As a general concept, well-being involves qualities such as contentment, joy, satisfaction and all kinds of happiness. Health symbolizes that a person can and do make choices that benefit health, but also that a person is oriented to time, space and person. The concept of well-being affects one's experiences and cannot be measured by others. The needs of fulfilled well-being can differ from person to person as it is a subjective experience to become satisfied. The core of nursing care has traditionally been connected to the promotion of health and well-being (Ehnfors, Ehrenberg & Thorell-Ekstrand, 2007). However, health care might create unnecessary suffering (health care suffering) if the suffering occurs with unreflected care. Which happens when patients feel powerless and are not seen or heard by the healthcare staff.
The Pediatric Acute Surgical Support (PASS) course was developed in 2016 for Vietnam, a low middle income country. PASS prepares “front line” medical professionals for the initial assessment and acute resuscitation of neonates and children with immediately life-threatening surgical illnesses and injuries prior to receiving definitive care. It was jointly developed by US and VN faculty, taught by an interdisciplinary international team of pediatric surgeons, critical care and emergency medicine specialists, as well as nurse educators from high income countries to interdisciplinary multispecialty teams of learners from several children’s hospitals in Vietnam. The standardized blended curriculum includes didactic lectures on neonatal and pediatric surgical emergencies and organ system-specific accidental injuries for learners to read before attending the course. The course consists of on-site technical skills stations, interactive case management scenarios with live audience responses, and advanced simulations of pediatric multisystem trauma injuries. The emphasis is on competencies in the initial emergency response to acute pediatric surgical illnesses and team dynamics. Short term outcome assessment is accomplished by capturing learners’ demographics; quantitative before and after testing of the course learners’ knowledge base, team performance in managing complex traumatic injuries and team dynamics; and learners’ evaluation of PASS content, delivery and faculty. We report our experience of piloting PASS in Vietnam, having trained 6 multispecialty groups of 121 learners that include 35 nurses, and 3 new VN PASS instructors from 4 children’s hospitals in Ho Chi Minh City between 2016 and 2019. Future directions include longitudinal follow-up to evaluate PASS sustainability in learners’ knowledge acquisition and skills retention, PASS implementation to lower level hospitals in Vietnam by a joint team of US and VN PASS instructors, and tracking the long-term effects of PASS on patient clinical outcome. Opportunities of extending PASS collaboration with other formal pediatric resuscitation training programs, and PASS deployment outside Vietnam are explored.
An ecological view on child care. Ecology is the interaction of living beings among themselves and with their environment (Haeckel, 1866), which today extends to a network of social, psychological and economic interrelations: “Everything Is Connected to Everything Else” is the first law of Global Ecology (B Commoner, 1971). Human action can modify environment for better or worse, this having ethical dimensions.
Development results from the interaction of genetics with the environment. Epigenetics refers to the complex control of gene expression and its role in normal development.
The route of development begins in mammals with remarkable vulnerability to the environment, during the preimplantation period and decreases with time.
This is a retrospective study of outcomes in all children with autism who received early interventions between 15 months to 3 years of age with combined protocol treatment. The study also compares the percentage of children getting similar outcomes in age groups >3 to 5 yrs., >5 to 10 yrs. and >10 yrs. age groups. Relation of outcomes to severity of autism at the time of diagnosis was also assessed. It was found that the children who received early intervention with combined pharmacological, ABA, O.T, speech and nutritional therapy were close to neurotypical than who received only ABA, O.T, speech and 1;1 IEP. Patients were classified according to age with assessment of, maternal risk factors, birth complication, media exposure, family history, age at interventions, lab studies and imaging studies. Patients with chromosomal anomalies, seizure disorder and other medical or neurological disorders were excluded from study. The most important pre determinants for successful outcomes were parental counselling, parental acceptance and regular follow up with a focal person who could explain, counsel and direct to other disciplines. For determining the long-term outcomes, the longest period of follow up was 10years and shortest period 2years.
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