Functioning of family system in pediatric oncology during treatment phase

The study focuses on parents\u2019 psychological implications caused by the treatment of their children su\ufb00ering from tumor. It investigates some speci\ufb01c mothers\u2019 resource factors such as their strategies of coping and the perception of their own family functioning in terms of cohesion and adaptability. The study was performed with 34 mothers of children su\ufb00ering from acute lymphoblastic leukemia(ALL),duringthetreatmentphase.TheusedtoolsweretheCopingOrientationtoProblem Experienced\u2014New Italian Version, to investigate coping strategies, and the Family Adaptability and Cohesion Evaluation Scale-III, to analyze both real and ideal perception of family functioning. The data related to coping, show how the involved mothers tend to mainly use the strategies of positive aptitude, orientation toward problem and social support ( F = 99.88, d f= 4, P< .01). The family functioning, in terms of adaptabilit y, is described as chaotic relating to both the real (\u3c72 = 13.29,d f =3, P=.004)andideal(\u3c72=11.52,d f=2, P=.003)family,whereasintermsof cohesion, itisperceivedaschie\ufb02ydisengagedintherealfamily(\u3c72 =12.3,d f=3, P=.006)andasenmeshed in the ideal one (\u3c72 = 12.58, d f= 3, P= .006). Statistically positive correlations were only detected between adaptability and avoidance ( r = 0.49, P< .01); adaptability and orientation toward problem (r = 0.36, P< .05); and adaptability and transcendent orientation ( r = 120.04, P< .05). Despitethecriticalsituation,themothershaveshownoptimisticview,careforproblemmanagementandcapabilitytoaskforhelp.Thesecopingstrategiesallowthetherapeuticalliancebetween families and health care workers, so useful for the quality of childcarThe study focuses on parents\u2019 psychological implications caused by the treatment of their children su\ufb00ering from tumor. It investigates some speci\ufb01c mothers\u2019 resource factors such as their strategies of coping and the perception of their own family functioning in terms of cohesion and adaptability. The study was performed with 34 mothers of children su\ufb00ering from acute lymphoblastic leukemia(ALL),duringthetreatmentphase.TheusedtoolsweretheCopingOrientationtoProblem Experienced\u2014New Italian Version, to investigate coping strategies, and the Family Adaptability and Cohesion Evaluation Scale-III, to analyze both real and ideal perception of family functioning. The data related to coping, show how the involved mothers tend to mainly use the strategies of positive aptitude, orientation toward problem and social support ( F = 99.88, d f= 4, P< .01). The family functioning, in terms of adaptabilit y, is described as chaotic relating to both the real (\u3c72 = 13.29,d f =3, P=.004)andideal(\u3c72=11.52,d f=2, P=.003)family,whereasintermsof cohesion, itisperceivedaschie\ufb02ydisengagedintherealfamily(\u3c72 =12.3,d f=3, P=.006)andasenmeshed in the ideal one (\u3c72 = 12.58, d f= 3, P= .006). Statistically positive correlations were only detected between adaptability and avoidance ( r = 0.49, P< .01); adaptability and orientation toward problem (r = 0.36, P< .05); and adaptability and transcendent orientation ( r = 120.04, P< .05). Despitethecriticalsituation,themothershaveshownoptimisticview,careforproblemmanagementandcapabilitytoaskforhelp.Thesecopingstrategiesallowthetherapeuticalliancebetween families and health care workers, so useful for the quality of childcar

The Use of Psychotropic Medication in Pediatric Oncology for Acute Psychological and Psychiatric Problems: Balancing Risks and Benefits

Severe acute behavioral and emotional problems represent one of the most serious treatment-related adverse effects for children and adolescents who have cancer. The critical and severe nature of these symptoms often makes necessary the use of psychotropic drugs. A working group composed of experts in multiple disciplines had the task of creating an agreement regarding a management plan for severe acute behavioral and emotional problems (SABEPs) in children and adolescents treated for cancer. To obtain global information on the use of psychotropic drugs in pediatric oncology, the working group first developed and mailed a 15-item questionnaire to many Italian pediatric oncology centers. Overall, an evident lack of knowledge and education regarding the use of psychotropic medications for the treatment of SABEPs was found. Thus, by referring to an adapted version of the Delphi method of consensus and standard methods for the elaboration of clinical questions (PICOs), the working group elaborated evidence-based recommendations for psychotropic drugs in the pediatric oncology setting. Furthermore, based on a thorough multivariate analysis of needs and difficulties, a comprehensive management flow was developed to optimize therapeutic interventions, which allows more accurate and efficient matching of the acute needs of patients while guiding treatment options

Organizing national responses for rare blood disorders: the Italian experience with sickle cell disease in childhood

Background Sickle cell disease (SCD) is the most frequent hemoglobinopathy worldwide but remains a rare blood disorder in most western countries. Recommendations for standard of care have been produced in the United States, the United Kingdom and France, where this disease is relatively frequent because of earlier immigration from Africa. These recommendations have changed the clinical course of SCD but can be difficult to apply in other contexts. The Italian Association of Pediatric Hematology Oncology (AIEOP) decided to develop a common national response to the rising number of SCD patients in Italy with the following objectives: 1) to create a national working group focused on pediatric SCD, and 2) to develop tailored guidelines for the management of SCD that could be accessed and practiced by those involved in the care of children with SCD in Italy. Methods Guidelines, adapted to the Italian social context and health system, were developed by 22 pediatric hematologists representing 54 AIEOP centers across Italy. The group met five times for a total of 128 hours in 22 months; documents and opinions were circulated via web. Results Recommendations regarding the prevention and treatment of the most relevant complications of SCD in childhood adapted to the Italian context and health system were produced. For each topic, a pathway of diagnosis and care is detailed, and a selection of health management issues crucial to Italy or different from other countries is described (i.e., use of alternatives for infection prophylaxis because of the lack of oral penicillin in Italy). Conclusions Creating a network of physicians involved in the day-to-day care of children with SCD is feasible in a country where it remains rare. Providing hematologists, primary and secondary care physicians, and caregivers across the country with web-based guidelines for the management of SCD tailored to the Italian context is the first step in building a sustainable response to a rare but emerging childhood blood disorder and in implementing the World Health Organization\u2019s suggestion \u201cto design (and) implement \u2026 comprehensive national integrated programs for the prevention and management of SCD"

The Manchester Color Wheel: validation in secondary school pupils

<p>Abstract</p> <p>Background</p> <p>As part of our research programme into facilitating improved ways of communicating with patients, especially about more sensitive clinical issues, we have been investigating whether there are any non-verbal methods that might aid this process. One such approach is to ask patients to choose a color in response to a particular question, for instance about health or psychological status, and for this purpose we developed the Manchester Color Wheel (MCW). This instrument consists of positive, neutral and negative colors and its validation in normal adults and those with anxiety or depression showed that it is responsive to change and reproducible. It also has the capacity to identify a positive frame of mind. We concluded that it might be a particularly useful instrument in adolescents and therefore this study aimed to validate it in a secondary school.</p> <p>Methods</p> <p>620 pupils (aged 11–17 years, mean age 14.0 years, 298 (48.1%) males, 322 (51.9%) females) at Sale Grammar School in Greater Manchester were asked to relate their mood to a MCW color and also complete the Hospital Anxiety Depression (HAD) questionnaire. To give these pupils an experience in science, 197 were divided into four subgroups for an ‘experiment’ to ascertain whether, compared to controls, a change in mood color choice could be induced by participation in sport, music or art activities.</p> <p>Results</p> <p>Although mood color and HAD depression score are unlikely to be measuring exactly the same psychological state, a negative mood color was chosen by 62.5% of HAD depressed compared to only 14.5% of HAD normal pupils (p < 0.001). In contrast, a positive mood color was chosen by 48.9% of normal and only 18.8% of depressed pupils (p < 0.001). In the ‘experiment’, compared to controls, all activities resulted in an increased choice of positive mood colors which reached significance for sport and music.</p> <p>Conclusion</p> <p>This study confirms the potential utility of the MCW to rapidly and easily assess a variety of health issues in large populations, including adolescents. Some of our results should also be of interest to educationalists.</p