Sacrificing a limb for life: psychological interventions in osteosarcoma

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Overprotection and the psychological states of cerebral palsy patients and their caretakers in Hong Kong: A preliminary report

Objective: To examine the relation between perceived overprotection and the psychological states of cerebral palsy patients and their primary caretakers in Hong Kong. Design: Cross-sectional survey, in which data of 14 pairs of cerebral palsy patients and their caretakers were analysed. Setting: Duchess of Kent Children's Hospital, Hong Kong. Participants: Cerebral palsy patients and their primary caretakers in Hong Kong. Main outcome measures: Perceived overprotection and psychological states. Results: Nearly two thirds of the 14 patients (mean age of 15 years) and 86% of the 14 primary caretakers (mean age of 47 years) perceived various levels of overprotection. For both patients and caretakers, perceived overprotection was positively associated with anxiety and unhappiness. The patients' and caretakers' psychological states and perception of overprotection were not related to the actual motor ability of the patients. Perceived overprotection of the patients was not related to that of the caretakers. Conclusion: Caretakers should be mindful that a well-meaning move may have undesirable consequences. More support and child-rearing education should be considered for caretakers.published_or_final_versio

Psychological vulnerability and resilience in children and adolescents with thalassaemia major

Objectives: Chronic childhood illness may be a risk factor for psychosocial or psychiatric disturbances. Yet, children with chronic illnesses may also show resilience and active coping with varying degrees of success or failure. The present study aims to outline the patterns of coping and adjustment of patients with thalassaemia major, and identify specific developmental issues associated with living with the chronic illness. Method: Seventy-three patients receiving treatments at Queen Mary Hospital were assessed with a set of semi-structured interview and questionnaires instruments covering the children's perceptions of their quality of life, illness and treatment. Their psychological adjustment was assessed through measures on life satisfaction, the extent and nature to which they felt they had been adversely affected by the illness and treatment, and their views of the future and of themselves. Results: The patients had multiple concerns and dissatisfactions with their illness, treatments, and health status, but many of their concerns were also commonly noted in normal healthy children. Resilience is demonstrated in a proportion of patients. There were clear developmental trends showing that patients had changing concerns over different stages of their development. Older patients had more adverse impact as chronicity and mental exhaustion in coping with the illness seemed to be an important factor affecting adjustment. Conclusions: The results indicate the need for psychosocial interventions, especially for the older patients with thalassaemia major.link_to_subscribed_fulltex

The development of a strength-focused mutual support group for caretakers of children with cerebral palsy

Objective: To examine the efficacy of a strength-focused mutual support group for reducing stress and enhancing psychological well-being of the caretakers of children with cerebral palsy. Methods: This pre- and post-intervention outcome study, conducted by Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, recruited 12 primary caretakers of children with cerebral palsy in Hong Kong. A strength-focused support group manual was developed to help such caretakers to identify and cultivate the character strengths of their children and enhance their own positive emotions. Participants were asked to complete a full set of questionnaires at 3 time-points: before and immediately after the intervention (consisting of 4 weekly sessions), and after the 1-month follow-up booster session. Two additional questionnaires were administered before each session to check mood. Parenting stress, anxiety, depression, social support, hope, and other psychological well-being measures were also assessed. Results: Half of the caretakers (n = 6) who had attended the full intervention programme were included in the data analysis. Participants exhibited a significantly lower level of parental stress and higher hope level both after the 4 intervention sessions and at the booster session. Their perceived social support was significantly increased when the group was ongoing but not after it ended. Conclusion: This group intervention programme could effectively help caretakers reduce their parenting stress and enhance their hopefulness. Launching a similar programme with more sessions and regular follow-up sessions might help maintain positive effects and establish a social support network. © 2011 Hong Kong College of Psychiatrists.link_to_OA_fulltex

An episode of syncope attacks in adolescent schoolgirls: Investigations, intervention and outcome

An increasing number of students in a secondary convent girls school developed syncope attacks over a time course of about two months. Fourteen students who suffered from syncope and 12 other students from the same class with no symptoms were assessed by a team of psychologists and paediatricians with the aim of identifying the cause of the problem and to formulate possible remedial action. Psychological assessments included a mental state examination, developmental, personal and psychological history, state-trait anxiety, self-esteem, hypnotic suggestibility, and students' beliefs about the cause and nature of the syncope attacks. Physical investigations included physical examination, blood pressure and electrocardiogram. The results indicated that most participants and controls had no physical or psychological pathologies. The two groups were not different on the physical and psychological measures. Analyses of the interview data, however, indicated that all the syncope sufferers belonged to a cohesive and exclusive social network. Social psychological circumstances rather than individual psychopathology were noted to be primarily responsible for the spread and maintenance of the mass hysterical influence. Intervention consisted of health education, authoritative reassurance and back-up support. Follow-up assessment after three and 12 months indicated no further syncope episodes

Right-lobe live donor liver transplantation improves survival of patients with acute liver failure

Backgroud: Right-lobe live donor liver transplantation (LDLT) is used by many liver transplant centres for treating adult patients with terminal liver disease, but its incremental benefit for the intended recipient over cadaveric liver graft transplantation has not been determined. The impact of LDLT as a proactive approach on the outcome of patients with acute liver failure was analysed. Methods: From January 1999 to March 2001, right-lobe LDLT was offered proactively to 50 consecutive patients with acute liver failure and their families. The outcome of those who opted for right-lobe LDLT (n = 34) was compared with that of those who did not opt for LDLT (n = 16). Results: In the group that opted for right-lobe LDLT, 16 patients eventually received a live donor right-lobe graft (14 patients survived) and three patients received a cadaveric liver graft that became available while the potential live donor was undergoing evaluation (all three patients survived). Among the group who did not opt for LDLT, only one patient received a cadaveric liver graft and survived. The former group had a higher overall survival rate (17 of 34 versus one of 16). With a proactive approach, the overall transplant rate was increased from four of 50 to 20 of 50. The morbidity rate among donors was low and none died. Conclusion: Right-lobe LDLT improves the overall survival rate of patients with acute liver failure and should be considered as one of the treatment options for adult patients with acute liver failure.link_to_subscribed_fulltex

Effect of individual psychological intervention in Chinese women with gynecologic malignancy: A randomized controlled trial

Purpose: To evaluate the effectiveness of psychological intervention in the care of cancer patients and to determine whether routine use of individual psychological therapies is indicated. Patients and Methods: Patients with newly diagnosed gynecologic malignancies from August 1999 to November 2000 were recruited and randomly assigned to either a control group receiving routine medical care or to an intervention group receiving individual psychotherapy. A set of fixed-choice, self-report questionnaires assessing the patients' psychological status, quality of life, and their perceptions related to the medical consultations was completed at recruitment and then every 3 months for 18 months. Data analysis was performed according to the intention-to-treat principle by fitting the data into a linear mixed-effects model. Multivariable analyses were performed to examine the effects of confounding factors. Results: One hundred fifty-five patients participated in the trial. There were no statistically significant differences between the two groups at baseline. There was a trend toward better quality of life and functional status and also improvement of the symptoms over time for both groups. No differences were found between the groups in the scores measured by any of the instruments at baseline and at any time points after the cancer diagnosis. Psychological intervention had no significant effects on the psychosocial parameters. Conclusion: Routine use of psychological therapies as given in our format has no significant effect on the patients' quality of life and psychological status. © 2005 by American Society of Clinical Oncology.link_to_subscribed_fulltex

White matter fractional anisotropy (FA) in the assessment of treatment-induced neurotoxicity in childhood cancer survivors: association with neurocognitive function

We evaluated the mean white matter fractional anisotropy (FA) of childhood medulloblastoma and acute lymphoblastic leukemia survivors who had undergone standardized whole brain irradiation and chemotherapy treatment regimes, to determine if the severity of reduction in FA (compared to normal subjects) correlates with IQ scores; full-scale IQ (FSIQ), verbal IQ (VIQ) and performance IQ (PIQ). We found statistically significant correlations between deviation in mean white matter FA and FSIQ (r = 0.661, p< 0.0001), VIQ (r = 0.500, p = 0.007), PIQ (r = 0.716, p < 0.0001), suggesting that white matter FA is a useful biomarker of treatment-induced neurotoxicity