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Orange Cove, CA, United States

Buchbinder D.,CHOC Childrens Hospital
Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses | Year: 2011

Although increasing numbers of studies have examined late effects in survivors, there is a paucity of long-term outcome studies in their siblings, so-called sibling survivors. Our aim was to provide a review of publications relevant to survivorship and its impact on the long-term psychosocial health of sibling survivors using a family systems framework. A review of publications identified 19 articles that reported findings suggesting that aspects of psychosocial health may be impaired in sibling survivors. Baseline functioning of sibling survivors may be altered at the start of survivorship secondary to apprehension, memories, and emotions. New demands are placed on sibling survivors, including doubts, questions, and worries due to survivorship. Survivor disfigurement may also place demands on sibling survivors associated with behavioral problems. Associated with these changes, there may be alterations in adaptation, including depression, somatic complaints, and posttraumatic stress symptoms. Sibling survivors may also report health risk behaviors and decreased vitality. Identification of the impact of survivorship on the long-term psychosocial health of sibling survivors may help ensure the long-term psychosocial health of all survivors.

Mucci G.A.,CHOC Childrens Hospital | Torno L.R.,University of California
Handbook of Long Term Care of The Childhood Cancer Survivor | Year: 2015

This authoritative reference examines in depth the myriad challenges facing pediatric cancer survivors and proposes a robust framework for structured follow-up of these patients through adulthood. Approaches to long-term follow-up include both established models of care and targeted models of lifelong surveillance of late effects by bodily systems and neurological outcomes. Sections devoted to quality of life and re-entry after treatment focus on key concerns such as health risk behaviors, school and career issues, psychological challenges, and care disparities. And a robust resources section adds extra usefulness to the expert coverage. Among the Handbook’s topics: Developmental considerations in the transition from child and adolescent to adult survivorship. Long-term follow-up roadmaps by disease and treatment. Neuropsychological effects of pediatric brain tumors and associated treatment. Building resiliency in childhood cancer survivors: a clinician’s perspective. School issues and educational strategies for survivors of childhood cancer. Educating and preparing the childhood cancer survivor for long-term care: a curriculum model for cancer centers. A work of rare scope, scholarship, and clinical acumen, the Handbook of Long-Term Care of the Childhood Cancer Survivor is a rewarding, practice-building resource essential to a wide range of healing professionals, including pri mary care physicians, pediatricians, oncologists, nurses, psychologists, neuropsychologists, child psychologists, and licensed therapists. © Springer Science+Business Media New York 2015.

Ji T.,University of California at Irvine | Ji T.,Peking University | Guo Y.,University of California at Irvine | Kim K.,University of California at Irvine | And 8 more authors.
Molecular Cancer | Year: 2015

Background: Neuropilin 2 (NRP2) isa multi-functional co-receptor to many receptors, including VEGF receptor, c-Met and others. NRP2 has recently been implicated in tumor angiogenesis, growth, and metastasis of many other cancers. However, its role in osteosarcoma remains poorly understood. Results: NRP2 was overexpressed in osteosarcoma cell lines and tissues, and associated with poor survival of osteosarcoma patients. Knockdown of NRP2 expression by short-hairpin (Sh) RNA resulted in reduced tumor growth, metastasis, and blood vessel formation of osteosarcoma. Knockdown of NRP2 expression by ShRNA also inhibited the recruitment of HUVEC cells to osteosarcoma cells. Inhibition of Wnt signaling by overexpression of secreted Wnt antagonists soluble LRP5, Frzb, and WIF1 markedly down-regulated mRNA and protein expression of NRP2 in osteosarcoma cell lines. Conclusions: Regulation of NRP2 receptor expression may represent a novel approach for treatment of osteosarcoma through retarding osteosarcoma growth, metastasis and blood vessel formation. In addition, down-regulation of NRP2 expression can be achieved by expression of secreted Wnt antagonists. © Ji et al.

Fortier M.A.,University of California | Tan E.T.,University of California | Mayes L.C.,Yale University | Wahi A.,University of California | And 4 more authors.
Paediatric Anaesthesia | Year: 2013

Objectives: To examine the role of ethnicity and language in parent report of children's postoperative behavioral recovery. Aim: To compare incidence of new onset negative behavior change in English- and Spanish-speaking White and Hispanic children following outpatient surgery. Background: Postoperative behavioral change in children is common; however, it is unknown whether cultural variables including ethnicity and language may influence parent report of children's behavioral recovery. Methods/Materials: Participants included 288 parents (English-speaking White, English-speaking Hispanic, Spanish-speaking Hispanic parents) of children undergoing outpatient elective surgery. Parents completed the post-hospitalization behavior questionnaire (PHBQ) and parents' postoperative pain measure (PPPM) on postoperative days one, three, and seven at home. Results: Most parents (83%) reported onset of new negative behavioral change in children postoperatively. Generalized estimating equations revealed significant group differences in overall behavior change [Wald χ2(12) = 375.69, P < 0.0001] after controlling for demographic and socioeconomic differences. At all three postoperative days, Spanish-speaking Hispanic (SSH) parents reported lower negative behavioral changes in their children compared to English-speaking White (ESW) parents (day 1: P < 0.01; day 3: P < 0.001; day 7: P < 0.10). On postoperative days one and three, SSH parents also reported lower total PHBQ scores than English-speaking Hispanic (ESH) parents [day 1: χ2(1) = 6.72, P = 0.01; day 3: χ2(1) = 7.98, P = 0.005]. Conclusion: The present study provides evidence that parent report of children's postoperative behavioral recovery may be influenced by cultural variables, such as ethnicity and language. The present results contribute to a growing body of evidence that highlights the need for culturally sensitive assessment and care of families in the medical setting. The findings may reflect differences in cultural values such as stoicism; however, future studies would benefit from examination of the factors that may account for the differences in reported behavior change after surgery (i.e., report bias, cultural values). © 2012 Blackwell Publishing Ltd.

Morris M.,CHOC Childrens Hospital | Cleary J.P.,CHOC Childrens Hospital | Soliman A.,Miller Childrens and Womens Hospital
Pediatrics | Year: 2015

OBJECTIVE: The survival rates for extremely low birth weight (ELBW) infants have improved, but many are discharged from the hospital with significant challenges. Our goal was to improve outcomes for this population by using a multidisciplinary team-based quality improvement approach. METHODS: A unique program called the Small Baby Unit (SBU) was established in a children's hospital to care for the ELBW infant born at 28 weeks or less and weighing less than 1000 g at birth. These patients were cared for in a separate location from the main neonatal unit. A core multidisciplinary team that participates in ongoing educational and process-improvement collaboration provides care. Evidence-based guidelines and checklists standardized the approach. RESULTS: Data from the 2 years before and 4 years after opening the SBU are included. There was a reduction in chronic lung disease from 47.5% to 35.4% (P = .097). The rate of hospital-acquired infection decreased from 39.3% to 19.4% (P < .001). Infants being discharged with growth restriction (combined weight and head circumference <10th percentile) decreased from 62.3% to 37.3% (P = .001). Reduced resource utilization was demonstrated as the mean number per patient of laboratory tests decreased from 224 to 82 (P < .001) and radiographs decreased from 45 to 22 (P < .001). CONCLUSIONS: Care in a distinct unit by a consistent multidisciplinary SBU team using quality improvement methods improved outcomes in ELBW infants. Ongoing team engagement and development are required to sustain improved outcomes. Copyright © 2015 by the American Academy of Pediatrics.

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