scholarly journals Symptoms in Children Receiving Treatment for Cancer—Part II: Pain, Sadness, and Symptom Clusters

2019 ◽  
Vol 36 (4) ◽  
pp. 262-279 ◽  
Author(s):  
Lauri A. Linder ◽  
Mary C. Hooke
Keyword(s):  
Children And Adolescents ◽  
Emotional Health ◽  
Symptom Assessment ◽  
Symptom Clusters ◽  
Current Evidence ◽  
Common Symptom ◽  
Symptom Profiles ◽  
Multiple Cycles ◽  
Cancer Experience ◽  
Multiple Symptoms

Children and adolescents receiving treatment for cancer experience multiple symptoms as a consequence of their disease and its treatment that interfere with the child’s quality of life. Understanding of symptom assessment in children with cancer is foundational to the work of the Children’s Oncology Group Nursing Discipline, whose research aims are to address knowledge gaps including understanding illness-related distress. This article is the second of a two-part summary of current evidence addressing the assessment of symptoms frequently reported by children and adolescents receiving treatment for cancer. Studies reporting assessment of pain, sadness, and symptom clusters published between January 2008 and May 2018 were included. Forty-three publications addressed pain. Pain was highly prevalent and distressing, varied in its trajectory across a cycle of chemotherapy and across multiple cycles of treatment, and correlated with biomarkers associated with the pain response. Consequences of pain were poorer functional status and emotional health. Twenty publications addressed sadness. Sadness was the most prevalent psychosocial symptom. Its prevalence decreased over the course of treatment and over a cycle of chemotherapy. Persistent sadness was of greater severity and distress. Eight publications addressed symptom clusters. These studies identified both groups of co-occurring symptoms and groups of patients with common symptom profiles. This two-article series provides evidence for the distressing nature of symptoms among children receiving cancer treatment. Efforts to support clinicians in routine symptom assessment are needed. Additional research directed at alleviating symptoms and building resilience among the child experiencing symptoms is needed.

scholarly journals Symptoms and symptom clusters in adolescents with cancer

2021 ◽  
Vol 5 (2) ◽  
pp. 14-24
Author(s):  
Remziye Semerci ◽  
Melahat Akgunmela Kostak ◽  
Tuba Eren ◽  
Filiz Savran ◽  
Gulcan Avci
Keyword(s):  
Symptom Assessment ◽  
Paediatric Oncology ◽  
Symptom Clusters ◽  
Emotional Symptoms ◽  
Purposeful Sampling ◽  
Memorial Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
Cancer Experience ◽  
Oncology Unit ◽  
Adolescent Inpatients

Abstract Clinical specialists have suggested that adolescents with cancer experience multiple problems including physical, psychological, and emotional symptoms. This study aimed to identify symptoms and symptoms clusters among adolescent inpatients and outpatients receiving cancer treatment. The study’s sample consisted of 26 adolescents who were selected with the purposeful sampling method in a paediatric oncology unit in Edirne, Turkey. Data were collected using the Memorial Symptom Assessment Scale (MSAS). From the results of the research, in terms of symptoms, outpatients reported a greater lack of concentration than inpatients did. Inpatients reported more hair loss and weight loss symptoms than outpatients. Adolescent inpatients and outpatients experienced the most symptoms during the treatment. Inpatient adolescents experienced more acute treatment-related symptoms than did outpatients. The study recommends regular monitoring and screening for nurses to identify symptom and symptom clusters. Keywords: Adolescent; nursing; symptom cluster; symptom assessment; cancer;  

scholarly journals POS1199 CLINICAL MANIFESTATIONS OF SARS-CoV2 INFECTIONS IN CHILDREN AND ADOLESCENTS WITH RHEUMATIC AND MUSCULUSKELETAL DISEASES – SURVEY DATA FROM GERMANY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 882.1-882
Author(s):  
C. Sengler ◽  
S. Eulert ◽  
M. Niewerth ◽  
T. Kallinich ◽  
H. Wittkowski ◽  
...  
Keyword(s):  
Disease Activity ◽  
Children And Adolescents ◽  
Symptom Onset ◽  
Clinical Manifestations ◽  
Virus Detection ◽  
German Society ◽  
Underlying Disease ◽  
Common Symptom ◽  
Disease Course ◽  
Cardiorespiratory Failure

Background:Although children and adolescents are less likely to develop COVID-19 and generally show milder disease courses, it is unclear what impact the SARS-CoV2 infection has on children and adolescents with rheumatic and musculoskeletal disease (RMD). Due to their underlying disease as well as therapeutic immunosuppression these patients may be at higher risk of being more severely affected by SARS-CoV2. Furthermore, SARS-CoV2 infection might trigger a flare of the underlying disease.Objectives:To evaluate clinical characteristics and disease course of COVID-19 in children and adolescents with RMD and to analyze possible effects of SARS-CoV2 infection on the underlying disease under different therapeutic regimens.Methods:Data from juvenile patients with RMD recorded via the SARS-CoV2 questionnaire within the National Pediatric Rheumatology Database and the registry for hospitalized children and adolescents with COVID-19 of the German Society for Pediatric Infectious Diseases were analyzed. In addition to age, sex and diagnosis, information was collected about the date and method of a positive SARS-CoV2 testing, reason for testing, on clinical manifestations, disease course, treatment and outcome of COVID-19, on drug therapy at the time of virus detection, on disease activity (NRS 0 – 10, 0 = best) of the underlying disease at the last visit before and after the SARS-CoV2 infection.Results:From April 17th 2020 until January 25th 2021, data of 67 patients with RMD and confirmed SARS-CoV2 infection were collected. Mean age was 13.5 ± 3.9 years with equal sex distribution. The majority of patients were diagnosed with juvenile idiopathic arthritis (JIA, 64%), 12 (18%) patients had an autoinflammatory disease (FMF, CAPS, PFAPA, TRAPS) and 5 (7%) a connective tissue disease. Fifty-two patients (78%) were treated with a disease modifying antirheumatic drug (DMARD), 39% with a biological DMARD and 9% systemic glucocorticoids at the time of SARS-CoV-2 infection. Nineteen patients (28%) were tested for SARS-CoV-2 because of typical symptoms, the majority (67%) because of contact to an infected person. PCR was used most often (in 60 %).52 patients (78%) developed symptoms of COVID-19, 15 patients remained asymptomatic. The most common symptom of COVID-19 was rhinitis (42%) and fever (38%), followed by fatigue (34%), taste/smell disorder (33%), sore throat (27%) and cough (23%).Disease severity was graded as mild in 44 of 52 (85%) symptomatic patients, only two patients were hospitalized, one of whom required intensive care and died of cardiorespiratory failure 3 days after symptom onset. In 22 of 26 (85%) SARS-CoV2-positive patients, no relevant increase in disease activity (difference in NRS ≤ 1 before/after infection) of the underlying disease was observed 31 days after symptom onset (median, IQR 17-52 days). One patient, who had paused tocilizumab for 2 doses, experienced a flare of his seronegative polyarthritis 2 months after asymptomatic SARS-CoV-2 infection.Conclusion:In our cohort, the clinical picture of COVID-19 in children and adolescents with RMD was similar to that of healthy peers. The majority of patients showed mild disease course with good outcome under various medications, however, one patient with a severe course of COVID-19 died. In addition, SARS-CoV2 infection does not appear to have a relevant impact on the underlying disease activity, whereas discontinuation of therapy might pose a risk of flare.Disclosure of Interests:None declared.

scholarly journals Triggers and Clinical Presentations of Functional Neurological Disorders: Lessons from World War 1

2020 ◽  
Vol 83 (2) ◽  
pp. 174-181
Author(s):  
Stefanie Caroline Linden
Keyword(s):  
Life Events ◽  
Somatic Symptom ◽  
Somatic Symptoms ◽  
Symptom Clusters ◽  
Physical Factors ◽  
World War ◽  
Combat Experience ◽  
Female Patients ◽  
Symptom Profiles ◽  
Somatic Symptom Disorders

Introduction: The psychological contribution to functional neurological and somatic symptom disorders is a major topic in current medical debate. Objective: For an understanding of the processes leading to functional somatic symptoms, it is paramount to explore their relationship with stress and life events and to elucidate the contribution of cultural factors. Methods: A total of 937 case records of civilian and military patients with functional somatic disorders treated in London during World War 1 were analysed. Group differences in symptom profiles and contemporaneous diagnoses were tested with χ2 tests. Results: Paralyses and speech disturbances were significantly more common in soldiers (43.3 and 17.2% of cases) than in civilian male (28.1 and 6.5%) and female patients (32.4 and 7.5%), whereas female patients had the highest rates of pain (48.6%) and somatic symptoms (67%). Triggers were identified in around two-thirds of cases and included accidents, physical illness, and work stress, in addition to the combat experience of the soldier patients. The nature of the trigger influenced symptom expression, with acute (combat and noncombat) events being particularly prone to trigger loss of motor function. Symptom profiles showed a great deal of multi-morbidity and overlap, although some symptom clusters were more (motor and speech disturbance) or less common (pain and loss of energy) in soldiers than civilians. Triggering life events in civilians were similar to those reported by patients with somatic symptom disorders today, with an important role of physical factors. Patterns of multi-morbidity and symptom clusters also resembled those of modern cohorts. Conclusions: Analysis of historical records, illness trajectories, and treatments can enhance the understanding of the presentation, mechanisms, and course of functional neurological and related disorders and their consistency over time.

scholarly journals Physical activity versus metformin for increasing insulin sensitivity in children and adolescents at-risk for type 2 diabetes

2016 ◽  
Vol 85 (2) ◽  
pp. 26-28
Author(s):  
Andrew D Hanna ◽  
Natalie V Scime
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
At Risk ◽  
Insulin Sensitivity ◽  
Children And Adolescents ◽  
Pediatric Population ◽  
Current Evidence ◽  
Beneficial Effects ◽  
Pediatric Populations

Global rates of type 2 diabetes (T2D) among children and adolescents are steadily rising. As such, an increasing amount of attention and research has begun to focus on strategies to prevent this chronic and burdensome disease in pediatric populations. The purpose of this article is to briefly review current evidence pertaining to the effectiveness of physical activity versus metformin in improving insulin sensitivity of children at-risk (ie, obese and/or insulin resistant) for developing T2D. Potential barriers to each preventative intervention will also be discussed. Physical activity, both aerobic and resistance, has demonstrated effectiveness in a moderate number of demographically diverse pediatric studies. However, the pediatric population is already alarmingly sedentary with barriers such as lack of motivation, social stigma and discomfort presenting a challenge. A small number of studies have demonstrated the beneficial effects of metformin in children and adolescents for improved insulin sensitivity. However, longer and larger studies are required to confirm these findings and elucidate upon the long-term safety and efficacy of this pharmaceutical in pediatric populations. While no head-to-head studies examining physical activity and metformin exist in pediatric populations and more research is needed, current evidence seems to favour the use of physical activity given the larger quantity of studies and generalizability of its beneficial effects. Thus, physical activity should be emphasized in clinical and public health practice when targeting at-risk children and adolescents to prevent a T2D diagnosis.

scholarly journals COVID-Q: validation of the first COVID-19 questionnaire based on patient-rated symptom gravity

2021 ◽  
Author(s):  
Giacomo Spinato ◽  
Cristoforo Fabbris ◽  
Federica Conte ◽  
Anna Menegaldo ◽  
Leonardo Franz ◽  
...  
Keyword(s):  
Comprehensive Evaluation ◽  
Principal Component ◽  
Symptom Assessment ◽  
Parallel Analysis ◽  
Nasopharyngeal Swab ◽  
Item Fit ◽  
Irt Models ◽  
Clinical Conditions ◽  
Negative Controls ◽  
Multiple Symptoms

Objectives The aim of the present study was to develop and validate the CoronaVirus Disease 2019 (COVID19) Questionnaire (COVIDQ), a novel symptom questionnaire specific for COVID19 patients, to provide a comprehensive evaluation which may be helpful for physicians. A secondary goal of the present study was to evaluate the performance of the COVIDQ in identifying subjects at higher risk of being tested positive for COVID19. Material and methods Consecutive not hospitalized adults who underwent nasopharyngeal and throat swab for severe acute respiratory syndrome coronavirus 2 (SARSCoV2) detection at Treviso Hospital in March 2020, were enrolled. Subjects were divided into positive (cases) and negative (controls) in equal number. All of them gave consent and answered the COVIDQ. Patients not able to answer the COVIDQ due to clinical conditions were excluded. Parallel Analysis and Principal Component Analysis were used to identify clusters of items measuring the same dimension. The Item Response Theory (IRT) based analyses evaluated the functioning of item categories, the presence of clusters of local dependence among items, item fit within the model and model fit to the data. Results Answers obtained from 230 COVID19 cases (113 males, and 117 females; mean age 55 years, range 20 to 99 years) and 230 controls (61 males, and 169 females; mean age 46 years, range 21 to 89) were analyzed. Parallel analysis led to the extraction of six components, which corresponded to as many clinical presentation patterns: asthenia, influenza symptoms, ear and nose symptoms, breathing issues, throat symptoms, and anosmia/ageusia. The final IRT models retained 27 items as significant for symptom assessment. The total score on the questionnaire was significantly associated with positivity to the molecular SARSCoV2 test: subjects with multiple symptoms were significantly more likely to be affected by COVID19 (p < .001). Older age and male gender also represented risk factors. Presence of breathing issues and anosmia/ageusia were significantly related to positivity to SARSCoV2 (p < 0.001). None of the examined comorbidities had a significant association with COVID19 diagnosis. Conclusion According to the analyses, COVIDQ could be validated since the aspects it evaluated were overall significantly related to SARSCoV2 infection. The application of the novel COVIDQ to everyday clinical practice may help identifying subjects who are likely to be affected by COVID19 and address them to a nasopharyngeal swab in order to achieve an early diagnosis.

scholarly journals Forced Oscillation Technique for Monitoring the Respiratory Status of Children with Cystic Fibrosis: A Systematic Review

Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 857
Author(s):  
Ioanna Loukou ◽  
Maria Moustaki ◽  
Agni Deligianni ◽  
Olympia Sardeli ◽  
Konstantinos Douros
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Children And Adolescents ◽  
Forced Oscillation ◽  
Clinical Symptoms ◽  
Current Evidence ◽  
Forced Oscillation Technique ◽  
Gold Standard Method ◽  
Respiratory Status ◽  
Alternative Modality

Spirometry is considered the gold standard method for monitoring lung function of patients with cystic fibrosis (CF) but it requires patients’ cooperation and therefore it is not useful for the majority of preschool-aged children. Oscillometry is an alternative modality for lung function monitoring that requires minimal cooperation and can be applied in children as young as 3 years of age. Furthermore, it generates lesser aerosol compared to spirometry, an issue that is of considerable importance in the COVID-19 era. The aim of this review was to present the existing clinical data regarding the application of oscillometry in children and adolescents with CF. The method seems to have acceptable feasibility and repeatability. However, there is conflicting data regarding the correlation of oscillometry values with the clinical symptoms of CF patients either in clinically stable or in exacerbation periods. Furthermore, it is not clear to what extent oscillometry measurements correlate with the spirometry indices. Based on current evidence, spirometry cannot be substituted by oscillometry in the monitoring of the respiratory status of children and adolescents with CF.

scholarly journals Depression in Children and Adolescents with Autism Spectrum Disorder

Children ◽  
2018 ◽  
Vol 5 (9) ◽  
pp. 112 ◽  
Author(s):  
Melissa DeFilippis
Keyword(s):  
Autism Spectrum Disorder ◽  
Children And Adolescents ◽  
Rating Scales ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
High Rate ◽  
Current Evidence ◽  
Comorbid Depression ◽  
Adolescents With Asd ◽  
Higher Functioning

Autism spectrum disorder (ASD) has a high rate of psychiatric comorbidity. The prevalence of comorbid depression seems to correlate with higher functioning forms of ASD and increasing age. Adolescence is a time when youth struggle with identity and interpersonal relationships, and a diagnosis of ASD further complicates this process. Adolescents with ASD may be more aware of the social communication deficits that come with the diagnosis than children with ASD, and it is theorized that higher functioning adolescents may experience this more acutely. While this may be true, the lack of reliable rating and diagnostic scales for depression in individuals with ASD makes it difficult to accurately measure rates of depression among individuals with more severe verbal deficits. While some research has focused on the prevalence of comorbid depression in children and adolescents with ASD and on the associated risk factors, there is very little evidence guiding treatment, including no empirical studies on psychopharmacology for depression in this population. Available evidence exists only in psychosocial approaches to treatment at this time and is mostly limited to adult studies. Current evidence will be presented in this review, including prevalence rates of depression in youth with ASD, various risk and protective factors, the use of diagnostic rating scales, and treatment studies. The lack of evidence supporting various treatment approaches will be highlighted, including challenges specific to the treatment of depression in ASD, which are not addressed in the current treatment studies in typically developing youth with depression.

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