...PAEDIATRICS - NUTRITION NUTRITIONAL VULNERABILITY OF INFANTS Reasons for Vulnerability * Low Nutritional Stores: * Newborn infants (particularly preterm) have poor stores of fat and protein * The smaller the child, the less the calories reserve and shorter period of withstanding starvation * High Nutritional Demands for Growth: * Nourishment required is greatest in infancy due to rapid growth * At 4 months, 30% of infant’s energy intake used for growth * By 1 year, this falls to 5% and then by 3 years 2% * Risk of growth failure from restricted energy intake greater in first 6 months of life * Rapid Neuronal Development: * Brain grows rapidly during last trimester of pregnancy and first 2 years of life * At birth, brain accounts for 2/3 of basal metabolic rate * Process appears sensitive to undernutrition * Even modest energy deprivation increases risk of poor neurodevelopment outcome * Acute Illness or Surgery: * Catecholamine secretion increases after brief anabolic phase causing increased requirements due to increased metabolic rate * Nitrogen losses from urine / burns / severe sepsis * Only be corrected after several weeks due to replacement of previously lost tissue * Catch-up growth only if energy intake is as high as 150-200 kcal/kg/ day Long-term Outcome of Early Nutritional Deficiency * Linear Growth of Populations: ...
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...S w 908D01 PAEDIATRIC ORTHOPAEDIC CLINIC AT THE CHILDREN'S HOSPITAL OF WESTERN ONTARIO Manpreet Hora wrote this case under the supervision of Professor Robert D. Klassen and Dr. Kellie Leitch solely to provide material for class discussion. The authors do not intend to illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other identifying information to protect confidentiality. Ivey Management Services prohibits any form of reproduction, storage or transmittal without its written permission. Reproduction of this material is not covered under authorization by any reproduction rights organization. To order copies or request permission to reproduce materials, contact Ivey Publishing, Ivey Management Services, c/o Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada, N6A 3K7; phone (519) 661-3208; fax (519) 661-3882; e-mail cases@ivey.uwo.ca. Copyright © 2008, Ivey Management Services Version: (A) 2010-01-13 Dr. Kellie Leitch glanced at the data on wait times collected from the patients in one of her clinics. As Chief of Paediatric1 Orthopaedic surgery at the Children’s Hospital of Western Ontario (CHWO), she was very concerned by the long times that the young patients (and their parents) were experiencing in the daily clinic. Long wait times tended to aggravate the already pent-up distress and concern that they were feeling, and parents were...
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...Case report: Paediatric Orthopaedic Clinic 1- What is capacity utilization at every step in the process? What is the direct resource utilization? Using the data provided in the case, we are able to compile all data necessary to compute the capacity utilization at the clinic. Activity | # of Staff | Available time | Activity time | Number of Patients | Time needed | Utilization10 | | | /Staff | Total | N | F | N | F | N | F | Total | | 1. Front Desk | | | | | | | | | | | | a. Registration | 3 | 180 | 540 | 5 | 5 | 32 | 48 | 160 | 240 | 400 | 74 % | b. Verification | 3 | 255 | 765 | 9 | 4 | 32 | 48 | 288 | 192 | 480 | 63 % | 2. Radiology Department | | | | | | | | | | | | a. X-ray imaging | 6 | 240 | 9603 | 11 | 11 | 32 | 40.8 | 352 | 448.8 | 800.8 | 83 % | b. Development of X-rat | -1 | 240 | 9604 | 7 | 7 | 32 | 40.8 | 224 | 285.6 | 509.6 | 53%8 | c. Diagnostic reading and comments | 3 | 240 | 4805 | 5 | 5 | 32 | 40.8 | 160 | 204 | 364 | 76% | 3. Hand-off X-ray to Clinic | | | | | | | | | | | | a. Collection of X-ray | 3 | 2556 | 7657 | 2 | 2 | 32 | 40.8 | 64 | 81.6 | 145.6 | 19% 9 | b. Filing/exam room prep | 1 | 255 | 255 | 2 | 2 | 32 | 48 | 64 | 96 | 160 | 63% | 4. Examination Room | | | | | | | | | | | | a. Surgeon | 1 | 255 | 255 | 7 | 4 | 32 | 14.4 | 224 | 57.6 | 281.6 | 110% | b. Resident | 1(2)2 | 255 | 255 | - | 7 | - | 33.6 |...
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...Paediatric Nurse My name is Tanika Bicar and I am a qualified paediatric nurse. I have to be very committed, compassionate and mature to for fill the needs of this job. My job is to plan and provide anti-discriminatory care for children of all ages who suffer from different conditions including illnesses and diseases or for those who are recovering, as well as working closely with their parents or guardians. I work with others in the multidisciplinary team such as doctors, psychologists and social workers to assess the needs of children and using good judgement, choose what level of nursing care is required. I would also give useful advice to the parents or guardians on how to look after the child when they are at home. This is where my interpersonal skills, knowledge and understanding comes into play....
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...Case report: Paediatric Orthopaedic Clinic 1- What is capacity utilization at every step in the process? What is the direct resource utilization? Using the data provided in the case, we are able to compile all data necessary to compute the capacity utilization at the clinic. Activity | # of Staff | Available time | Activity time | Number of Patients | Time needed | Utilization10 | | | /Staff | Total | N | F | N | F | N | F | Total | | 1. Front Desk | | | | | | | | | | | | a. Registration | 3 | 180 | 540 | 5 | 5 | 32 | 48 | 160 | 240 | 400 | 74 % | b. Verification | 3 | 255 | 765 | 9 | 4 | 32 | 48 | 288 | 192 | 480 | 63 % | 2. Radiology Department | | | | | | | | | | | | a. X-ray imaging | 6 | 240 | 9603 | 11 | 11 | 32 | 40.8 | 352 | 448.8 | 800.8 | 83 % | b. Development of X-rat | -1 | 240 | 9604 | 7 | 7 | 32 | 40.8 | 224 | 285.6 | 509.6 | 53%8 | c. Diagnostic reading and comments | 3 | 240 | 4805 | 5 | 5 | 32 | 40.8 | 160 | 204 | 364 | 76% | 3. Hand-off X-ray to Clinic | | | | | | | | | | | | a. Collection of X-ray | 3 | 2556 | 7657 | 2 | 2 | 32 | 40.8 | 64 | 81.6 | 145.6 | 19% 9 | b. Filing/exam room prep | 1 | 255 | 255 | 2 | 2 | 32 | 48 | 64 | 96 | 160 | 63% | 4. Examination Room | | | | | | | | | | | | a. Surgeon | 1 | 255 | 255 | 7 | 4 | 32 | 14.4 | 224 | 57.6 | 281.6 | 110% | b. Resident | 1(2)2 | 255 | 255 | - | 7 | - | 33.6 | - | 235.2 | 235.2 | 92% | c. Cast technician...
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...cannot be adequately oxygenated. The paediatric patient has differences in their airway anatomy compared to an adult patient. Any procedures on a paediatric patient are difficult and risky in any environment. This paper will discuss paediatric airway management and give reasons as to why SC should not be attempted. SC involves incising the cricothyroid membrane with a scalpel and inserting an endotracheal tube directly into the subglottic area of the trachea. The most important anatomical consideration for a paediatric surgical airway is the smaller size of the cricothyroid membrane (CTM) in the paediatric patient compared to the adult patient; differences become less acute as the paediatric patient grows in size. Combining CTM size with the upper airway structures cartilage being soft and pliable as it develops; any pressure caused by surgical apparatus on the CTM may cause it to collapse completely (Caroline, 2007). The paediatric patient has a shorter airway and the diameter is smaller. The narrowest area of the paediatric patient’s airway is situated below the level of the vocal cords at the cricoid cartilage and this differs from the adult patient’s airway as the narrowest point is located at the level of the vocal cords. Therefore the paediatric patient has a funnel shaped airway compared to the cylindrical shape of the adult patient’s airway (Caroline, 2007; Wheeler, Wong, & Shanley, 2009). The anatomical features of the paediatric patient’s upper airway can make SC a...
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...Using Simulation Modeling to Improve Patient Flow at an Outpatient Orthopedic Clinic Thomas R. Rohleder, PhD Division of Health Care Policy and Research Mayo Clinic 200 First Street SW Rochester, Minnesota 55905 tel: 507-538-1532 Email: rohleder@mayo.edu Peter Lewkonia, MD Faculty of Medicine University of Calgary Calgary, Alberta Diane Bischak, PhD Haskayne School of Business University of Calgary Calgary, Alberta Paul Duffy, MD Faculty of Medicine University of Calgary Calgary, Alberta Rosa Hendijani Haskayne School of Business University of Calgary Calgary, Alberta July 2011 Abstract We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced. Keywords: Outpatient Clinic, Discrete Event Simulation, Process Improvement, Patient Waiting I. Introduction Visiting hospital outpatient clinics is a very common way for...
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...clinical leads, Peter Hammond from Harrogate and Fiona Campbell from Leeds, this work and report would not have been possible. Contents Executive summary Context Background and rationale Aims of the project Timing of the project Process undertaken for the project Evidence base and policy background Results from the snapshot research Good practice Examples of good practice Review of key findings Project recommendations Core values, competencies and skills needed to deliver a quality consultation References Appendix 1 – Principles of a diabetes transition service Appendix 2 – Snapshot research 4 6 8 9 10 11 12 18 19 20 25 26 27 28 30 33 3 Executive summary Transition processes in diabetes healthcare are important. The move from paediatric to...
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...This plan will be illustrating the care pathway for the 2 physiological disorders and the roles of the practitioners involved. The two physiological disorders are eczema and nephrotic syndrome. The practitioners involved in eczema are the GP and pharmacist. General Practitioners (GP): GPs look after the health of people in the local community and deal with a wide range of health problems. They take into account physical, emotional and social factors when diagnosing treatment and recommending the required treatment (AGGAS, 2013). If a GP is unable to deal with a problem themselves, the usually refer the patient to a hospital for tests, treatment, or to see a consultant with specialist knowledge (NHS Choices, 2013). For example in eczema, if the GP sees that the condition is not getting any better, or is worsening, the will refer the patient to see a dermatologist. Also, they assess, plan, implement and monitor the progress and response to treatment; and provide advice and counselling to the patients (AGGAS, 2013). Goal/Objective Completion Date Action to be taken To identify the physiological disorder Immediately 1) Baseline assessment i.e. medical history to identify clinical background and to identify and themes, patterns etc. 2) Assess baseline measurements: pulse and respiration; and observe the affected area i.e. inner elbows. 3) Confirm diagnosis and identify any potential allergies. To successful control the disorder On-going 1) Prescribe mediation i.e. 2) Refer...
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...When I found this Therapeutic Recreation program was offered at the University of Lethbridge, I was excited to receive the degree I have wanted for 22 years. I planned to use the education to make a stronger proposal to change my Child Life Activity Convenor position to a Therapeutic position on the Paediatric Unit in Medicine Hat. Smaller populations often struggle due to limited resources, but the level of needs for the individuals in the community remains the same. Most paediatric patients seen in the Medicine Hat Regional Hospital have short stays with rounds of IV therapy or surgical care which could benefit from Child Life Therapy, but some patients demand higher care with holistic needs during and after discharge. In recent years the unit in Medicine Hat has had an increase in...
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...Case Reports in Pediatric Dentistry Edited by Evert van Amerongen Maddelon de Jong-Lenters Luc Marks Jaap Veerkamp Quintessence Publishing Co Ltd London, Berlin, Chicago, Tokyo, Barcelona, Beijing, Istanbul, Milan, Moscow, New Delhi, Paris, Prague, São Paulo, Seoul and Warsaw Foreword It is essential that clinicians treating children have a high degree of awareness and knowledge of a wide range of oral conditions to optimize the dental care for their patients. Some of these conditions are commonly encountered whereas others are rather infrequent, thus giving the practicing dentist limited experience to build up diagnostic and treatment skills. The latter may concern, for example, different types of developmental disturbances such as hypodontia or disturbances of mineralization of dental hard tissues, as well as pathologic conditions in oral mucosa and bone. Of great interest in increasing knowledge and clinical experiences is the case reports/presentations, which, unfortunately to a limited extent, are published in pediatric scientific journals. This book has been produced in an attempt to overcome this and to give dentists involved in clinical dentistry for children an opportunity to a systematic approach in continuing education in diagnostics, indications, treatment, and follow-up of cases that could be seen in their own practices. In this book, 16 cases treated by experienced clinicians are presented, including case history, examination, diagnosis, indications for...
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...received less than adequate care. The following case study, written in first person, is told by Dr Phil Hammond,2 who joined the Bath GP training scheme in the late 1980s and in 1990 formed the whistleblowing3 comedy double-act 'Struck off and die' with Dr Tony Gardner. Heard it on the grapevine Although I'd heard rumours about the poor performance of an adult heart surgeon (nicknamed 'Killer') in Bristol when I was a house officer in Bath, there were no such rumours about paediatric heart surgery. When I spoke to one of my former consultants in November 1998, he said they had never heard anything bad about the Bristol unit until 1995, when the mainstream media finally caught up with Private Eye. However, he did say that when he worked at the Hammersmith Hospital in London in 1985, he noticed an abnormal referral pattern coming out of South Wales. Babies with more complex heart defects requiring surgery appeared to be bypassing the Bristol area. This was corroborated by an anaesthetist who worked on the paediatric cardiac surgery unit at Guy's Hospital in the late 1980s. He noticed that his unit, and the unit at the Royal Brompton Hospital, were receiving many difficult referrals from Cardiff and the South West. When he asked the referring doctors why they did not send them to the nearby unit in Bristol, he was told, 'Difficult cases die in Bristol. So we only send them the easy ones.' This pattern of doctors far away from Bristol...
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...Paediatrics is one of the most challenging and arguably most rewarding specialities there is. An inquiring and critical mind as well as correct communication skills is imperative to success in the field. Through my elective experiences I came to have vastly greater respect for the hospital, the clinicians, multi-disciplinary team and teachers required to diagnose and treat a patient as a whole in addition to broadening my experiences in medicine and life overall. I decided to dedicate my two week elective in the Paediatric Department of Charlotte Maxeke Academic Johannesburg Hospital as I enjoyed the hospital culture as well as, CMAJH being a quaternary hospital, I was more likely to be exposed to a range of different patients. Paediatrics...
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...Many physicians across North America hesitate to prescribe medical marijuana to their adult patients out of fear, why would they even start considering prescribing it to children . This fear mainly originates from the fact that as medical students in medical school, doctors learn absolutely nothing about prescribing it, therefor, cannot knowledgeably advise patients on dosage and side effects of this medication. This is quite sad considering how much benefits can come from medical marijuana, especially in paediatric care, as it useful, safe and in some cases lifesaving. The stereotype associated with "weed" forces doctors to second guess the benefits that may come from it. The fact that it is considered a Schedule 1 drug in United States and a Schedule 2 drug in Canada according to the Controlled Substance Act makes it almost impossible to conduct effective research. Medical Marijuana is a very broad acting and universally useful medicine, if used appropriately like any medication prescribed that has been put on the market out by the pharmaceutical companies. If you look at medical history, marijuana was one of the main components of medicine in the 19th century, dealing with a variety of ailments, any where loss of appetite to diarrhoea to mental illness, (Schaffer Library, 1). Unfortunately the modern day medicine industry has been brainwashed into the belief that we constantly need to innovate and make money from treatment, and consequently these "innovations" are rewarded...
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...Immediate Post Operative Care 2 The following essay will use a systematic approach to critically evaluate the care and treatment delivered to a non-elective paediatric orthopaedic patient within the Post Anaesthetic Care Unit (PACU) by a student Operating Department Practitioner at a local trust hospital. The assessment and management of the patients care will be examined and rationale provided for strategies employed during delivery of individualised patient care. In accordance with Health and Care Professional Council’s standards of conduct, performance and ethics (HCPC, 2012) the confidentiality of the service user will be up held at all times. The service user shall be referred to as “Daisy” to protect her confidentiality. Daisy was received to the PACU after surgical stabilisation of her left fibula and tibia with flexible intramedullary nails following a fall. A specified paediatric bay was utilised enabling the patient to be cared for separately from the adults in the PACU (RCOA, 2013). Anaesthetic and surgical handover was received (RCOA, 2013) which detailed that she was 14 years old with no known allergies. She had no significant medical history. She had a general anaesthetic with 140mfg of Propofol used on induction followed by Sevoflurane as a maintenance agent. 30mg of Atricurium, 4mg Dexamethasone, 4mg Ondansatron, 10mg Morphine and 1g Paracetemol had been administered intraoperatively. 1 litre of Hartmanns solution had been administered during surgery and...
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