Effectiveness of the Hospital Learning Center (Queen Sirikit National Institute of Child Health): Satisfaction with service and parents' attitudes towards children's illness.

Background: All children, whether healthy or ill, should have access to equal educational opportunities. Healthcare institutions and hospitals have been approved to work with schools to establish learning centers to provide education to sick children. This study has been conducted to develop a practical model for learning centers in hospitals across Thailand to create equality and ensure valuable human resources for the future. The main goal of this study was to evaluate the effectiveness of a hospital learning center for continuing education of child patients and to determine the factors that are most appropriate study plans, the parents' attitude about their child's illness, and the children's satisfaction with the learning center. Methods: The total sample population was 400, consisting of 200 parents and 200 child patients aged 4 to 18 years. The respondents were given a questionnaire to obtain their feedback using a Likert scale. Results: The most common child patients were those with chronic illness followed by those with common illnesses, and lastly children with developmental problems. All 200 children received continuing education; 20 child patients (10%) who had been evaluated received a modified education plan. After analyzing the results of satisfaction with the learning center, the scores ranged from 4.21 to 5.00 (mean = 4.28, SD = 0.62).   Conclusions: Sick children can continue their education at the hospital learning center in Queen Sirikit National Institute of Child Health. Study plans can be modified to suit children with chronic illnesses and developmental problems, children in primary and secondary school, and those requiring prolonged hospitalization. Parents in the study had appropriate attitudes about the disease and education of their children. Sick children gave the highest ratings showing extremely high satisfaction with the hospital learning center.

Clinical abnormalities, early intervention program of Down syndrome children: Queen Sirikit National Institute of Child Health experience.

OBJECTIVE: Queen Sirikit National Institute of Child Health is a tertiary institute of children in Thailand, where early intervention programs have been provided since 1990 by multidisciplinary approach especially in Down syndrome children. This aim of the present study is to follow the impact of early intervention on the outcome of Down syndrome children. The school attendance number of Down syndrome children was compared between regular early intervention and non-regular early intervention. MATERIAL AND METHOD: The present study group consists of 210 Down syndrome children who attended early intervention programs at Queen Sirikit National Institute of Child Health between June 2008 and January 2012. Data include clinical features, school attendance developmental quotient (DQ) at 3 years of age using Capute Scales Cognitive Adaptive Test/Scale (CAT/CLAMS). Developmental milestones have been recorded as to the time of appearance of gross motor, fine motor, language, personal-social development compared to those non-regular intervention patients. RESULTS: Of 210 Down syndrome children, 117 were boys and 93 were girls. About 87% received regular intervention, 68% attended speech training. Mean DQ at 3 years of age was 65. Of the 184 children who still did follow-up at developmental department, 124 children (59%) attended school: mainstream school children 78 (63%) and special school children 46 (37%). The mean age at entrance to school was 5.8 ± 1.4 years. The school attendance was correlated with maternal education and regular early intervention attendance. CONCLUSION: Regular early intervention starts have proven to have a positive effect on development. The school attendance number of Down syndrome children receiving regular early intervention was statistically and significantly higher than the number of Down syndrome children receiving non-regular early intervention was. School attendance correlated with maternal education and attended regularly early intervention. Regular early intervention together with maternal education are contributing factors influencing school attendance in Down syndrome children in the present study

Dengue hemorrhagic fever grade III with diabetic ketoacidosis: a case report.

A 16-year-old, previously healthy Thai girl presented with DHF grade III. Fifteen hours after the first episode of shock, she had received an excessive amount of crystalloid isotonic solution and 20 ml per kilograms of Dextran-40 however she still had persistently rapid pulse rate and high hematocrit but also had polyuria with more than 4 ml/kg/hr of urine output. She was re-evaluated. Clinical signs showed severe dehydration with some ascites without signs of pleural effusion. Blood gas revealed increased anion gap metabolic acidosis. The cause of polyuria and metabolic acidosis was identified with hyperglycemia, ketouria and glucosuria. Afterwards she was diagnosed and treated as DHF grade III and DKA. Besides insulin administration, fluid resuscitation was very crucial. Intravenous fluid rehydration was needed while the unnecessary extra-volume could cause massive plasma leakage and later on fluid overload. Volume replacement was adjusted to degree of dehydration when signs of volume overload were monitored closely. She was out of DKA at 14 hours after the start of insulin and the intravenous fluid was stopped at 27 hours (36 hours after the first episode of shock). The final diagnosis was DHF grade III, diabetes mellitus with DKA and hepatitis.