Conceptualizing mental health difficulties among a pediatric oncology population from a traumatic stress perspective is gaining speed. Research has shown support for the development of posttraumatic stress reactions among chronically ill children and their family members. Despite this evidence, the majority of intervention studies have not incorporated key trauma-informed intervention components that have proven to be effective in symptom reduction for trauma-exposed children. Examining key aspects of both the child trauma and pediatric psychology fields have enabled researchers to meld their strengths into one comprehensive approach. This revised perspective has clinical implications for the development of prevention and intervention techniques that are more likely to yield superior outcomes. Yet, an evidence-based, trauma-informed intervention for youth has not yet been empirically examined among a pediatric oncology population. Thus, the purpose of this study was to examine the efficacy of TF-CBT intervention program for children/adolescents diagnosed with cancer and their parents. Methods: This was a prospective longitudinal study that utilized a single-subject, non-concurrent multiple baseline design to assess the efficacy of TF-CBT intervention. A sample of five youth (ages 9 to 15) and seven parents enrolled in the study; three youth and five parents completed their participation in the study. Manualized treatment consisted of six sessions lasting approximately two hours per session (including child and parent) that targeted psychoeducation, relaxation training, affective identification and expression skills, cognitive processes, coping strategies, trauma processing, and family processes. Examined constructs, including posttraumatic stress symptomatology, depression, quality of life, parenting stress, coping utilization, coping efficacy, somatization, internalizing, and externalizing symptoms, were assessed by child self-report, parent report, and parent self-report at enrollment (baseline), post-treatment, and one-, and three-month follow-up. Results: Simulation Modeling Analysis (SMA) revealed a statistically significant reduction, from baseline to intervention, for one parent's PTSS (R = -0.711, p = .027) and another parent's PTSS reduction approached significance (R = -0.747, p = .055). Comparatively, no significant reduction was found for child PTSS. One child showed a significant improvement in coping efficacy (R = 0.619, p = .048) as a function of the intervention, and an additional two child participants approached significance (R = 0.618, p = .055; R = 0.689, p = .094). Visual inspection of the data did reveal noteworthy reductions for some study participants in both domain specific (i.e., PTSS) and broader psychological outcomes (e.g., quality of life, somatization, internalizing and externalizing symptoms, etc.). Conclusions: These results provide some support for a trauma-informed CBT intervention for pediatric oncology patients in remission and their parents. / Ph. D.

Introduction: There is uncertainty whether low-risk febrile neutropenia (FN) episodes in children with cancer are best managed in the inpatient or outpatient setting. Methods: A cost-utility model was created to compare four different treatment strategies for low-risk FN in pediatric cancer patients. Outcome measures were quality-adjusted FN episodes (QAFNE), costs (Canadian dollar), and incremental cost-effectiveness ratios (ICER). Results: The most cost-effective strategy was outpatient treatment with intravenous antibiotics. It was cost saving ($2,732 versus $2,757) and more effective (0.66 QAFNE versus 0.55 QAFNE) as compared to outpatient treatment with oral antibiotics. An early discharge strategy after 48 hours in hospital was slightly more effective but significantly more expensive than outpatient treatment with intravenous antibiotics resulting in an unacceptably high ICER of more than $130,000 per QAFNE. Inpatient care was the least cost-effective strategy. Conclusions: Outpatient strategies for treatment of low-risk FN in children are more cost-effective than traditional inpatient care.

Introduction: There is uncertainty whether low-risk febrile neutropenia (FN) episodes in children with cancer are best managed in the inpatient or outpatient setting. Methods: A cost-utility model was created to compare four different treatment strategies for low-risk FN in pediatric cancer patients. Outcome measures were quality-adjusted FN episodes (QAFNE), costs (Canadian dollar), and incremental cost-effectiveness ratios (ICER). Results: The most cost-effective strategy was outpatient treatment with intravenous antibiotics. It was cost saving ($2,732 versus $2,757) and more effective (0.66 QAFNE versus 0.55 QAFNE) as compared to outpatient treatment with oral antibiotics. An early discharge strategy after 48 hours in hospital was slightly more effective but significantly more expensive than outpatient treatment with intravenous antibiotics resulting in an unacceptably high ICER of more than $130,000 per QAFNE. Inpatient care was the least cost-effective strategy. Conclusions: Outpatient strategies for treatment of low-risk FN in children are more cost-effective than traditional inpatient care.

Background. Recent efforts have focused on improving pediatric palliative care to relieve physical and psychological suffering throughout the course of illness, as well as to improve care at the end-of-life (EOL). One area of attention has been medical training, as healthcare providers have often reported feeling ill-equipped to manage EOL issues. As a pilot study, we developed and evaluated a daylong educational workshop on pediatric palliative care for oncology fellows. Procedure. Fellows (N = 32) from 20 hospitals participated in one of two workshops covering palliative care topics, such as pain/symptom management, communication, ethics, and bereavement. Training, knowledge, behavior, and attitudes regarding pediatric palliative care were assessed before the workshop, and knowledge was re-assessed immediately afterwards. Results. Fellows reported a general lack of training in EOL care, and only 41% rated their education as at least "somewhat" adequate. Colleagues and personal experience were more often sources on EOL care, rather than formal classes or textbooks. Although fellows reported open attitudes toward palliative care, such as involving adolescents in decision-making, only half felt comfortable in the presence of a dying person. Fewer than half felt comfortable providing EOL care, managing families' expectations, or knowledgeable enough to discuss hospice with patients/families. Following the workshop, knowledge of palliative care increased significantly from 75 to 85% correct. Conclusions. Fellows reported open beliefs about palliative care, but acknowledged weaknesses in their training and level of competence. The workshop showed efficacy in improving knowledge, but additional research is needed to evaluate larger educational initiatives and their long-term impact on clinical services and family satisfaction.

No description available.

In this project, problems related to loss of free flow in central venous catheter and implanted subcutaneous ports have been investigated. The catheters investigated in this project are intended for children with cancer diseases. The initial hypothesis was that the length, radius and curvature of the catheter would affect the flow. Two other things that can have a negative impact on the flow are if the catheter is squashed or kinked. Experiments and simulations have been performed in order to test the hypothesis and investigate how a deformation of the catheter affects the flow. The results from the experiments and simulations show that the length and radius of the catheter have major impact on the pressure drop, and hence the flow. The curvature of the catheter has less impact on the flow as long as the catheter is not kinked. Experiments with squashed catheters show a decrease in outlet pressure with a decrease of the catheter lumen. / Denna projektrapport ämnar undersöka problem relaterade till fritt flöde i centrala venkatetrar och inopererade subkutana portar. Katetrarna som testats i detta projekt är till för barn med cancersjukdomar. Den ursprungliga hypotesen var att längden, radien och krökningen hos katetern påverkar flödet. Ytterligare två saker som skulle kunna ha negativ effekt på flödet är om katetern är klämd eller veckad. För att testa hypotesen om hur deformationer av katetern påverkar flödet har experiment och simuleringar utförts. Resultaten från experiment och simuleringar visar att kateterns längd och radie har störst effekt på tryckfallet och därmed flödet. Krökningen på katetern har mindre betydelse, så länge katetern inte är veckad. Experiment med klämd kateter visar att utloppstrycket minskar med minskad kateterlumen.

No description available.

O adoecimento oncológico pode ser compreendido como significativo fator de risco ao desenvolvimento infanto-juvenil, fazendo-se relevante compreender as estratégias de organização psíquica diante do câncer e seu tratamento, para oferecer adequada assistência profissional a crianças e adolescentes com neoplasias. Em revisão sistemática da literatura científica nacional e internacional, notou-se que predominavam, nas pesquisas da área, temas relativos a dificuldades vivenciadas pelas crianças/adolescentes, dinâmica familiar, intervenções focais e enfrentamento do adoecimento, porém com diversidade de parâmetros e métodos, dificultando adequada avaliação das variáveis influentes no processo adaptativo de indivíduos em desenvolvimento acometidos pelo câncer. Nesse contexto, este trabalho teve por objetivo avaliar características de personalidade e recursos adaptativos de crianças e adolescentes em tratamento oncológico. Foram avaliados 40 escolares, de sete a 17 anos de idade, de ambos os sexos, residentes no interior do Estado de São Paulo, divididos em dois grupos: Grupo Clínico (G1, n=20, pacientes em tratamento oncológico em hospital-escola público) e Grupo de Comparação (G2, n=20, crianças e adolescentes com desenvolvimento típico, selecionados por balanceamento a partir das características etárias e de escolaridade de G1). Os participantes foram voluntários devidamente autorizados a participar do estudo por seus pais/responsáveis, bem como assentiram livremente com a pesquisa. Os instrumentos Critério de Classificação Econômica Brasil (CCEB), Inventário de Percepção de Suporte Familiar (IPSF), Inventário de Recursos do Ambiente Familiar (RAF) e o Questionário de Capacidades e Dificuldades (SDQ) foram aplicados individualmente com os pais/responsáveis, em ambiente adequado. O Teste das Matrizes Progressivas de Raven, Método de Rorschach (Escola Francesa) e Teste das Pirâmides Coloridas de Pfister foram aplicados com as crianças e adolescentes, também em sessões individuais realizadas em ambiente adequado. Os resultados foram sistematizados conforme respectivos padrões técnicos dos instrumentos utilizados, realizando-se análises descritivas (média e desviopadrão) e análises inferenciais (Teste t de Student ou Teste chi-quadrado, utilizando-se nível de significância de 5%), comparando G1 e G2. Os principais resultados indicaram predominância de semelhanças entre crianças e adolescentes que vivenciam o adoecimento oncológico e seus pares saudáveis, em termos de funcionamento psicológico geral. Foi verificado que, diante das demandas impostas pelo adoecimento e seu tratamento, crianças e adolescentes desenvolvem restrições em relação às manifestações emocionais, priorizando o autocontrole a partir da exacerbação do funcionamento lógico, com sinais de maior inibição e intelectualização nos participantes de G1. Depreende-se, portanto, que apesar do impacto do adoecimento oncológico, crianças e adolescentes em tratamento evidenciaram indicadores de manutenção do funcionamento adaptativo e preservação dos recursos familiares. Neste contexto, a inibição ou supressão de aspectos emocionais pareceu configurar possível fator protetor ao desenvolvimento, na medida em que os demais elementos do funcionamento mental, essenciais para adaptação ao tratamento oncológico, sinalizaram-se preservados. / Introduction: Cancer may affect child development. Therefore, it is important to understand strategies of psychic organization experienced when children and adolescents face oncological treatment, aiming to improve professional assistance. In a systematic review of national and international bibliographic databases, some themes prevailed, such as difficulties experienced by children/adolescents; family dynamics; focus interventions; and coping. Also evidenced were the diversity of parameters and methodologies used in researches, especially in the field of chronic illness management. Objective: This study aimed to assess personality characteristics and adaptive resources of children and adolescents facing cancer treatment. Method: 40 children and teenagers, aging from 07 to 17 years, from both genders, living in the state of São Paulo, Brazil, were evaluated and divided into two groups: Clinical Group (G1, n=20, patients under oncological treatment in a public university hospital) and control group (G2, n=20, children and adolescents with typical development, selected to match age and schooling characteristics of G1). Participants freely consented to participate as volunteers and were properly authorized by their respective parents/guardians. The instruments Critério de Classificação Econômica Brasil (CCEB, Brazilian Criteria of Economic Classification), Inventário de Percepção de Suporte Familiar (IPSF, Perception of Family Support Inventory), Inventário de Recursos do Ambiente Familiar (RAF, Home Environment Resources Scale) and the Strengths and Difficulties Questionnaire (SDQ) were applied individually to parents/guardians in a suitable environment. The Raven\'s Progressive Matrices Test; Rorschach (French School) and Pfister Colored Pyramids Test were applied to the children and adolescents, also in individual sessions and in proper environment. Results are presented according to technical patterns created by the employed instruments. Data were analyzed by descriptive (mean and standard deviation) and inferential tests (Student\'s t test or chi-square test) and significance levels were fixed at 5% for comparisons between groups (G1 and G2). Results: The main results of this study indicate predominance of similarities between children and adolescents who experience oncological diseases and their healthy peers, in terms of overall psychological functioning. More specific analyses show that given the demands imposed by disease and treatment, subjects are found to develop restrictions in emotional manifestations, with control mostly based on logical function. Conclusions: Our results suggest that despite possible deleterious impact of the disease, children and adolescents facing cancer are able to maintain the adaptive function and preserve family resources. In this context, inhibition or suppression of emotional aspects may be considered as a protective factor for development, while other elements of mental functioning, essential for coping with cancer treatment, are preserved.

Problem: Financial strain has been reported by families of children with cancer. However, the specific costs and their impact on these families remain unknown. Objectives: (a) to identify the costs incurred by families of children newly diagnosed with cancer in Ontario, (b) to determine the variables that influence these costs, and (c) to explore the impact of these costs on families. Conceptual Framework: The conceptual framework incorporated the social, economic, disease, and treatment cost predictors with the direct and indirect cost of illness components. Setting: Two university-affiliated tertiary paediatric hospitals in Canada. Sample: English speaking parents of children newly diagnosed with cancer who were receiving treatment. Design: A prospective concurrent mixed method design. Instrumentation: The Ambulatory and Home Care Record © (AHCR) (Guerriere & Coyte, 1998) was used to record costs and an interview guide was developed to explore the impact of these costs on families. Procedure: Parents recorded the resources consumed and costs incurred during one week per month for three consecutive months beginning the 4th week following diagnosis and listed any additional costs incurred since diagnosis or between the face-to-face interviews. Parents also discussed the impact of these costs on their families in an audio taped interview. Data Analysis: Descriptive statistics and multiple regression modelling were used to describe families’ total costs (expressed in 2007 Canadian dollars) and to determine factors that influenced them. Descriptive qualitative content analytic methods were used to analyze the transcribed interview data. Results: In total, 99 parents including 28 fathers and 71 mothers completed three sets of cost diaries. The mean total three month expenditure was $28,475 (SD $12,670; range $2013 to $79,249) per family. There were no statistically significant factors that influenced families’ direct costs; however, 23% of the variance for indirect costs was explained by inpatient tertiary hospitalizations, language spoken at home, and distance to the hospital. Parents described the costs associated with their child’s illness and coping and management strategies used to lessen the financial impact including managing their expenses and seeking ways to increase their cash flow. Significance: Findings will inform health professionals and policy makers about families who are faced with potentially catastrophic costs following their child’s diagnosis with cancer.

Problem: Financial strain has been reported by families of children with cancer. However, the specific costs and their impact on these families remain unknown. Objectives: (a) to identify the costs incurred by families of children newly diagnosed with cancer in Ontario, (b) to determine the variables that influence these costs, and (c) to explore the impact of these costs on families. Conceptual Framework: The conceptual framework incorporated the social, economic, disease, and treatment cost predictors with the direct and indirect cost of illness components. Setting: Two university-affiliated tertiary paediatric hospitals in Canada. Sample: English speaking parents of children newly diagnosed with cancer who were receiving treatment. Design: A prospective concurrent mixed method design. Instrumentation: The Ambulatory and Home Care Record © (AHCR) (Guerriere & Coyte, 1998) was used to record costs and an interview guide was developed to explore the impact of these costs on families. Procedure: Parents recorded the resources consumed and costs incurred during one week per month for three consecutive months beginning the 4th week following diagnosis and listed any additional costs incurred since diagnosis or between the face-to-face interviews. Parents also discussed the impact of these costs on their families in an audio taped interview. Data Analysis: Descriptive statistics and multiple regression modelling were used to describe families’ total costs (expressed in 2007 Canadian dollars) and to determine factors that influenced them. Descriptive qualitative content analytic methods were used to analyze the transcribed interview data. Results: In total, 99 parents including 28 fathers and 71 mothers completed three sets of cost diaries. The mean total three month expenditure was $28,475 (SD $12,670; range $2013 to $79,249) per family. There were no statistically significant factors that influenced families’ direct costs; however, 23% of the variance for indirect costs was explained by inpatient tertiary hospitalizations, language spoken at home, and distance to the hospital. Parents described the costs associated with their child’s illness and coping and management strategies used to lessen the financial impact including managing their expenses and seeking ways to increase their cash flow. Significance: Findings will inform health professionals and policy makers about families who are faced with potentially catastrophic costs following their child’s diagnosis with cancer.