Introdução: o tratamento oncológico em crianças inclui frequentemente quimioterapia e/ou radioterapia que podem determinar alterações à cavidade bucal que consequentemente predispõem à intercorrências estomatológicas. Objetivo: verificar as condições de saúde bucal em crianças e adolescentes portadores de neoplasias, no momento do diagnóstico, e sua relação com as complicações estomatológicas após intervenção odontológica. Metodologia: foram incluídas crianças e adolescentes portadores de neoplasias atendidas no Serviço de Oncologia Pediátrica do HCPA, durante o período de maio de 2011 a dezembro de 2012. Através de critérios específicos, os pacientes foram alocados em dois grupos, de acordo com as condições de saúde bucal, em Favorável e Desfavorável no momento do diagnóstico. A análise das condições de saúde bucal foi relacionada com os desfechos mucosite, infecções odontogênicas, gengivite, cistos de erupção e pericoronarite durante os primeiros seis meses de tratamento oncológico. Foram feitas associações com o potencial tóxico da QT, Gênero, Faixa Etária, RT de cabeça e pescoço, tempo até a primeira intercorrência e óbito. Análise estatística utilizou o teste Qui–quadrado para comparação de variáveis categóricas entre os dois grupos, Mann-Whitney para comparação da graduação de mucosite entre os dois grupos, Kaplan Meier para análise do tempo até o surgimento dos desfechos e Regressão de Cox para cálculo da probabilidade estimada de ocorrência dos desfechos. Resultados: foram incluídos 65 pacientes, sendo 36 meninos, 32 com Saúde Bucal Favorável e 33 com Saúde Bucal Desfavorável. No total foram realizadas 839 avaliações. O grupo Favorável apresentou menos infecções odontogênicas (P 0,003) que o grupo Desfavorável. No total foram realizadas 839 avaliações. O grupo Favorável apresentou menos infecções odontogênicas (P 0,003) que o grupo Desfavorável. Houve um aumento significativo de MO nos pacientes tratados com drogas com alto risco para mucosite (P 0,001). Os dados sugerem que o grupo Desfavorável apresenta mais infecções tanto durante o tratamento utilizando drogas de Alto Risco (26,1%) como Baixo Risco (40%) para a MO. A incidência de MO foi maior entre os pacientes da faixa etária de dentição permanente (13 a 18 anos) 82,4%, assim como entre os pacientes do gênero masculino (80,6%). A ocorrência de Infecção Odontogênica foi mais presente entre pacientes na faixa etária de dentição permanente (41,2%) e entre pacientes do gênero feminino (41,4%). O índice CPOD dos pacientes do grupo Desfavorável foi 3,57, considerado alto para risco de cárie na população estudada. Os índices de placa visível e sangramento gengival reforçaram as diferenças entre os dois grupos. Conclusões: os pacientes oncológicos pediátricos são expostos à toxicidade das drogas quimioterápicas e consequentemente estão suscetíveis aos riscos decorrentes de processos infecciosos. As infecções com origem na cavidade bucal são frequentes nesta população e sua prevenção está diretamente ligada aos protocolos de higiene bucal e tratamento odontológico. Os estudos com intervenção odontológica em pacientes pediátricos em tratamento oncológico são muito limitados e a nossa pesquisa tem importante papel para identificação do perfil destes pacientes e suas necessidades. Os resultados obtidos serão fundamentais para a elaboração de protocolos e estratégias de atendimento direcionadas a esta população. / Introduction: cancer treatment in children often includes chemotherapy and / or radiotherapy that can determine changes in the oral cavity which consequently predispose to complications Stomatological. Objective: To verify the conditions of oral health in children and adolescents with cancer, at the time of diagnosis, and their relation to complications Stomatological after dental intervention. Methodology: included children and adolescents with cancer treated at the Pediatric Oncology Unit of the HCPA, during the period from May 2011 to December 2012. Through specific criteria, patients were divided into two groups, according to the oral health conditions in Favorable and Unfavorable at diagnosis. The analysis of the oral health status was related outcomes mucositis, dental infections, gingivitis, pericoronitis and eruption cysts during the first six months of cancer treatment. Associations were made with the toxic potential of QT, Gender, Age Group, RT head and neck, time to first complication and death. Statistical analysis included the chi-square test to compare categorical variables between the two groups, Mann - Whitney test to compare the degree of mucositis between the two groups, Kaplan Meier analysis of time to the emergence of outcomes and Cox regression to calculate the estimated probability of occurrence of outcomes. Results: 65 patients were included, 36 boys , 32 with Oral Health Favorable and Unfavorable 33 with Oral Health . In total we performed 839 evaluations. The Favorable group had fewer dental infections (P 0.003 ) than the group Unfavorable . A significant increase OM in patients treated with drugs with high risk for mucositis (P 0.001). Data suggest that the most unfavorable group has infections during the treatment using both drugs High Risk (26.1%) and low risk (40 %) for the MO. The incidence of OM was higher among patients in the age group of permanent dentition (13- 18 years) 82.4%, and among male patients (80.6%). The occurrence of odontogenic infection was higher among patients aged permanent dentition (41.2%) and among female patients (41.4%). The DMFT Unfavorable group of patients was 3.57, considered high risk for caries in the population studied. The visible plaque index and gingival bleeding reinforced the differences between the two groups. Conclusions: The pediatric oncology patients are exposed to the toxicity of chemotherapy drugs and thus are susceptible to risks from infectious processes. Infections originating in the oral cavity are common in this population and its prevention is directly linked to the protocols of oral hygiene dental treatment. Studies of dental intervention in pediatric cancer treatment are very limited and our research has an important role to identify the profile of these patients and their needs. The results will be fundamental to the development of protocols and service strategies directed toward this population.

Background: There are 2,2 million children living in Sweden and every day about one child is diagnosed with cancer. Nurses have an important role in nursing the sick child and comforting it´s families. Little is known about the nurses´ experiences in working with this severely ill children. Aim: The aim of this study was to highlight nurses´ experiences of caring for children with cancer. Method: A method to contribute to evidence-based nursing with the ground in analysis of qualitative research was conducted. An analysis of fourteen qualitative articles was carried out. The analysis resulted in four main themes and eleven subthemes. Result: Four main themes emerged; The adequate knowledge needed, Difficulties in ethical stance, Caring relationships where the child is in the centre, Emotional contrasts. The results of the study showed that the nurses experienced that they were not fully-trained and that the knowledge was not sufficient when they were new to childhood cancer. The nurses experienced a lot of emotions caring for children with cancer and felt it valuable to use coping to deal with the upcoming emotions and prevent emotional burn-out. Conclusion:More knowledge in childhood cancer is needed for nurses caring for children sick with cancer. It is important for the nurses to see the child's best, but also to work family-centered. The work is emotionally stressful and requires coping strategies to prevent emotional burnout.

Although almost 16,000 children and adolescents are diagnosed with cancer each year, the incident rates have remained stable over recent years, and mortality has decreased consistently since 1975 (American Cancer Society, 2016). With increased survivorship, research and practice in pediatric oncology has focused more on the psychosocial well-being of patients during and after treatment. With research repeatedly indicating that patients and families appear to exhibit great resilience and adjustment, and low incidences of psychosocial difficulties (e.g., Kazak, 1994, Eiser et al. 2000), some researchers have examined adaptive style as a possible construct that may help explain the predominantly positive outcomes (e.g., Phipps and Srivastava, 1997). The current study examined adaptive styles and coping strategies in youth diagnosed with cancer to determine relationships between these variables, as well as between each of these constructs and measures of subjective well-being, and psychosocial and educational adjustment. This study was also the first to examine relationships between youth and parent adaptive styles. A total of 180 youth between 9 and 17 years old who have been diagnosed with cancer participated in this study. Each youth also had one parent who participated. Each youth participant completed a packet of self-report measures used to determine adaptive style group, coping strategy use, and subjective well-being scores. Each parent participant completed a questionnaire to provide sociodemographic information about the youth and parent, as well as information about their child’s illness and school experience. Parents also completed a packet of measures used to provide information about their child’s psychosocial adjustment and risk and to determine parent adaptive style. Data were analyzed to examine relationships between parent and youth adaptive style, group differences on measures of subjective well-being, psychosocial adjustment/risk, and academic variables, relationships between adaptive style and coping strategy use, and the predictive strength of adaptive style and coping strategies for the outcome variables. Although the distribution of adaptive styles was similar among participants in the current study compared to those in previous studies of adaptive style for Repressive, Low Anxious, and Defensive High Anxious adaptive styles, there was a higher percentage of participants with High Anxious adaptive style in the current study. A statistically significant bidirectional relationship was found between youth and parents with a Repressive adaptive style. Results revealed significant differences between groups on measures of subjective well-being and internalizing behaviors, with Repressive adaptive displaying the highest subjective well-being and lowest internalizing behavior scores. Repressive and Low Anxious adaptive style differed significantly from the two High Anxious groups on the school scale scores, with the Repressive and Low Anxious groups having more positive outcomes on the measure. Relating to coping strategies, youth in the two High Anxious groups used more strategies all together, including both adaptive and non-adaptive strategies. However adaptive strategies were more frequently related to positive adaptive styles and outcomes, while non-adaptive strategies tended to have a stronger relationship to High Anxious adaptive style and negative outcomes. Limitations are discussed, and suggestions for future research and practical implications are offered, based on the results of the current study.

SAMMANFATTNING Introduktion: I Sverige drabbas årligen cirka 300 barn under 18 år av cancer, som även är den vanligaste dödsorsaken hos barn. Det innebär många tuffa behandlingar på sjukhus. Familjen är barnets viktigaste mikrosystem, vilket spelar stor roll dess samspel med uppväxtens omgivande miljö. Därmed är det viktigt att ta reda på familjens erfarenheter av ett cancersjukt barn. Syfte: Syftet med denna studie är att beskriva familjemedlemmars erfarenheter av ett cancersjukt barn i familjen. Metod: Beskrivande design med allmän kvalitativ litteraturöversikt. Huvudresultat: Sju teman identifierades: föräldraskapets utmaningar, påverkan på parrelationen, påverkan på arbetet, påverkan på vardagen, syskonens påverkan, psykisk påverkan och vårdpersonalens betydelse för familjen. Föräldrarna delade upp sig, en var alltid på sjukhuset och den andra tog hand om hemmet och syskon. Det hade ingen tid för att ta hand om relationen till varandra. Vardagen förändrades, barnet kunde inte längre gå till skolan samt inte umgås med kompisar som tidigare. Syskonen till cancersjuka barnet upplevde att det inte fick lika mycket uppmärksamhet. Alla familjer blev påverkade psykisk, bland annat av rädsla och oro. Vårdpersonalens betydelse för familjen, visade sig familjerna ha delade meningar om. Slutsats: Denna litteraturöversikt visar att det är en stor påfrestning på familjen på många olika sätt då ett barn i familjen får cancer. För att hantera situationen använde familjer flera olika sorters copingstrategier. Alla tre olika typerna av copingstrategier: problemfokuserad-, emotionell- och meningsfokuserad coping sågs användas. Att sjukvårdspersonalen stöttar hela familjen under den tuffa tiden är viktigt för att familjen ska få så bra erfarenheter som möjligt. / ABSTRACT Introduction: In Sweden, 300 children under age 18, are yearly affected by cancer. This implies tough treatments in hospital. Cancer is the most common death in children. The family is the child's most important microsystem. Therefore, it's important to find out the family experiences of a child with cancer.  Aim: The aim of this study is to describe family members´ experience of a child with cancer in the family. Method: Descriptive design with general qualitative literature review. Result: Seven themes identified: the challenges of parenthood, the impact on the relationship, the impact on work, the impact on everyday life, the siblings' impact, psychological impact and the importance of care staff for the family. The parents split up, one was in the hospital and one took care of the home. There was no time to take care of the relationship. Everyday life changed, the child could no longer go to school and could not spend time with friends as before. The siblings felt that it did not receive as much attention like before. All families were mentally affected. The importance of care staff for the family turned out to be shared by the families.  Conclusion: This literature review shows that it's a great strain on the family in many different ways when a child gets cancer. Problem-focused, emotional and meaning-focused coping were used by the family. That the care staff supports the whole family during the tough times is important for the family to have good experiences.

Background: As a nurse, when caring for children with cancer, you need to offer the best care for the child and in the meantime focus on family centered care in order to meet the thoughts and wishes the family carries. Caring for children with cancer might contain many obstacles and difficulties. Communication, education and to understand one's role as a nurse is important when caring for these children. Aim: To identify nursing experience when caring for children with cancer. Method: A literature overview has been done and ten studies were gathered through the databases PubMed and Cinahl. The analysis of these studies created four categories with associated subcategories. Results: It came through those nurses faced difficulties in pediatric care in different situations. These situations created categories which were: Ethical issues, Education, Cooperation with the family and Nurses emotions and support. Conclusion: Factors found in this study were nurses' experience of lacking the necessary preparation, the need of emotional support and the importance of working close to the families. It is found that nurses felt unprepared for their work and dealing with tough situations. The relationship between the nurse and the patient's family is important to provide high quality care. Nurses expressed the need for support from colleagues and family members in order to grow as a nurse and as a person.

Indiana University-Purdue University Indianapolis (IUPUI) / Phase I clinical trials (P1Ts) are the first step in testing new medical therapies in humans, and are essential for developing new and innovative therapies for children with cancer. P1Ts are ethically controversial as they are not intended to directly benefit participants, but are particularly controversial for children with cancer who are only able to participate when there is no known curative therapy for their cancer. Benefits of pediatric oncology P1T participation may include improved quality of life (QOL) and hope. Risks may include fostering unrealistic hope, burdening children with additional medical procedures and toxicities, and limiting the opportunity for palliation. The goal of this dissertation was to investigate the P1T participation experience for children with cancer and their parents by: (1) assessing what is currently known about the participation experience, (2) exploring ways to understand and assess treatment burden and QOL during participation, and (3) interviewing parents about the experience of having a child participate in a P1T. Following a review of the literature, two studies were conducted: a longitudinal pilot study of 13 parent and child dyads who enrolled in a pediatric oncology early phase clinical trial at the recruiting institution, and a phenomenological study of 11 parents of children with cancer who participated in pediatric oncology P1Ts. Key findings included a dearth of research on the experiences of children and parents in pediatric oncology P1Ts. Instead, existing research has focused on consent processes. The longitudinal pilot study provided some insight into experiences of children and parents during trial participation, including that there may be time points when parents’ and children’s perceptions of the child’s quality of life substantively differ. Interviews with parents confirmed some of the anticipated benefits and risks of participation in P1Ts, and highlighted parents’ sense of running out of time to find an effective treatment and needing to use time they have with their child well. Specific challenges in conducting this research were participant attrition due to disease progression and the need for multi-site research to obtain an adequate sample.

Bakgrund: Då ett barn drabbas av onkologisk sjukdom och är i behov av sjukhusvård påverkas hela familjen och deras vardag i hemmet. Hemsjukvård kan främja familjernas vardagsliv, normalitet samt barnets delaktighet i vården.  Syfte: Syftet var att beskriva barnsjuksköterskors erfarenheter av att vårda barn med onkologisk sjukdom i hemmet. Metod: En kvalitativ metod med induktiv ansats tillämpades. Individuella intervjuer genomfördes utifrån en semistrukturerad intervjuguide. Tio barnsjuksköterskor från verksamheter belägna i södra- och mellersta Sverige deltog. Kvalitativ manifest innehållsanalys enligt Graneheim och Lundman (2004) användes för att analysera insamlade data. Resultat: Analysen genererade i tre huvudkategorier: Barnet och familjen i centrum, En utmanande miljö samt Teamsamverkans betydelse. Barnsjuksköterskor beskrev erfarenheter av att se och inkludera familjen, stödja normalitet och trygghet samt att värna barnets rättigheter. Det ansågs vara utmanande att möta förväntningar, vara känslomässigt engagerad och att möta praktiska hinder. Teamsamverkan utgjorde en viktig del där behovet av reflektion var elementärt. Slutsats: Då barn med onkologisk sjukdom vårdas i hemmet genererar det flertalet fördelar för barnet och hela familjen. Den familjecentrerade omvårdnaden utgör grunden för vårdandet men omvårdnaden i hemmet är komplex och det föreligger flera utmaningar. Teamsamverkan och reflektion är centrala element relaterat till utmaningarna barnsjuksköterskor möter i hemmet. / Background: When a child suffers from an oncological disease and needs hospital care, the whole family and their everyday life is affected. Home care can promote families' everyday life and the child's participation in care. Aim: The aim of this study was to describe the experiences of pediatric nurses when caring for children with oncological diseases at home. Method: A qualitative method with an inductive approach was used. Individual interviews were conducted based on a semi-structured interview guide. Ten pediatric nurses from businesses located in southern- and central Sweden participated. A qualitative manifest content analysis according to Graneheim and Lundman (2004) was used to analyze the collected data. Results: The analysis was generated in three main categories: The child and family in center, A challenging environment and The importance of teamwork. Pediatric nurses described experiences of seeing and including the family, supporting normality and safety, and protecting the child's rights.  Meeting expectations, being emotionally engaged and facing practical obstacles was seen as challenging. Team collaboration was important and the need for reflection was elementary. Conclusion: Caring for children with oncological diseases at home generates several advantages for the child and the entire family, family-centered care is the starting point for the pediatric nurses. Nursing in home is complex with several challenges. Team collaboration and reflection are fundamental elements to challenges those pediatric nurses face in the child’s home.

Bakgrund: Varje år får cirka 400 000 barn i världen cancer och överlevnadsgraden är ungefär 80%. I Sverige drabbas omkring 350 barn av cancer årligen. Syfte: Syftet med studien är att beskriva sjuksköterskors erfarenhet av att vårda barn med cancersjukdom. Metod: En litteraturstudie med åtta vetenskapliga artiklar som har en kvalitativdesign. Databaserna PubMed och Cinahl användes för att hitta artiklar som svarar på vårt syfte.   Resultat: Analysen resulterade i tre huvudkategorier och nio underkategorier. Huvudkategorierna var följande: Skapa en god relation med familjen är viktig; Ett krävande men samtidigt givande arbete; Betydelsen av organisationen och teamet. Konklusion: Sjuksköterskans relation till familj/patient är avgörande för god omvårdnad, men det kräver stöd från teamet och ledningen för att upprätthålla sin professionella roll. Byggande av starka relationer, medvetenhet om gränser och möjligheten till hjälp och stöd är viktigt. Chefer och ledare kan använda resultatet för att upprätthålla en god arbetsmiljö. Fortsatt forskning behövs för att förbättra sjuksköterskans omvårdnad till barn med cancer genom interventionsstudier. / Background: Every year, approximately 400,000 children worldwide are diagnosed with cancer, and the survival rate is about 80%. In Sweden, around 350 children are affected by cancer each year. Aim: The purpose of the study was to describe nurses' experience of caring for children with cancer.  Methods: A literature review consisting of eight scientific articles with a qualitative design. The databases PubMed and Cinahl were used to find articles that address our purpose. Results: The analysis resulted in three main categories and nine subcategories. The main categories were as follows: Creating a good relationship with the family is important; A demanding but rewarding job; The importance of organization and teamwork. Conclusion: The nurse's relationship with the family/patient is crucial for good care, but it requires support from the team and management to maintain their professional role. Building strong relationships, awareness of boundaries, and the availability of help and support are important. Managers and leaders can use the results to maintain a good working environment. Further research is needed to improve the nurse's care for children with cancer through intervention studies.

BACKGROUND: Globally, 80% of children with cancer live in low- and middle-income countries (LMIC) and 20% or less are expected to survive. Research demonstrates a gap on recording experiences of planners who have successfully established a pediatric cancer unit (PCU), lack of studies on systematic, evidence-based planning of a PCU, and absence of an actionable, practical framework that guides planners. OBJECTIVES: This qualitative study used a case study approach to examine the key elements in the planning process of effectively establishing a new PCU and identify the challenges that need to be addressed. METHODS: Porter’s Value Chain Model served as the theoretical framework to guide the research agenda. Semi-structured in-depth interviews were conducted in 2017 with a purposive sample of 35 key informants reflecting experiences from 30 countries. An interview guide was developed and recruitment continued until saturation. Participants included physicians, nurses, architects, administrators, consultants, and academicians. Data were also employed from three other sources: document review, observation, and pre-dissertation findings. Interviews were recorded, transcribed using REV, and analyzed using NVIVO. Data were analyzed using a thematic analysis and principles of grounded theory method were applied in the interview guide design and analysis. RESULTS: Respondents reported nine strategic elements essential in the process: leadership, mission, planning principles, organizational structure, situation analysis, medical model, financing, stakeholders, and international partnerships. Corruption, distrustful culture, ineffective communication, and lack of data were cited as key barriers. DISCUSSION: Documenting best practices and implementing a data-driven, systems-based planning is essential in advancing local PCU management know-how in LMIC. The modified Porter’s Value Model showed promise as a generalizable model for future public health practitioners and created a framework for systems-based, multidisciplinary approach in strategic planning. / 2020-06-30T00:00:00Z

No description available.