from the neighborhoods and extended households of children with SM. Whole blood was collected at enrollment and was either processed immediately for plasma or was preserved and stored accordingly for future RNA and DNA isolation. We performed genotyping for endothelial protein C receptor (EPCR) polymorphisms, quantitative reverse-transcriptase PCR to estimate transcript levels of var genes encoding P.falciparum erythrocyte membrane protein 1 (PfEMP1), and used plasma to quantify a number of cytokines, chemokines, angiogenic growth factors, soluble EPCR and erythropoietin with ELISA-based assays. The work presented in this dissertation identified both cytoadhesion of infected erythrocytes (IEs) and host immune factors as important contributors to SM pathogenesis. We have shown that polymorphisms associated with less bound and more soluble EPCR are associated with reduced risk of SM; that EPCR-binding PfEMP1 are important in SM and that their transcript levels are higher in CM than SMA; that the immune profile, while quite similar in CM and SMA, is differentiated especially by elevated levels of chemokines and IL-10 in CM. Lastly, our studies on the association of TNF-α and EPO with disease severity in CM highlight the importance of understanding both systemic and local effects of host mediators when considering targets for adjunctive therapies, and the importance of selectively inhibiting the pathogenic effects without compromising the beneficial roles of that target.
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    Migraine Headaches in Children and Adolescents
    (2009-05-04) Ness, Molly
    Migraine affects four to ten percent of school-aged children, and nearly twice as many adolescents. The symptoms of migraine are distinctive, and it is important for parents to be familiar with these symptoms. Children and adolescents with migraine may be treated successfully with over-the-counter pain medications. However, there is strong evidence that sumatriptan nasal spray is another safe and effective migraine medication for children over age 8.
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    Mortality and Cause of Death Following Pediatric Cardiac Surgery for Congenital Heart Defects
    (2021-06) Zmora, Rachel
    Congenital heart defects (CHD) affect almost 1% of births. The primary method for managing these defects is surgery. These analyses used data from the Pediatric Cardiac Care Consortium (PCCC), a large, US-based registry of pediatric interventions for CHDs. The PCCC was previously linked to the National Death Index and was linked to the American Medical Association Physician Masterfile as part of this dissertation. The first two analyses examined the associations between surgeon and center characteristics and post-surgical mortality using multilevel modeling. These analyses examined procedure-specific volume at the surgeon and center levels as well as training center status at the center level and years since graduation from medical school at the surgeon level. In the third analysis, multiple cause of death data were examined to determine the burden of contributing causes of death. Standardized mortality ratios and competing risk Cox regression compared these results with those calculated using underlying cause of death. The first analysis found that after adjusting for known patient-level risk factors, center factors including procedure-specific volume were not associated with early post-discharge mortality. The second analysis of short and medium term mortality demonstrated a consistent center-level association between procedure-specific volume and mortality among several complex repairs. No association was observed among patients with relatively simple ventricular septal defect repairs. Finally, we found that standardized mortality ratios based on underlying cause of death underestimated the burden of death associated with injury as well as perinatal, infectious, endocrine, genitourinary, and circulatory diseases. These differences varied by age and defect severity. Perinatal and endocrine disease were highest among those with severe defects. Differences in mortality due to infection showed a bimodal association with age at the time of death. The combination of multi-level modeling and multiple cause of death methods leveraged in these analyses advances the understanding of the roles of healthcare systems and multiple causes of death.
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    A New Model for Acute Pain Management in Children: Examining Patient Characteristics and Potential Implications for Research and Practice
    (2021-05) Eull, Donna
    AbstractCurrent literature suggests that acute pain management in hospitalized children remains substandard, resulting in adverse physical, cognitive, and emotional effects for many children. Improvements to pediatric acute pain management require an updated conceptual model and validation of current assumptions from the literature. The purpose of the three studies in this dissertation was to advance the state of the science on acute pain management in hospitalized children through an updated conceptual model, a critical review of literature, and analysis of pain management data from a children's hospital. The new acute pain management model transforms the role of the nurse from gatekeeper to facilitator in genuine partnership with children and families. The critical review of the literature suggested that differences in medication type and frequency for acute pain are associated with children’s sex and race/ethnicity, however study limitations make it difficult to draw meaningful conclusions about potential disparities in acute pain management for children. Findings from a retrospective chart review suggested no differences by sex, race/ethnicity, or limited English proficiency (LEP) in the average number of pain assessments, medication by weight, or outcomes. The results from this study may indicate progress in the management of acute pain in hospitalized children, as children in this study demonstrated average pain intensity scores which typically indicate mild, well-controlled pain. Replication of this study in other hospitals is needed to determine organizational effects on pain outcomes. Future research should also focus on identifying the components needed to establish genuine partnerships with patients and families and the potential influence of parents on effective pain management.
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    Should my child have X-rays for their ankle injury?
    (2008-03-31) Anderson, Anthony
    Ankle injuries have been reported to constitute up to 12% of emergency department visits. However, only one in five of these patients have an ankle fracture. For this reason, the Ottawa Ankle Rules(OAR) were developed to help clinicians decide which adults should have radiographs. With the success of this model, a study was designed to assess the validity of the OAR in the evaluation of pediatric patients. The results of the study showed that although the OAR were successful in detecting most fractures, it missed a significant number of "pediatric fractures." However, the data indicated that the rules were valid for children older than 15 years-old. Finally, the study indicated a new set of rules more appropriate for pediatric patients under 15 years-old.