Shared Spiritual Beliefs between Adolescents with Cancer and Their Families
quality of life; Adolescent; Adult; Female; Follow-Up Studies; Humans; Male; Prognosis; Decision Making; Longitudinal Studies; Single-Blind Method; Young Adult; Cross-Sectional Studies; Family/psychology; Religion and Medicine; Spirituality; Advance Care Planning/statistics & numerical data; Adolescent Behavior; family; adolescents; cancer; congruence; spirituality; funding from the American Cancer Society to adapt/translate this protocol into; Neoplasms/psychology/therapy; Spanish. There are no other conflicts of interest to disclose.; study from the National Institutes of Health. Maureen E. Lyon is also receiving
BACKGROUND: FAmily CEntered (FACE) Advance Care Planning helps family decision makers to understand and honor patients' preferences for future health care, if patients cannot communicate. Spiritual well-being is a key domain of pediatric oncology care and an integral dimension of pediatric advance care planning. PROCEDURE: As part of four-site randomized controlled trial of FACE for teens with cancer, the functional assessment of chronic illness therapy-spiritual well-being- version 4 (FACIT-Sp-EX-4) was completed independently by 126 adolescents with cancer/family dyads. The prevalence-adjusted and bias-adjusted kappa (PABAK) measured congruence on FACIT-Sp-EX-4. RESULTS: Adolescents (126) had mean age of 16.9 years, were 57% female and 79% White. Religious/spiritual classifications were: Catholic (n = 18), Protestant (n = 76), Mormon (n = 3), none/atheist (n = 22), other (n = 5), and unknown (n = 2). Agreement at item level between spiritual well-being of adolescents and families was assessed. Three items had ≥90% agreement and Excellent PABAK: "I have a reason for living," "I feel loved," "I feel compassion for others in the difficulties they are facing." Three items had <61% agreement and Poor PABAK: "I feel a sense of harmony within myself," "My illness has strengthened my faith or spiritual beliefs," "I feel connected to a higher power (or God)." Dyadic congruence was compared by social-demographics using median one-way analysis. Male family members (median = 72%) were less likely to share spiritual beliefs with their adolescent than female family members (median = 83%), P = .0194. CONCLUSIONS: Family members may not share spiritual beliefs with adolescents and may be unaware of the importance of spiritual well-being for adolescents.
Livingston J; Cheng YI; Wang J; Tweddle M; Friebert S; Baker JN; Thompkins J; Lyon ME
Pediatric Blood and Cancer
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/pbc.28696" target="_blank" rel="noreferrer noopener">10.1002/pbc.28696</a>
Longitudinal Understanding of Prognosis among Adolescents with Cancer
Child; Adolescent; Female; Follow-Up Studies; Humans; Male; Parents/psychology; Prognosis; Longitudinal Studies; oncology; Surveys and Questionnaires; Communication; palliative care; psycho-oncology; psychosocial; Neoplasms/pathology/psychology/therapy; Oncologists/psychology
OBJECTIVE: Despite calls to increase prognosis communication for adolescents with cancer, limited research has examined their perceptions of prognosis as compared with their parents. We assessed adolescents' understanding of their prognosis relative to parents and oncologists. METHODS: Families of adolescents (aged 10-17) were recruited at two pediatric institutions following a new diagnosis or relapse. Seventy-four adolescents, 68 mothers, and 40 fathers participated at enrollment; 76 adolescents, 69 mothers, and 35 fathers participated one year later. The adolescent's primary oncologist reported on prognosis only at enrollment. Participants rated the likelihood of the adolescent's survival in five years, as well as reporting prognosis communication and sources of information. RESULTS: Most oncologists (65%) and fathers (63%) discussed prognosis in numerical terms with the adolescent at baseline, which was greater than mother report (49%) of discussions of numerical prognosis with adolescents. Adolescents reported a better prognosis than oncologists, but comparable with mothers at diagnosis and one year. Adolescents' prognosis estimates were stable over time (P > .05). At diagnosis, adolescent-father (P = 0.025) and adolescent-oncologist (P < 0.001) discrepancies were larger for youth with advanced than non-advanced cancer. Adolescents whose parents received numerical prognosis estimates from the oncologist, and whose fathers reported providing numerical prognosis estimates had more accurate understandings of prognosis (P < 0.05). CONCLUSIONS: Adolescent prognosis estimates were comparable with those of parents at diagnosis and one year but more favorable than that of oncologists. Although additional research is needed, results suggest discrepancies in prognosis estimates between family members and oncologists, particularly for adolescents with advanced cancer.
Fisher RS; Kenney AE; Fults MZ; Manring S; Rodriguez EM; Desjardins L; Rausch JR; Young-Saleme T; Ranalli MA; Vannatta K; Compas BE; Gerhardt CA
Pediatric Blood and Cancer
2021
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/pbc.28826" target="_blank" rel="noreferrer noopener">10.1002/pbc.28826</a>
A two-step multidisciplinary approach to treat recurrent esophageal strictures in children with epidermolysis bullosa dystrophica
Male; Treatment Outcome; Follow-Up Studies; Child; Humans; Adolescent; Female; Child Preschool; Infant; Recurrence; Combined Modality Therapy; Gastrostomy; Dilatation/methods; Epidermolysis Bullosa Dystrophica/complications; Esophageal Stenosis/etiology/therapy; feeding difficulties; Epidermolysis Bullosa; surgical intervention; orthograde balloon dilation; retrograde dilation; growth improvement; nutrition
In children with severe generalized recessive dystrophic epidermolysis bullosa (RDEB), esophageal scarring leads to esophageal strictures with dysphagia, followed by malnutrition and delayed development. We describe a two-step multidisciplinary therapeutic approach to overcome malnutrition and growth retardation. In Step 1, under general anesthesia, orthograde balloon dilation of the esophagus is followed by gastrostomy creation using a direct puncture technique. In Step 2, further esophageal strictures are treated by retrograde dilation via the established gastrostomy; this step requires only a short sedation period. A total of 12 patients (median age 7.8 years, range 6 weeks to 17 years) underwent successful orthograde balloon dilation of esophageal strictures combined with direct puncture gastrostomy. After 12 and 24 months in 11 children, a substantial improvement of growth and nutrition was achieved (body mass index [BMI] standard deviation score [SDS] + 0.59 and + 0.61, respectively). In one child, gastrostomy was removed because of skin ulcerations after 10 days. Recurrent esophageal strictures were treated successfully in five children. The combined approach of balloon dilation and gastrostomy is technically safe in children with RDEB, and helps to promote catch-up growth and body weight. In addition, recurrent esophageal strictures can be treated successfully without general anesthesia in a retrograde manner via the established gastrostomy.
Vowinkel T; Laukoetter M; Mennigen R; Hahnenkamp K; Gottschalk A; Boschin M; Frosch M; Senninger N; Tubergen D
Endoscopy
2015
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1055/s-0034-1391308" target="_blank" rel="noreferrer noopener">10.1055/s-0034-1391308</a>
Efficacy and tolerance of gastrostomy feeding in pediatric forms of neuromuscular diseases
Male; Treatment Outcome; Infant Newborn; Follow-Up Studies; Child; Humans; Adult; Adolescent; Female; Child Preschool; Infant; Nutritional Status; Weight Gain; Gastrostomy; Gastroesophageal Reflux/complications; Enteral Nutrition; Neuromuscular Diseases/complications/therapy; feeding difficulties; SMA type I; surgical intervention; percutaneous endoscopic gastrostomy; gastroesophageal reflux; GERD
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a simple and reliable method, but there are few data about its use in pediatric forms of neuromuscular diseases (NMD). The aim of this study was to evaluate the nutritional effects and tolerance of gastrostomy feeding in NMD patients. METHODS: Twelve patients with NMD, ranging in age from 1 month to 25.5 years, underwent a gastrostomy placement (PEG, n = 11; surgical gastrostomy, n = 1) between January 1990 and December 2000. Diseases were muscular dystrophies (n = 5), infantile spinal muscular atrophies (n = 3), congenital myopathies (n = 3), and polyradiculoneuritis (n = 1). Height-for-age (Z(H/A)), weight-for-age (Z(W/A)), and weight-for-height (Z(W/H)) z scores were assessed at birth, at the time of gastrostomy placement, after a 6-month and 1-year follow-up, and at the end of follow-up. Complications that occurred during the gastrostomy feeding period were recorded. Comparisons of z scores at the different times were performed with repeated-measures analyses of variance. RESULTS: Z(W/A) (p < .05) and Z(W/H) (p < .001) improved in the whole group after gastrostomy. For the 10 patients for whom follow-up was more than 1 year, Z(W/A) (p < .03) and Z(W/H) (p < .001) increased from the time of gastrostomy to the end of follow-up. Among 5 patients who had a gastroesophageal reflux diagnosed before gastrostomy placement, 3 had at least 1 episode of pneumonia and 2 died of respiratory distress caused by the worsening of NMD. No other major complication was encountered. CONCLUSIONS: Gastrostomy feeding is well tolerated and results in an improvement of nutritional indices in NMD patients. Special care should be taken in patients with preexisting gastroesophageal reflux.
Seguy D; Michaud L; Guimber D; Cuisset J; Devos P; Turck D; Gottrand F
Journal of Parenteral and Enteral Nutrition
2002
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0148607102026005298" target="_blank" rel="noreferrer noopener">10.1177/0148607102026005298</a>
Deep brain stimulation in children: experience and technical pearls
Adolescent; Adult; Age; Factors Brain/pa [Pathology]; Brain/ra [Radiography]; Child; Preschool; Deep Brain Stimulation/ae [Adverse Effects]; Deep Brain Stimulation/mt [Methods]; Dystonia/pp [Physiopathology]; Dystonia/th [Therapy]; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Movement; Retrospective Studies; Tomography; X-Ray Computed Treatment Outcome; tone and motor problems; Glutaric acidemia type I; Lesch-Nyhan syndrome; deep brain stimulation; secondary dystonia
OBJECT: Deep brain stimulation (DBS) is an established technique for the treatment of several movement disorders in adults. However, the technical approach, complications, and results of DBS in children have not been well documented. METHODS: A database of DBS implantations performed at a single institution, prospectively established in 1998, was reviewed for patients who received DBS prior to the age of 18. Diagnoses, surgical technique, and complications were noted. Outcomes were assessed using standard rating scales of neurological function. RESULTS: Of 815 patients undergoing DBS implantation over a 12-year period, 31 were children (mean age at surgery 13.2 years old, range 4-17 years old). Diagnoses included the following: DYT1 primary dystonia (autosomal dominant, Tor1ADELTAGAG mutation, 10 cases), non-DYT1 primary dystonia (3 cases), secondary dystonia (11 cases), neurodegeneration with brain iron accumulation (NBIA, 3 cases), levodopa-responsive parkinsonism (2 cases), Lesch-Nyhan disease (1 case), and glutaric aciduria Type 1 (1 case). Six children ages 15-17 years old underwent awake microelectrode-guided surgery. For 25 children operated under general anesthesia, the surgical technique evolved from microelectrode-guided surgery to image-guided surgeries using real-time intraoperative MR imaging or CT for lead location confirmation. Complications included 5 hardware infections, all in children younger than 10 years old. At 1 year after implantation, patients with DYT1 dystonia had a mean improvement in the Burke-Fahn-Marsden Dystonia Rating Scale movement subscore of 75%, while those with secondary dystonia had only small improvements. Outcomes in the 3 children with NBIA were disappointing. CONCLUSIONS: Results of DBS in children with primary and secondary dystonias were similar to those in adults, with excellent results for DYT1 dystonia in children without fixed orthopedic deformity and much more modest results in secondary dystonia. In contrast to reported experience in adults with NBIA, these results in children with NBIA were poor. Infection risk was highest in the youngest patients.
Air E L; Ostrem J L; Sanger T D; Starr P A
Journal of Neurosurgery - Pediatrics
2011
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<a href="http://doi.org/10.3171/2011.8.PEDS11153" target="_blank" rel="noreferrer noopener">10.3171/2011.8.PEDS11153</a>
Parents of children diagnosed with cancer: work situation and sick leave, a five-year post end-of-treatment or a child's death follow-up study
Survival Rate; Male; Treatment Outcome; Infant Newborn; Bereavement; Follow-Up Studies; Child; Humans; Adult; Adolescent; Female; Child Preschool; Infant; Survivors; Sweden; Sick Leave/statistics & numerical data; Fathers/psychology/statistics & numerical data; Mothers/psychology/statistics & numerical data; Neoplasms/economics/mortality/psychology/therapy
BACKGROUND: Cancer in a child is associated with a significant impact on parental employment. We assessed the proportions of parents of survivors and bereaved parents working and reporting sick leave five years after end of successful treatment (ST)/child's death (T7) compared with one year after end of ST/child's death (T6) and the association between partial post-traumatic stress disorder (PTSD) and work situation and sick leave at T7. Participants and procedure: The sample included 152 parents of survivors (77 mothers, 75 fathers) and 42 bereaved parents (22 mothers, 20 fathers) of children diagnosed with cancer in Sweden. RESULTS: The proportions of parents working or reporting sick leave did not differ among mothers and fathers of survivors (92% vs. 96% working, 20% vs. 18% on sick leave) or among bereaved mothers and fathers (91% vs. 90% working, 14% vs. 20% on sick leave) at T7. There was no change from T6 to T7 in the proportion of fathers working (fathers of survivors 91% vs. 96%, bereaved fathers 95% vs. 90%). Although more mothers of survivors (92% vs. 82%) and bereaved mothers (91% vs. 77%) worked at T7 than at T6, this increase was not significant. Fewer bereaved mothers reported sick leave at T7 than at T6 (14% vs. 59%, p < 0.05). Although more fathers reported sick leave at T7 than at T6 (fathers of survivors 18% vs. 8%, bereaved fathers 20% vs. 15%), this was not significant. Partial PTSD was not associated with parents' work situation or sick leave at T7. CONCLUSION: Results suggest little adverse effect on work situation and sick leave among parents of survivors and bereaved parents five years after end of ST/child's death from cancer. However, the pattern of change observed differed between parents, which could potentially indicate possible delayed consequences for fathers not captured in the present paper.
Wikman A; Hoven E; Cernvall M; Ljungman G; Ljungman L; von Essen L
Acta Oncologica
2016
<a href="http://doi.org/%2010.3109/0284186x.2016.1167956" target="_blank" rel="noreferrer noopener">10.3109/0284186x.2016.1167956</a>
Sick leave among parents of children with cancer - a national cohort study
Male; Infant Newborn; Follow-Up Studies; Prognosis; Parents/psychology; Child; Humans; Adult; Adolescent; Cohort Studies; Female; Child Preschool; Infant; Sweden/epidemiology; Only Child; Neoplasms/diagnosis/epidemiology/psychology; Registries; Sick Leave; Sick Leave/statistics & numerical data
BACKGROUND: Due to psychological distress and an increased care burden, parents of children diagnosed with cancer may face a higher risk of sickness absence from work. The objective of this study was to examine the association of childhood cancer with parents' sick leave. MATERIAL AND METHODS: The sample comprised 3626 parents of 1899 children diagnosed with cancer in Sweden during 2004-2009, and a matched control group of parents (n = 34 874). Sick leave was measured as number of days with sickness benefit, retrieved from national registries. Logistic and negative binomial regression models were used to compare outcomes with parents from the control cohort. RESULTS: The risk of sick leave was statistically significantly higher up to six years following a child's cancer diagnosis. The increase in number of days with sickness benefit was most pronounced the year after diagnosis. Although mothers' sick leave prevalence was higher, the increase in risk relative to control parents was similar for mothers and fathers. Bereavement was associated with a heightened risk of sick leave, especially on the year of the child's death. CONCLUSIONS: Findings confirm that mothers and fathers of children diagnosed with cancer are at higher risk of sickness absence from work, with particularly pronounced risk among bereaved parents. Acquisition of further knowledge is warranted regarding possibilities and constraints of parents trying to combine their work life with caring for both their child and themselves.
Hjelmstedt S; Lindahl NA; Montgomery S; Hed MI; Hoven E
Acta Oncologica
2017
<a href="http://doi.org/%2010.1080/0284186X.2016.1275780" target="_blank" rel="noreferrer noopener">10.1080/0284186X.2016.1275780</a>
Pediatric Palliative Care in Iran: Applying Regionalization of Health Care Systems
Palliative Care/og [Organization & Administration]; Neoplasms/th [Therapy]; Follow-Up Studies; Prognosis; Child; Humans; Qualitative Research; Quality of Health Care; Cancer Care Facilities/og [Organization & Administration]; Cancer Care Facilities/ut [Utilization]; Delivery of Health Care/og [Organization & Administration]; Health Services Accessibility/og [Organization & Administration]
Khanali ML; Rassouli M; Eshghi P; Zendedel K; Akbari Sari A; Heravi Karimooi M; Tahmasebi M; Shirin Abadi Farahani A
Asian Pacific Journal of Cancer Prevention
2018
<a href="http://doi.org/10.22034/APJCP.2018.19.5.1303" target="_blank" rel="noreferrer noopener">10.22034/APJCP.2018.19.5.1303</a>
Children's outcomes at 2-year follow-up after 4 years of structured multi-professional medical-ethical decision-making in a neonatal intensive care unit
OBJECTIVE: We reviewed our decisions about continuation/withdrawal of life-sustaining treatments in a group of critically ill newborns who were discussed in structured medical ethical decision-making meetings, and provide the surviving children's outcomes at 2-year follow-up. STUDY DESIGN: In an explorative observational study, 61 cases were evaluated. The children involved had been discussed in such a structured way from 2009 to 2012 in a level III-D neonatal intensive care unit. RESULTS: Decisions made were: full treatment (n=6), earlier restriction cancelled (n=3), treatment restriction (n=30) and palliative care (n=22). Parents of six children disagreed with the decision proposed. Thirteen (54%) of the 24 children who survived (39%) had moderate to severe neurological problems; 8 (33%) had additional sequelae; only one 2-year-old child was healthy. CONCLUSIONS: Decisions made varied to a large extent. The poor outcomes should be disseminated among decision makers. Future studies must explore new ways to improve outcome prediction, extend follow-up periods and consider what living with severe handicaps really means for both child and family.
de Boer JC; Gennissen L; Williams M; van Dijk M; Tibboel D; Reiss I; Naghib S; Sol J
Journal of Perinatology
2017
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<a href="http://doi.org/10.1038/jp.2017.30" target="_blank" rel="noreferrer noopener">10.1038/jp.2017.30</a>
Association between religious and socio-economic background of parents of children with solid tumors and DNR orders
adolescent; Child; Female; Humans; infant; Male; retrospective studies; Survival Rate; Young Adult; Neoplasms; decision making; Adult; Parents; Education; Prognosis; Follow-Up Studies; Socioeconomic Factors; Resuscitation Orders; Religion; Medical Records; Preschool
BACKGROUND: The influence of socio-economic and religious background on decisions made by parents of children with incurable cancer regarding DNR orders is not fully understood. PROCEDURE: A retrospective analysis of medical charts of patients who died between January 2000 and January 2011 was performed. The following data were sought: written evidence of DNR discussion with parents, religious background, educational level, monthly income. RESULTS: There was evidence of a discussion on DNR in 73/90 charts. DNR consent was obtained in 14/17 (82.4%) cases where at least one parent had >15 years of education versus in only 24/45 (53.3%) cases where both parents had ≤15 years education as determined by univariate analysis (P = 0.03). DNR consent was also more likely to be obtained among parents of children with income >10,000 NIS (24/30, 80.0% vs. 20/38, 52.6%, P = 0.013). Parents of Jewish (22/30, 73.3%), Islamic (16/26, 61.5%), and Christian (8/9, 88.9%) background were equally likely to provide DNR consent. However, Druze families were less likely to do so (2/8, 25.0%, P = 0.036). CONCLUSIONS: The process of decision-making to a DNR request was associated with parents' educational level and monthly family income, and not by religious background, with the exception of Druze families.
2014-02
Hileli I; Weyl Ben Arush M; Hakim F; Postovsky S
Pediatric Blood & Cancer
2014
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Journal Article
<a href="http://doi.org/10.1002/pbc.24712" target="_blank" rel="noreferrer">10.1002/pbc.24712</a>
Use of a clinical pathway to improve the acute management of vaso-occlusive crisis pain in pediatric sickle cell disease
adolescent; Child; Female; Humans; infant; Male; Young Adult; Pain; Pain Management; Adult; Analgesics; Prognosis; Follow-Up Studies; Prospective Studies; Critical Pathways; Anemia; Preschool; Arterial Occlusive Diseases; Sickle Cell; Tertiary Care Centers
BACKGROUND: The most common, debilitating morbidity of sickle cell disease (SCD) is vaso-occlusive crisis (VOC) pain. Although guidelines exist for its management, they are generally not well-followed, and research in other pediatric diseases has shown that clinical pathways improve care. The purpose of our study was to determine whether a clinical pathway improves the acute management of sickle cell vaso-occlusive crisis (VOC) pain in the pediatric emergency department (PED). PROCEDURE: Pain management practices were prospectively investigated before and after the initiation of a clinical pathway in the PED of an urban, tertiary care center with 50,000 ED visits per year and approximately 200 active sickle cell patients. The pathway included instructions for triage, monitoring, medication administration, and timing of assessments and interventions. Data were eligible from 35 pre-pathway and 33 post-pathway visits. Primary outcome was time interval to administration of first analgesic medication. Statistical analysis was by Student's t-test, using natural-log-transformed data for outcomes with skewed distribution curves. RESULTS: Time interval to first analgesic improved from 74 to 42 minutes (P = 0.012) and to first opioid from 94 to 46 minutes (P = 0.013). The percentage of patients who received ketorolac increased from 57% to 82% (P = 0.03). Decrease in time interval to subsequent pain score assessment was not statistically significant (110 to 72 minutes (P = 0.07)), and change in pain score was not different (P = 0.25). CONCLUSIONS: The use of a clinical pathway for sickle cell VOC in the PED can improve important aspects of pain management and merits further investigation and implementation.
2014-04
Ender KL; Krajewski JA; Babineau J; Tresgallo M; Schechter W; Saroyan JM; Kharbanda A
Pediatric Blood & Cancer
2014
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Journal Article
<a href="http://doi.org/10.1002/pbc.24864" target="_blank" rel="noreferrer">10.1002/pbc.24864</a>
Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: randomized controlled trial of efficacy and economic effects
adolescent; Child; Female; Humans; Male; Pain Management; Pain Measurement; Follow-Up Studies; Treatment Outcome; Chronic Pain; Inpatients; Depression; Catastrophization; Anxiety; Disability Evaluation
Pediatric chronic pain, which can result in deleterious effects for the child, bears the risk of aggravation into adulthood. Intensive interdisciplinary pain treatment (IIPT) might be an effective treatment, given the advantage of consulting with multiple professionals on a daily basis. Evidence for the effectiveness of IIPT is scarce. We investigated the efficacy of an IIPT within a randomized controlled trial by comparing an intervention group (IG) (n=52) to a waiting-list control group (WCG) (n=52). We made assessments before treatment (PRE), immediately after treatment (POST), as well as at short-term (POST6MONTHS) and long-term (POST12MONTHS) follow-up. We determined a combined endpoint, improvement (pain intensity, disability, school absence), and investigated 3 additional outcome domains (anxiety, depression, catastrophizing). We also investigated changes in economic parameters (health care use, parental work absenteeism, subjective financial burden) and their relationship to the child's improvement. Results at POST showed that significantly more children in the IG than in the WCG were assigned to improvement (55% compared to 14%; Fisher P<.001; 95% confidence interval for incidence difference: 0.21% to 0.60%). Although immediate effects were achieved for disability, school absence, depression, and catastrophizing, pain intensity and anxiety did not change until short-term follow-up. More than 60% of the children in both groups were improved long-term. The parents reported significant reductions in all economic parameters. The results from the present study support the efficacy of the IIPT. Future research is warranted to investigate differences in treatment response and to understand the changes in economic parameters in nonimproved children.
2014-01
Hechler T; Ruhe A-K; Schmidt P; Hirsch J; Wager J; Dobe M; Krummenauer F; Zernikow B
Pain
2014
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Journal Article
<a href="http://doi.org/10.1016/j.pain.2013.09.015" target="_blank" rel="noreferrer">10.1016/j.pain.2013.09.015</a>
Parent and clinician preferences for location of end-of-life care: Home, hospital or freestanding hospice?
adolescent; Child; Female; Humans; Male; Neoplasms; Terminal Care; home care services; hospice care; Parents; Prognosis; Questionnaires; Follow-Up Studies; Attitude to Death; Physicians; Choice Behavior; Residence Characteristics; Hospitals; quality of life; Preschool
BACKGROUND: Current options for location of end-of-life (EOL) care for children with cancer include home, hospital, and freestanding pediatric hospice (FSPH). However, access to these options varies greatly depending on geographical location. We aimed to determine bereaved parent and clinician preferences for location to EOL care and death. PROCEDURE: We administered questionnaires to 75 bereaved parents (response rate 54%) and 48 pediatric oncology clinicians (response rate 91%) at a large teaching hospital. Main outcome measure was parent and clinician ranking for preferred location of EOL care and death if given the options of home, hospital or FSPH. RESULTS: Majority of parents and clinicians ranked home as their first choice for EOL care (70.2% and 87%, respectively) and death (70.8% and 89.1%, respectively). Compared to clinicians, parents gave a higher ranking to hospital (P < 0.01) and lower ranking to FSPH (P < 0.01) as the preferred location for EOL care and death. Congruence between actual and preferred location of EOL care was more likely when a palliative care team was involved (P < 0.01) and less likely for children with haematologic malignancies (P = 0.03). CONCLUSIONS: Parents and clinicians prefer home as the location for EOL care and death for children with cancer. Hospital based palliative care is a preferred alternative if home is not desired. FSPH is a relatively recent phenomena and further research needs to be directed towards understanding its cost benefit in comparison to home and hospital-based EOL care. Pediatr Blood Cancer © 2013 Wiley Periodicals, Inc.
2013-11
Kassam A; Skiadaresis J; Alexander S; Wolfe J
Pediatric Blood & Cancer
2013
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Journal Article
<a href="http://doi.org/10.1002/pbc.24872" target="_blank" rel="noreferrer">10.1002/pbc.24872</a>
Exploring communication difficulties in pediatric hematology: oncology nurses
Child; Female; Humans; Male; Neoplasms; Terminal Care; Adult; Attitude of Health Personnel; Prognosis; Follow-Up Studies; Oncology Nursing; Communication Barriers; Qualitative Research; Pediatric Nursing; Nurse-Patient Relations; Hospitals; Hematology; Turkey; Nursing Staff; Pediatric; Hospital
BACKGROUND: Communication plays an important role for the well being of patients, families and also health care professionals in cancer care. Conversely, ineffective communication may cause depression, increased anxiety, hopelessness and decreased of quality life for patients, families and also nurses. OBJECTIVE: This study aimed to explore communication difficulties of pediatric hematology/oncology nurses with patients and their families, as well as their suggestions about communication difficulties. MATERIALS AND METHODS: It was conducted in a pediatric hematology/oncology hospital in Ankara, Turkey. Qualitative data were collected by focus groups, with 21 pediatric hematology/oncology nursing staff from three groups. Content analysis was used for data analysis. RESULTS: Findings were grouped in three main categories. The first category concerned communication difficulties, assessing problems in responding to questions, ineffective communication and conflicts with the patient's families. The second was about the effects of communication difficulties on nurses and the last main category involved suggestions for empowering nurses with communication difficulties, the theme being related to institutional issues. CONCLUSIONS: Nurses experience communication difficulties with children and their families during long hospital stays. Communication difficulties particularly increase during crisis periods, like at the time of first diagnosis, relapse, the terminal stage or on days with special meaning such as holidays. The results obtained indicate that pediatric nurses and the child/family need to be supported, especially during crisis periods. Feeling of empowerment in communication will improve the quality of care by reducing the feelings of exhaustion and incompetence in nurses.
2013
Citak EA; Toruner Ebru Kilicarslan; Gunes NB
Asian Pacific Journal Of Cancer Prevention
2013
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Journal Article
<a href="http://doi.org/10.7314/apjcp.2013.14.9.5477" target="_blank" rel="noreferrer">10.7314/apjcp.2013.14.9.5477</a>
Psychological health in siblings who lost a brother or sister to cancer 2 to 9 years earlier: Psychological health in siblings who lost a brother or sister to cancer
Child; Female; Humans; Male; Young Adult; bereavement; Neoplasms; Cohort Studies; Adult; Questionnaires; Follow-Up Studies; Self Concept; Siblings; Health Status; Mental Health; Sweden; Case-Control Studies; Adaptation; Psychological; sibling bereavement; Sleep Initiation and Maintenance Disorders
2013-03
Eilegård A; Steineck G; Nyberg T; Kreicbergs U
Psycho-oncology
2013
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Journal Article
<a href="http://doi.org/10.1002/pon.3053" target="_blank" rel="noreferrer">10.1002/pon.3053</a>
Long term posttraumatic growth after breast cancer: prevalence, predictors and relationships with psychological health
Cross-Sectional Studies; Female; Humans; Adult; Prevalence; Attitude to Health; Follow-Up Studies; Aged; Middle Aged; Predictive Value of Tests; Adaptation; Psychological; retrospective studies; Post-Traumatic/diagnosis/epidemiology/psychology; Stress Disorders; Disease-Free Survival; Breast Neoplasms/epidemiology/psychology; Quality of Life/psychology
This study evaluated the prevalence and predictors of long term posttraumatic growth (PTG) after breast cancer, and relationships of PTG with psychological health in a random sample of 307 currently disease-free women 5-15 years after diagnosis. This cross-sectional study reveals long term posttraumatic growth scores comparable to those found in shorter term studies. Prevalence of a better appreciation of life is especially noteworthy. With the exception of perceived current sequelae of disease associated in a somewhat curvilinear fashion with PTG, demographic and medical variables are poor predictors of the issue. On the contrary, dispositional positive affectivity and adaptative coping of positive, active, relational, religious and to some extent denial coping have a strong effect on growth. Finally, PTG is slightly associated with mental quality of life and happiness. Findings are discussed in the light of posttraumatic growth theory.
2010
Lelorain S; Bonnaud-Antignac A; Florin A
Journal Of Clinical Psychology In Medical Settings
2010
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Journal Article
<a href="http://doi.org/10.1007/s10880-009-9183-6" target="_blank" rel="noreferrer">10.1007/s10880-009-9183-6</a>
Long-term effects of the death of a child on parents' adjustment in midlife
Female; Humans; Male; Grief; Adult; Follow-Up Studies; Middle Aged; Death; Health Status; Longitudinal Studies; Wisconsin; Time; Stress; adolescent; Adaptation; Psychological; bereavement; Parents/psychology; Psychiatric Status Rating Scales; Marriage/psychology; Bereavement Leave Policy Paper; Depressive Disorder/diagnosis/etiology/psychology; Family Conflict/psychology; Psychological/diagnosis/etiology/psychology
The death of a child is a traumatic event that can have long-term effects on the lives of parents. This study examined bereaved parents of deceased children (infancy to age 34) and comparison parents with similar backgrounds (n = 428 per group) identified in the Wisconsin Longitudinal Study. An average of 18.05 years following the death, when parents were age 53, bereaved parents reported more depressive symptoms, poorer well-being, and more health problems and were more likely to have experienced a depressive episode and marital disruption than were comparison parents. Recovery from grief was associated with having a sense of life purpose and having additional children but was unrelated to the cause of death or the amount of time since the death. The results point to the need for detection and intervention to help those parents who are experiencing lasting grief.
2008
Rogers CH; Floyd FJ; Seltzer MM; Greenberg J; Hong J
Journal Of Family Psychology
2008
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Journal Article
<a href="http://doi.org/10.1037/0893-3200.22.2.203" target="_blank" rel="noreferrer">10.1037/0893-3200.22.2.203</a>
End-of-life practices in the Netherlands under the Euthanasia Act
Female; Humans; Male; Analgesics; Questionnaires; Follow-Up Studies; Aged; Middle Aged; Netherlands; Suicide; 80 and over; cause of death; Opioid/administration & dosage; Hypnotics and Sedatives/administration & dosage; Assisted/legislation & jurisprudence/statistics & numerical data/trends; Euthanasia/legislation & jurisprudence/statistics & numerical data/trends; Withholding Treatment/statistics & numerical data/trends
BACKGROUND: In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices. METHODS: We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%. RESULTS: In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used. CONCLUSIONS: The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.
2007
van der Heide A; Onwuteaka-Philipsen BD; Rurup ML; Buiting HM; van Delden JJ; Hanssen-de Wolf JE; Janssen AG; Pasman HR; Rietjens JA; Prins CJ; Deerenberg IM; Gevers JK; van der Maas PJ; van der Wal G
The New England Journal Of Medicine
2007
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Journal Article
<a href="http://doi.org/10.1056/NEJMsa071143" target="_blank" rel="noreferrer">10.1056/NEJMsa071143</a>
Ocular characteristics in 10 children with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency: a cross-sectional study with long-term follow-up
Child; Cross-Sectional Studies; Female; Humans; Male; Follow-Up Studies; Disease Progression; Mutation; Severity of Illness Index; Preschool; infant; Q3 Literature Search; Atrophy; 3-Hydroxyacyl CoA Dehydrogenases/deficiency; Metabolism; Visual Acuity; Choroid Diseases/etiology/pathology; Electroretinography; Eye Diseases/diagnosis/etiology/physiopathology; Hypoglycemia/complications; Inborn Errors/complications/genetics; Myopia/etiology/physiopathology; Retinal Diseases/etiology/pathology; Vision Disorders/etiology/physiopathology
PURPOSE: To present long-term ocular complications and electroretinographic (ERG) findings in children with long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency - a life-threatening metabolic disease - and the relation to age at diagnosis, treatment and other clinical parameters. METHODS: Ten children with LCHAD deficiency underwent repeated ophthalmological evaluations including ERG. RESULTS: All 10 children developed chorioretinal pathology. Regardless of age at diagnosis, initiation of treatment and age at examination, inter-individual differences were present. Profound chorioretinal atrophy, severe visual impairment and progressive myopia had developed in two teenagers. Milder chorioretinopathy with or without subnormal visual acuity was present in all other children. ERG was pathological in seven children. The chorioretinopathy often started in the peripapillary or perimacular areas. In one patient, unilateral visual impairment was associated with fibrosis. CONCLUSION: Early diagnosis and adequate therapy might delay but not prevent the progression of retinal complications. Late diagnosis with severe symptoms at diagnosis, neonatal hypoglycaemia and frequent decompensations may increase the progression rate of the chorioretinopathy. LCHAD deficiency, a potentially lethal disease, is sometimes difficult to diagnose. Unusual chorioretinal findings should alert the ophthalmologist to the long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, especially if there is a history of neonatal hypoglycaemia or failure to thrive.
2008
Fahnehjelm KT; Holmstrom G; Ying L; Haglind CB; Nordenstrom A; Halldin M; Alm J; Nemeth A; von Dobeln U
Acta Ophthalmologica
2008
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Journal Article
<a href="http://doi.org/10.1111/j.1600-0420.2007.01121.x" target="_blank" rel="noreferrer">10.1111/j.1600-0420.2007.01121.x</a>
Efficacy and tolerability of levetiracetam versus phenytoin after supratentorial neurosurgery
Female; Humans; Male; Adult; Follow-Up Studies; Aged; Middle Aged; Treatment Outcome; 80 and over; retrospective studies; Anticonvulsants/administration & dosage/adverse effects; Brain Injuries/complications/surgery; Brain/drug effects/physiopathology/surgery; Drug Tolerance/physiology; Drug Toxicity; Epilepsy/drug therapy/etiology/prevention & control; Neurosurgical Procedures/adverse effects; Phenytoin/administration & dosage/adverse effects; Piracetam/administration & dosage/adverse effects/analogs & derivatives; Postoperative Complications/drug therapy/prevention & control; Supratentorial Neoplasms/complications/surgery
BACKGROUND: Antiepileptic drugs are routinely given after craniotomy. Though phenytoin (PHT) is still the most commonly used agent, levetiracetam (LEV) is increasingly administered for this purpose. This retrospective study compared the use of LEV and PHT as monotherapy prophylaxis following supratentorial neurosurgery. METHODS: Patients receiving LEV monotherapy after supratentorial craniotomy were reviewed and compared to a control group of patients receiving PHT monotherapy. RESULTS: One of 105 patients taking LEV and 9/210 patients taking PHT had seizures within 7 days of surgery (p = 0.17). Adverse drug reactions requiring change in therapy during hospitalization occurred in 1/105 patients taking LEV and 38/210 patients taking PHT (p < 0.001). Among patients followed for at least 12 months, 11/42 (26%) treated with LEV vs 42/117 (36%) treated with PHT developed epilepsy (p = 0.34); 64% remained on LEV, while 26% remained on PHT (p = 0.03). CONCLUSIONS: Both levetiracetam (LEV) and phenytoin (PHT) were associated with a low risk of early postoperative seizures and a moderate risk of later epilepsy. LEV was associated with significantly fewer early adverse reactions than PHT and with a higher retention rate in patients who were followed for at least 1 year and developed epilepsy.
2008
Milligan TA; Hurwitz S; Bromfield EB
Neurology
2008
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Journal Article
<a href="http://doi.org/10.1212/01.wnl.0000324624.52935.46" target="_blank" rel="noreferrer">10.1212/01.wnl.0000324624.52935.46</a>
Information exchange among physicians caring for the same patient in the community
Female; Humans; Male; Follow-Up Studies; Prospective Studies; Middle Aged; Cooperative Behavior; Communication; Physicians; Ontario; Continuity of Patient Care; Hospitals; Community; University; Access to Information; Medical Record Linkage; Office Visits
BACKGROUND: The exchange of information is an integral component of continuity of health care and may limit or prevent costly duplication of tests and treatments. This study determined the probability that patient information from previous visits with other physicians was available for a current physician visit. METHODS: We conducted a multicentre prospective cohort study including patients discharged from the medical or surgical services of 11 community and academic hospitals in Ontario. Patients included in the study saw at least 2 different physicians during the 6 months after discharge. The primary outcome was whether information from a previous visit with another physician was available at the current visit. We determined the availability of previous information using surveys of or interviews with the physicians seen during current visits. RESULTS: A total of 3250 patients, with a total of 39 469 previous-current visit combinations, met the inclusion criteria. Overall, information about the previous visit was available 22.0% of the time. Information was more likely to be available if the current doctor was a family physician (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.54-1.98) or a physician who had treated the patient before the hospital admission (OR 1.33, 95% CI 1.21-1.46). Conversely, information was less likely to be available if the previous doctor was a family physician (OR 0.38, 95% CI 0.32-0.44) or a physician who had treated the patient before the admission (OR 0.72, 95% CI 0.60-0.86). The strongest predictor of information exchange was the current physician having previously received information about the patient from the previous physician (OR 7.72, 95% CI 6.92-8.63). INTERPRETATION: Health care information is often not shared among multiple physicians treating the same patient. This situation would be improved if information from family physicians and patients' regular physicians was more systematically available to other physicians.
2008
van Walraven C; Taljaard M; Bell CM; Etchells E; Zarnke KB; Stiell IG; Forster AJ
Canadian Medical Association Journal
2008
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Journal Article
<a href="http://doi.org/10.1503/cmaj.080430" target="_blank" rel="noreferrer">10.1503/cmaj.080430</a>
Handgrip strength and mortality in the oldest old population: the Leiden 85-plus study
Female; Humans; Male; mortality; Follow-Up Studies; Prospective Studies; Aged; Comorbidity; Netherlands; Activities of Daily Living; Depression; Kaplan-Meier Estimate; Disability Evaluation; 80 and over; Study Design; Neuropsychological Tests; Hand Strength; Cardiovascular Diseases; Muscle Strength Dynamometer
BACKGROUND: Poor muscular strength has been shown to be associated with increased morbidity and mortality in diverse samples of middle-aged and elderly people. However, the oldest old population (i.e., over 85 years) is underrepresented in such studies. Our objective was to assess the association between muscular strength and mortality in the oldest old population. METHODS: We included 555 participants (65% women) from the Leiden 85-plus study, a prospective population-based study of all 85-year-old inhabitants of Leiden, Netherlands. We measured the handgrip strength of participants at baseline and again at age 89 years. We collected baseline data on comorbidities, functional status, levels of physical activity, and adjusted for potential confounders. During the follow-up period, we collected data on mortality. RESULTS: During a follow-up period of 9.5 years (range 8.5-10.5 years), 444 (80%) participants died. Risk for all-cause mortality was elevated among participants in the lowest tertile of handgrip strength at age 85 years (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.00-1.82, p = 0.047) and the lowest two tertiles of handgrip strength at age 89 years (HR 2.04, CI 1.24-3.35, p = 0.005 and HR 1.73, CI 1.11-2.70, p = 0.016). We also observed significantly increased mortality among participants in the tertile with the highest relative loss of handgrip strength over four years (HR 1.72, CI 1.07-2.77, p = 0.026). INTERPRETATION: Handgrip strength, a surrogate measurement of overall muscular strength, is a predictor of all-cause mortality in the oldest old population and may serve as a convenient tool for prognostication of mortality risk among elderly people.
2010-03
Ling CHY; Taekema D; de Craen Anton JM; Gussekloo J; Westendorp RG; Maier AB
Canadian Medical Association Journal
2010
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Journal Article
<a href="http://doi.org/10.1503/cmaj.091278" target="_blank" rel="noreferrer">10.1503/cmaj.091278</a>
Long-term outcome and clinical spectrum of 73 pediatric patients with mitochondrial diseases
Child; Female; Humans; infant; Male; Cohort Studies; Follow-Up Studies; Severity of Illness Index; Survival Analysis; Longitudinal Studies; Probability; Time Factors; Proportional Hazards Models; Preschool; infant; Q3 Literature Search; Newborn; AIM; IM; retrospective studies; cause of death; DNA; Mitochondrial Diseases/ge [Genetics]; Mitochondrial/ge [Genetics]; MELAS Syndrome/di [Diagnosis]; Mitochondrial Encephalomyopathies/di [Diagnosis]; DNA Fragmentation; HEREDITARY; Leber/di [Diagnosis]; Leber/ge [Genetics]; Leber/mo [Mortality]; MELAS Syndrome/mo [Mortality]; MELAS Syndrome/th [Therapy]; Mitochondrial Diseases/di [Diagnosis]; Mitochondrial Diseases/mo [Mortality]; Mitochondrial Encephalomyopathies/mo [Mortality]; Mitochondrial Encephalomyopathies/th [Therapy]; Mitochondrial Myopathies/di [Diagnosis]; Mitochondrial Myopathies/ge [Genetics]; Mitochondrial Myopathies/mo [Mortality]; Optic Atrophy
OBJECTIVES: We sought to determine the clinical spectrum, survival, and long-term functional outcome of a cohort of pediatric patients with mitochondrial diseases and to identify prognostic factors. METHODS: Medical charts were reviewed for 73 children diagnosed between 1985 and 2005. The functional status of living patients was assessed prospectively by using the standardized Functional Independence Measure scales. RESULTS: Patients fell into 7 phenotypic categories: neonatal-onset lactic acidosis (10%), Leigh syndrome (18%), nonspecific encephalopathy (32%), mitochondrial (encephalo)myopathy (19%), intermittent neurologic (5%), visceral (11%), and Leber hereditary optic neuropathy (5%). Age at first symptoms ranged from prenatal to 16 years (median: 7 months). Neurologic symptoms were the most common (90%). Visceral involvement was observed in 29% of the patients. A biochemical or molecular diagnosis was identified for 81% of the patients as follows: deficiency of complex IV (27%), of pyruvate dehydrogenase or complex I (25% each), of multiple complexes (13%), and of pyruvate carboxylase (5%) or complexes II+III (5%). A mitochondrial DNA mutation was found in 20% of patients. At present, 46% of patients have died (median age: 13 months), 80% of whom were 5 years (n = 32), 62% had Functional Independence Measure quotients of >0.75. CONCLUSIONS: Mitochondrial diseases in children span a wide range of symptoms and severities. Age at first symptoms is the strongest predictor mortality. Despite a high mortality rate in the cohort, 62% of patients aged >5 years have only mild impairment or normal functional outcome.
2007
Debray FG; Lambert M; Chevalier I; Robitaille Y; Decarie JC; Shoubridge EA; Robinson BH; Mitchell GA
Pediatrics
2007
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Journal Article
<a href="http://doi.org/10.1542/peds.2006-1866" target="_blank" rel="noreferrer">10.1542/peds.2006-1866</a>
Transdermal fentanyl in the management of children with chronic severe pain: results from an international study
Child; Female; Humans; Male; Pain; Pain Measurement; Analgesics; Follow-Up Studies; Severity of Illness Index; Risk Assessment; Single-Blind Method; International Cooperation; adolescent; Preschool; Chronic disease; Administration; Dose-Response Relationship; Drug; Opioid/administration & dosage; Cutaneous; Fentanyl/administration & dosage; Intractable/diagnosis/drug therapy; Skin Absorption/drug effects
BACKGROUND: The current study was conducted to assess the safety and tolerability of a transdermal fentanyl delivery system for the relief of chronic pain in a pediatric population, and also to validate titration recommendations and conversion to transdermal fentanyl from oral opioid therapy. METHODS: This 15-day (with 3-month extension), single-arm, open-label trial was conducted at 66 sites in 10 countries. A total of 199 pediatric patients (ages 2-16 years) with both malignant and nonmalignant conditions who were receiving oral or parenteral opioids for moderate to severe chronic pain were enrolled. Transdermal fentanyl doses were titrated upward according to the rescue medication consumed during the previous application period. Degree of pain was assessed by patients and parents/guardians using visual and numeric scales. Level of play and quality of life were assessed using the Play Performance Scale (PPS) and the Child Health Questionnaire (CHQ). Adverse events were monitored on Days 1-15. Hypoventilation and sedation were monitored every 4 hours during the first 72 hours of the study. RESULTS: A total of 173 patients completed the primary treatment period and 130 entered the extension phase. The average daily pain intensity scores were reported to have decreased by Day 16 and improvements in the mean PPS scores were observed to the end of the extension period. The CHQ scores demonstrated improvements in 11 of 12 domains after Month 1 of the extension period. CONCLUSIONS: Transdermal fentanyl was found to be a safe and well tolerated alternative to oral opioid treatment for children ages 2-16 years who were previously exposed to opioid therapy.
2005
Finkel JC; Finley A; Greco C; Weisman SJ; Zeltzer L
Cancer
2005
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Journal Article
<a href="http://doi.org/10.1002/cncr.21497" target="_blank" rel="noreferrer">10.1002/cncr.21497</a>
Neurologically impaired children and digestive problems
Child; Humans; Follow-Up Studies; Prospective Studies; Treatment Outcome; Fundoplication; Enteral Nutrition; adolescent; Preschool; infant; Q3 Literature Search; Injections; disabled children; Botulinum Toxin Type A/administration & dosage; Brain Damage; Chronic/complications/therapy; France; Gastric Acidity Determination; Gastroesophageal Reflux/complications/therapy; Gastroscopy; Intramuscular; Protein-Energy Malnutrition/etiology/therapy
2006
Podevin G; Capito C; Leclair MD; Heloury Y
Archives De Pediatrie
2006
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Journal Article
<a href="http://doi.org/10.1016/j.arcped.2006.03.041" target="_blank" rel="noreferrer">10.1016/j.arcped.2006.03.041</a>
Safety and efficacy of rosuvastatin therapy for the prevention of hyperlipidemia in adult cardiac transplant recipients
Female; Humans; Male; Survival Rate; Cohort Studies; Follow-Up Studies; Prospective Studies; Aged; Middle Aged; Treatment Outcome; Risk Assessment; Drug Administration Schedule; 80 and over; Comparative Study; Dose-Response Relationship; Drug; Graft Survival; control; dosage; Fluorobenzenes/administration &; Graft Rejection; Heart Transplantation/adverse effects/methods; Hyperlipidemia/drug therapy/prevention &; Postoperative Complications/prevention &; Pyrimidines/administration &; Sulfonamides/administration &
BACKGROUND: Hyperlipidemia after orthotopic heart transplantation (OHT) is associated with immunosuppression. Many OHT patients have increased lipid levels above published guidelines despite treatment with high doses of statins. Treatment with rosuvastatin (ROS) in OHT patients has not yet been evaluated. Therefore, we assessed its efficacy and safety in an OHT population. METHODS: Twenty-one OHT recipients, median age 66 years, whose lipid levels were sub-optimal on the highest tolerated doses of statins, received ROS in addition to standard immunosuppression. Total cholesterol (TC), low-density lipoprotein (LDL-C) and high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), liver transaminases (AST) and creatinine kinase (CK) were measured before and during treatment with ROS. RESULTS: After 6 weeks on an average ROS dose of 10 mg/day, a TC:HDL-C ratio of <4 was reached in 76% of patients, and 70% of patients reached an LDL-C level of <2.5 mmol/liter (100 mg/dl). TC decreased to <5.2 mmol/liter (200 mg/dl) in 80% of patients and TG decreased to <2 mmol/liter (175 mg/dl) in 61% of patients. Except for the HDL-C increase, all changes were statistically significant. The decrease in the median TC:HDL-C ratio between baseline and 6 weeks was also statistically significant (p = 0.001). There were no significant changes in CK or AST levels, and no clinical evidence of myositis. One patient developed myalgia and 2 were withdrawn from the study because of mild elevation of CK (<3-fold upper limit of normal [ULN]). CONCLUSIONS: In the setting of tertiary referral centers, ROS appears to be safe and effective in lowering LDL-C in OHT recipients in whom treatment with other statins failed to achieve target LDL-C. No evidence of liver or muscle dysfunction was noted. Long-term studies are needed to ascertain the effect of ROS therapy on incidence of coronary artery disease (CAD) in this population.
2005
Samman A; Imai C; Straatman L; Frolich J; Humphries K; Ignaszewski A
The Journal Of Heart And Lung Transplantation : The Official Publication Of The International Society For Heart Transplantation
2005
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Journal Article
<a href="http://doi.org/10.1016/j.healun.2004.07.016" target="_blank" rel="noreferrer">10.1016/j.healun.2004.07.016</a>
The ocular features of the mucopolysaccharidoses
Child; Female; Humans; Male; Adult; Follow-Up Studies; adolescent; Preschool; infant; Q3 Literature Search; retrospective studies; Corneal Opacity/etiology; Eye Diseases/etiology; Mucopolysaccharidoses/complications; Mucopolysaccharidosis I/complications; Mucopolysaccharidosis VI/complications; Ocular Hypertension/etiology; Optic Atrophy/etiology; Papilledema/etiology; Vision Disorders/etiology; Visual Acuity
AIMS: The mucopolysaccharidoses (MPS) are a heterogeneous group of rare disorders characterised by accumulation of glycosaminoglycans within multiple organ systems. This study aimed to determine the prevalence and severity of ocular complications in patients with MPS. METHODS: Clinical ophthalmic features and electrodiagnostic results of 50 patients with a diagnosis of MPS were retrospectively reviewed. RESULTS: A total of 79% of MPS IH patients had a visual acuity of less than 6/12 equivalent in their better eye, compared to 44% of MPS IH/S and 25% of MPS VI patients. In total, 16% of MPS IH and 25% of MPS IH/S had severe corneal opacification, compared to 38% of MPS VI patients. 16% of MPS IH patients had optic atrophy; 21% of MPS VI patients had mild disc swelling, 29% had markedly swollen discs, and 14% had optic atrophy. One patient with MPS IH, one with MPS IH/S and six with MPS VI had ocular hypertension. One MPS VI patient had glaucoma that required topical therapy. Nine patients with MPS IH had electrodiagnostic evidence of retinopathy, as did one MPS VI patient. CONCLUSIONS: Ocular complications causing significant reduction in vision are common in MPS. The majority of MPS I and MPS VI patients have corneal opacification, which can lead to difficulties in diagnosis and monitoring of glaucoma, optic disc changes, and retinopathy.
2006
Ashworth JL; Biswas S; Wraith E; Lloyd IC
Eye (london, England)
2006
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Journal Article
<a href="http://doi.org/10.1038/sj.eye.6701921" target="_blank" rel="noreferrer">10.1038/sj.eye.6701921</a>
Hospitalization for mental illness among parents after the death of a child.
Child; Female; Humans; Male; Adult; Follow-Up Studies; Middle Aged; Death; Longitudinal Studies; Sex Factors; Life Change Events; Hospitals; Risk; Regression Analysis; Registries; Preschool; Non-U.S. Gov't; Research Support; bereavement; infant; Comparative Study; Parents/psychology; Substance-Related Disorders/epidemiology; Hospitalization/statistics & numerical data; Mental Disorders/epidemiology; Mood Disorders/epidemiology; Psychiatric; Schizophrenia/epidemiology
BACKGROUND: The loss of a child is considered one of the most stressful events in the life of a parent. We hypothesized that parental bereavement increases the risk of hospital admission for a psychiatric disorder, especially for affective disorders. METHODS: We studied a cohort of 1,082,503 persons identified from national registers in Denmark who were born between 1952 and 1999 and had at least one child under 18 years of age during the follow-up period, from 1970 to 1999. Parents who lost a child during follow-up were categorized as "bereaved" from the date of death of the child. RESULTS: As compared with parents who did not lose a child, parents who lost a child had an overall relative risk of a first psychiatric hospitalization for any disorder of 1.67 (95 percent confidence interval, 1.53 to 1.83). Bereaved mothers had a higher relative risk of being hospitalized for any psychiatric disorder than bereaved fathers (relative risks, 1.78 [95 percent confidence interval, 1.60 to 1.98] and 1.38 [95 percent confidence interval, 1.17 to 1.63], respectively; P value for interaction, 0.01). The relative risks of hospitalization specifically for affective disorders were 1.91 (95 percent confidence interval, 1.59 to 2.30) and 1.61 (95 percent confidence interval, 1.15 to 2.27) for bereaved mothers and fathers, respectively. Among mothers, the relative risk of being hospitalized for any psychiatric disorder was highest during the first year after the death of the child but remained significantly elevated five years or more after the death. CONCLUSIONS: The risk of psychiatric hospitalization was increased among parents, especially mothers, who lost a child.
2005
Li J; Laursen TM; Precht DH; Olsen J; Mortensen PB
The New England Journal Of Medicine
2005
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Journal Article
<a href="http://doi.org/10.1056/NEJMoa033160" target="_blank" rel="noreferrer">10.1056/NEJMoa033160</a>
The spectrum of adult congenital heart disease in Europe: morbidity and mortality in a 5 year follow-up period. The Euro Heart Survey on adult congenital heart disease
Female; Humans; Male; Pregnancy; Pregnancy Complications; Adult; Data Collection; Follow-Up Studies; Aged; Middle Aged; Survival Analysis; adolescent; Adolescent Transitions; Patient Acceptance of Health Care/statistics & numerical data; Heart Defects; Europe/epidemiology; Ambulatory Care/statistics & numerical data; Cardiovascular Agents/therapeutic use; Cardiovascular/mortality; Congenital/mortality
AIMS: To describe clinical and demographic characteristics at baseline of a European cohort of adults with congenital heart disease (CHD) and to assess mortality and morbidity in a 5 year follow-up period. METHODS AND RESULTS: Data collected as part of the Euro Heart Survey on adult CHD was analysed. This entailed information transcribed from the files of 4110 patients diagnosed with one of eight congenital heart conditions ('defects'), who consecutively visited the outpatient clinics of one of the participating centres in 1998. The patients were included retrospectively and followed until the end of 2003 for a median follow-up of 5.1 years. Notwithstanding their overall relatively good functional class and low mortality over the follow-up period, a considerable proportion of the patients had a history of endocarditis, arrhythmias, or vascular events. There were major differences between the eight defects, both in morbidity and regarding specific characteristics. Outcomes were worst in cyanotic defects and in the Fontan circulation, but a considerable proportion of the other patients also suffer from cardiac symptoms. In particular, arrhythmias are common. CONCLUSION: The spectrum of adult CHD in Europe emerging from this survey is one of a predominantly young population with substantial morbidity but relatively low mortality in a 5 year period.
2005
Engelfriet P; Boersma E; Oechslin E; Tijssen J; Gatzoulis MA; Thilen U; Kaemmerer H; Moons P; Meijboom F; Popelova J; Laforest V; Hirsch R; Daliento L; Thaulow E; Mulder B
European Heart Journal
2005
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Journal Article
<a href="http://doi.org/10.1093/eurheartj/ehi396" target="_blank" rel="noreferrer">10.1093/eurheartj/ehi396</a>
Brief report: family-based group intervention for young siblings of children with chronic illness and developmental disability
adolescent; Child; Female; Humans; infant; Male; Adult; Chronic disease; Follow-Up Studies; Siblings; Social Adjustment; Developmental Disabilities; Family Therapy; Analysis of Variance; Practice; Preschool; Adaptation; Psychological; Attitudes; PedPal Lit; Health Knowledge; Intervention; Interventions; sibling bereavement
OBJECTIVE: To evaluate the impact of a family-based group intervention for young siblings of children with chronic illness and developmental disability (CI/DD). METHODS: Forty-three healthy siblings (ages 4-7 years) of children with CI/DD and their parents participated in an intervention designed to address sibling challenges that cut across types of diagnostic conditions. The intervention consisted of six sessions of collateral and integrated sibling-parent groups. Measures of sibling knowledge, sibling sense of connectedness with other children in similar family circumstances, and sibling global functioning were collected before and after intervention. A subsample of 17 families completed a 3-month follow-up. RESULTS: Siblings' knowledge of the child's disorder and sibling connectedness increased significantly from pre- to posttreatment for both boys and girls, regardless of the nature of the brother or sister's condition. Sibling perceptions of self-competence increased from pre- to posttreatment, whereas parent reports of sibling behavioral functioning remained within the normal range. Improvements in sibling knowledge and connectedness maintained at follow-up. Parent satisfaction with the program was high. CONCLUSIONS: Results support more controlled evaluations of family-based intervention to improve young sibling adaptation to CI/DD.
2005-12
Lobato DJ; Kao BT
Journal of Pediatric Psychology
2005
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/jpepsy/jsi054" target="_blank" rel="noreferrer">10.1093/jpepsy/jsi054</a>
Psychological Distress and the Impact of Social Support on Fathers and Mothers of Pediatric Cancer Patients: Long-Term Prospective Results
Child; Humans; Adult; Questionnaires; Follow-Up Studies; Prospective Studies; PedPal Lit; Mothers/psychology; Neoplasms; social support; Parent caregivers; Depression/diagnosis/psychology; Fathers/psychology
2005
Wijnberg-Williams BJ; Kamps WA; Klip EC; Hoekstra-Weebers JE
Journal of Pediatric Psychology
2005
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Journal Article
<a href="http://doi.org/10.1093/jpepsy/jsj087" target="_blank" rel="noreferrer">10.1093/jpepsy/jsj087</a>
Family focused grief therapy: a randomized, controlled trial in palliative care and bereavement
Female; Humans; Male; Grief; Palliative Care; Terminal Care; Adult; Follow-Up Studies; Middle Aged; Family Relations; Treatment Outcome; Longitudinal Studies; Social Adjustment; Family Health; Personality Inventory; Stress; bereavement; Caregivers/psychology; Family/psychology; SSHRC CURA; Family Therapy/methods; Depressive Disorder/therapy; Psychological/therapy
OBJECTIVE: The aim of family focused grief therapy is to reduce the morbid effects of grief among families at risk of poor psychosocial outcome. It commences during palliative care of terminally ill patients and continues into bereavement. The authors report a randomized, controlled trial. METHOD: Using the Family Relationships Index, the authors screened 257 families of patients dying from cancer: 183 (71%) were at risk, and 81 of those (44%) participated in the trial. They were randomly assigned (in a 2:1 ratio) to family focused grief therapy (53 families, 233 individuals) or a control condition (28 families, 130 individuals). Assessments occurred at baseline and 6 and 13 months after the patient's death. The primary outcome measures were the Brief Symptom Inventory, Beck Depression Inventory, and Social Adjustment Scale. The Family Assessment Device was a secondary outcome measure. Analyses allowed for correlated family data and employed generalized estimating equations based on intention to treat and controlling for site. RESULTS: The overall impact of family focused grief therapy was modest, with a reduction in distress at 13 months. Significant improvements in distress and depression occurred among individuals with high baseline scores on the Brief Symptom Inventory and Beck Depression Inventory. Global family functioning did not change. Sullen families and those with intermediate functioning tended to improve overall, whereas depression was unchanged in hostile families. CONCLUSIONS: Family focused grief therapy has the potential to prevent pathological grief. Benefit is clear for intermediate and sullen families. Care is needed to avoid increasing conflict in hostile families.
2006
Kissane DW; McKenzie M; Bloch S; Moskowitz C; McKenzie DP; O'Neill I
The American Journal Of Psychiatry
2006
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Journal Article
<a href="http://doi.org/10.1176/appi.ajp.163.7.1208" target="_blank" rel="noreferrer">10.1176/appi.ajp.163.7.1208</a>
Course of disability and respiratory function in untreated late-onset Pompe disease
Child; Female; Humans; Male; Adult; Questionnaires; Follow-Up Studies; Aged; Middle Aged; Disease Progression; Disabled Persons; Time Factors; adolescent; Preschool; 80 and over; Q3 Literature Search; Age of Onset; Respiratory Function Tests; Glycogen Storage Disease Type II/physiopathology
Fifty-two untreated patients with late-onset Pompe disease completed questionnaires about their clinical condition and level of handicap at baseline and at 1-year (n = 41) and 2-year follow-ups (n = 40). During this period, declines in functional activities, respiratory function, handicap, and survival were recorded on a group level. This study illustrates the progressiveness of late-onset Pompe disease and indicates the need for close clinical follow-up of both children and adults with this disorder.
2006
Hagemans ML; Hop WJ; Van Doorn PA; Reuser AJ; Van der Ploeg AT
Neurology
2006
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Journal Article
<a href="http://doi.org/10.1212/01.wnl.0000198776.53007.2c" target="_blank" rel="noreferrer">10.1212/01.wnl.0000198776.53007.2c</a>
Bereavement care for families part 2: Evaluation of a paediatric follow-up programme
Child; Female; Humans; Male; Pediatrics; Family; Follow-Up Studies; Program Evaluation; bereavement
In North America, parents are not expected to outlive their child. When they do, neighbours, co-workers, friends and family do not know what to say or do resulting in parents feeling isolated in their grief and left alone to find the support they need. The Paediatric Palliative Care team at Capital Health's, Stollery Children's Hospital (Stollery) in Edmonton, Alberta, Canada began a programme of bereavement follow-ups in April 2002 to offer support to families who had experienced the death of their child. In Part 1 of this article (deJong-Berg and deVlamming, 2005) implementation and the current state of the programme is outlined, and in Part 2 we present the results of the programme evaluation conducted in spring, 2005. Eighty-one families were invited to take part in a satisfaction survey to determine the helpfulness of this bereavement follow-up programme. Twenty-nine parents, representing 21 families, took part. Parents reported that written information received was useful and that they felt supported knowing a resource was available. They also felt also felt that the programme extended the care given by the Stollery staff throughout their child's illness and death. This article reports the findings of the programme evaluation and discusses the implications for practice and future research.
2006
deJong-Berg MA; Kane L
International Journal Of Palliative Nursing
2006
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Journal Article
<a href="http://doi.org/10.12968/ijpn.2006.12.10.22121" target="_blank" rel="noreferrer">10.12968/ijpn.2006.12.10.22121</a>
Long-term follow-up of neonatal mitochondrial cytopathies: a study of 57 patients
Child; Female; Humans; infant; Male; Prognosis; Follow-Up Studies; Disease Progression; Longitudinal Studies; Preschool; infant; Newborn; Diseases/blood/diagnosis/mortality; Lactic Acid/blood; Mitochondrial Myopathies/blood/complications/diagnosis/mortality
OBJECTIVES: We sought to determine the long-term clinical and biochemical outcome of newborns with mitochondrial cytopathies (MCs) and to identify possible prognostic factors that may modify the course of these diseases. MATERIAL AND METHODS: Fifty-seven newborns with MCs were identified in a retrospective review (1983-2002). We defined 2 different outcome categories: clinical (neurologic, hepatic, myopathic, and multiorganic) and biochemical (lactate level normalization or initially normal remaining unchanged, decreased but not normalized, and persistently high). We used 2 different statistical approaches: (1) survival studies depending on the initial symptoms and lactate and enzymatic deficiencies using the Kaplan-Meier method; and (2) the same variables compared with different survival age groups and clinical and biochemical outcome categories using the chi2 test. RESULTS: Thirty-three patients died (57.8%), 12 remain alive (21%), and 12 were lost in the follow-up; 6 of them are currently older than 4 years. Most of the patients manifested multiorganic disease (64.8%) and high lactate level (77.1%) over time. Children surviving to 2.5 to 3 years of age were more likely to survive for a long period of time. Initial neurologic and hepatic presentation increased the risk to develop neurologic disease and severe persistent hyperlactacidemia, respectively. Initial severe hyperlactacidemia and combined enzyme deficiencies were significant risk factors for higher mortality and multiorganic disorders. Two patients with exclusively myopathic outcome are alive and cognitively normal at 12 years of life. CONCLUSIONS: Children with neonatal-onset MCs have very high mortality and poor prospects. However, some with life-threatening presentations may gradually improve, giving rise to less severe diseases. Those with exclusively myopathic symptoms have a better prognosis.
2005
Garcia-Cazorla A; De Lonlay P; Nassogne MC; Rustin P; Touati G; Saudubray JM
Pediatrics
2005
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Journal Article
<a href="http://doi.org/10.1542/peds.2004-2407" target="_blank" rel="noreferrer">10.1542/peds.2004-2407</a>
The impact on health-related quality of life from non-steroidal anti-inflammatory drugs, methotrexate, or steroids in treatment for juvenile idiopathic arthritis
Child; Female; Humans; Male; Follow-Up Studies; Health Status; Multivariate Analysis; quality of life; adolescent; Preschool; PedPal Lit; infant; Comparative Study; Arthritis; Anti-Inflammatory Agents; Antirheumatic Agents/adverse effects/therapeutic use; Glucocorticoids/adverse effects/therapeutic use; Juvenile Rheumatoid/drug therapy; Methotrexate/adverse effects/therapeutic use; Methylprednisolone/adverse effects/therapeutic use; Non-Steroidal/adverse effects/therapeutic use
OBJECTIVE: To assess and compare the impact of medication treatments on health-related quality of life (HRQOL), family function, and medical status in children with juvenile idiopathic arthritis (JIA). METHODS: Fifty-seven children diagnosed with JIA were assessed by a pediatric rheumatologist and placed into one of three treatment groups: (1) non-steroidal anti-inflammatory; (2) methotrexate; or (3) steroids via IV methylprednisolone. Questionnaires were administered at baseline and 4-month follow-up. The attending pediatric rheumatologist provided additional medical information. RESULTS: Data document the impact of JIA on HRQOL, particularly on physical and pain domains. Steroid patients experienced improved HRQOL at follow-up relative to other groups, despite reporting more problems with side effects. CONCLUSION: These results demonstrate positive benefits of steroids in treating JIA children, despite the greatest incidence of adverse side effects.
2006
Riddle R; Ryser CN; Morton AA; Sampson JD; Browne RH; Punaro MG; Gatchel RJ
Journal of Pediatric Psychology
2006
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Journal Article
Long-term use of peripherally inserted central venous catheters for cancer chemotherapy in children
Child; Female; Humans; Male; Adult; Follow-Up Studies; Risk Factors; Incidence; adolescent; Preschool; Non-U.S. Gov't; Research Support; PedPal Lit; infant; retrospective studies; Infusions; Intravenous; Neoplasms/drug therapy; Catheterization; Antineoplastic Agents/administration & dosage; Central Venous/adverse effects; Hematologic Tests
BACKGROUND: Peripherally inserted central venous catheters (PICCs) have been increasingly used in pediatric patients. However, little is known about the incidence and risk of complications when using this device in children with cancer. The purposes of this study are to assess the feasibility of PICCs and to determine the risk factors for PICC-related complications in pediatric patients with various types of malignancies. PATIENTS AND METHODS: We attempted to place PICCs in 53 patients with a median age of 5 years ranging from 2 months to 20 years. PICCs were used to administer fluid, parenteral nutrition, anticancer agents, antibiotics, and blood products and also for the through-line blood sampling. The duration of catheterization and the incidence of PICC-related complications requiring removal were retrospectively evaluated in association with the diagnosis, sex, age and body weight of the patients, size, insertion site and tip location of the catheters, type of treatment, and duration of leukopenia. RESULTS: PICCs were successfully placed in 109 of 112 attempts (97.3%) in 53 patients, and they were followed for a total of 11,797 catheter days (median placement, 87 days; range, 3 to 512 days). Fifty five PICCs (50.5%) were removed as a result of PICC-related complications with a rate of 4.66 per 1,000 catheter days. The most common reasons for catheter removal were occlusion (n=18), breakage/leakage (15), and infection (10). More than 70% of such complications occurred more than 30 days after placement. The catheter tip location in the superior vena cava or the right atrium might decrease the risk of complications. Other parameters did not influence the incidence of complications. CONCLUSIONS: PICCs were found to provide a reliable access for prolonged intravenous administration and blood sampling in children intensively treated for hematologic and solid malignancies, thus leading to a reduction of physical pain and psychological stress in such patients. However, the long-term placement of PICCs may also be related to an increased risk of complications.
2006
Matsuzaki A; Suminoe A; Koga Y; Hatano M; Hattori S; Hara T
Support Care Cancer
2006
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Journal Article
The use of conscious sedation for pain control during forearm fracture reduction in children: does race matter?
Child; Female; Humans; Male; Pain Measurement; Cohort Studies; Logistic Models; Follow-Up Studies; Risk Assessment; Multivariate Analysis; Probability; Chi-Square Distribution; Emergency Service; adolescent; Preschool; Non-U.S. Gov't; Research Support; PedPal Lit; Comparative Study; retrospective studies; Analgesia/methods; Hospital; Fractures; Attitude to Health/ethnology; African Americans/statistics & numerical data; Bone/ethnology/radiography/surgery; Conscious Sedation/methods; European Continental Ancestry Group/statistics & numerical data; Forearm Injuries/ethnology/radiography/surgery; Fracture Fixation/methods; Injury Severity Score
Recent reports in the medical literature indicate that certain racial disparities have been identified in healthcare. The authors sought to identify the potential relationship between the use of pain medications in African-American and Caucasian children undergoing forearm fracture reduction. This retrospective cohort study was performed at a university-affiliated tertiary care children's hospital emergency department. All Caucasian and African-American patients who underwent a closed reduction of a fractured ulna or radius over the 2-year observational period were enrolled. Patients were excluded from the study if they were admitted to the hospital for an open reduction or had multiple injuries. The relationship between race, gender, insurance status, time of admission, length of stay in the emergency department, fracture characteristics, and the use of conscious sedation was analyzed. t tests, chi-square tests, and stepwise logistic regression were used for data analysis. A total of 503 patients were included, 83% Caucasian and 17% African-American. Four hundred four patients received conscious sedation as part of their fracture reduction procedure and 99 did not. Univariate analysis showed that African-American and Caucasian children had different forearm fracture patterns (P = 0.0116) and different severities of angulation (P = 0.0094). Multivariate statistical analysis revealed that higher amounts of fracture translation (P < 0.0001) and angulation (P < 0.0027) and younger age of the patient (P = 0.0059) were significant predictors of conscious sedation use. Race was not found to be significantly associated with the use of conscious sedation (P = 0.0606 in univariate analysis, P = 0.1678 in multivariate analysis). The authors found that the decision to use conscious sedation for pediatric forearm fractures was not influenced by race, but was influenced by certain fracture characteristics and patient age.
2006
VanderBeek BL; Mehlman CT; Foad SL; Wall EJ; Crawford AH
Journal of Pediatric Orthopaedics
2006
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Journal Article
Surviving cancer in childhood can mean lifelong health issues
Child; Humans; Adult; Follow-Up Studies; Health Status; adolescent; PedPal Lit; Pain/etiology; Graft vs Host Disease; Survivors; Cataract/etiology; Hearing Loss/etiology; Hematopoietic Stem Cell Transplantation/adverse effects; Vision Disorders/etiology
2006
Senior K
Lancet Oncology
2006
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Journal Article
Modulation of cortical-limbic pathways in major depression: treatment-specific effects of cognitive behavior therapy
Female; Humans; Male; Adult; Follow-Up Studies; Middle Aged; Sensitivity and Specificity; Personality Inventory; Antidepressive Agents; Depressive Disorder; Ambulatory Care; Outcome and Process Assessment (Health Care); Non-U.S. Gov't; Research Support; Comparative Study; Blood Glucose/metabolism; Brain Mapping; Cerebral Cortex/physiopathology/radionuclide imaging; Cognitive Therapy; Emission-Computed; Energy Metabolism/physiology; Fluorodeoxyglucose F18/diagnostic use; Frontal Lobe/physiopathology/radionuclide imaging; Limbic System/physiopathology/radionuclide imaging; Major/physiopathology/radionuclide imaging/therapy; Nerve Net/physiopathology/radionuclide imaging; Neural Pathways/physiopathology/radionuclide imaging; Paroxetine/therapeutic use; Prefrontal Cortex/physiopathology/radionuclide imaging; Second-Generation/therapeutic use; Tomography
BACKGROUND: Functional imaging studies of major depressive disorder demonstrate response-specific regional changes following various modes of antidepressant treatment. OBJECTIVE: To examine changes associated with cognitive behavior therapy (CBT). METHODS: Brain changes underlying response to CBT were examined using resting-state fluorine-18-labeled deoxyglucose positron emission tomography. Seventeen unmedicated, unipolar depressed outpatients (mean +/- SD age, 41 +/- 9 years; mean +/- SD initial 17-item Hamilton Depression Rating Scale score, 20 +/- 3) were scanned before and after a 15- to 20-session course of outpatient CBT. Whole-brain, voxel-based methods were used to assess response-specific CBT effects. A post hoc comparison to an independent group of 13 paroxetine-treated responders was also performed to interpret the specificity of identified CBT effects. RESULTS: A full course of CBT resulted in significant clinical improvement in the 14 study completers (mean +/- SD posttreatment Hamilton Depression Rating Scale score of 6.7 +/- 4). Treatment response was associated with significant metabolic changes: increases in hippocampus and dorsal cingulate (Brodmann area [BA] 24) and decreases in dorsal (BA 9/46), ventral (BA 47/11), and medial (BA 9/10/11) frontal cortex. This pattern is distinct from that seen with paroxetine-facilitated clinical recovery where prefrontal increases and hippocampal and subgenual cingulate decreases were seen. CONCLUSIONS: Like other antidepressant treatments, CBT seems to affect clinical recovery by modulating the functioning of specific sites in limbic and cortical regions. Unique directional changes in frontal cortex, cingulate, and hippocampus with CBT relative to paroxetine may reflect modality-specific effects with implications for understanding mechanisms underlying different treatment strategies.
2004
Goldapple K; Segal Z; Garson C; Lau M; Bieling P; Kennedy S; Mayberg H
Archives Of General Psychiatry
2004
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Journal Article
<a href="http://doi.org/10.1001/archpsyc.61.1.34" target="_blank" rel="noreferrer">10.1001/archpsyc.61.1.34</a>