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Zhou Y, Cui Y, Wang H, Wang F, Lu C, Shen Y. Developing a tool for nurses to assess risk of infection in pediatric oncology patients in China: a modified Delphi study. J Biomed Res 2016; 30:386-392. [PMID: 27845302 PMCID: PMC5044711 DOI: 10.7555/jbr.30.20160014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/24/2016] [Accepted: 05/24/2016] [Indexed: 11/23/2022] Open
Abstract
Infections are identified as the most common preventable cause of death in pediatric oncology patients. Assessing and stratifying risk of infections are essential to prevent infection in these patients. To date, no tool can fulfill this demand in China. This study aimed to develop a nursing work-based and Chinese-specific tool for pediatric nurses to assess risk of infection in oncology patients. This research was a modified Delphi study. Based on a literature review, a 37-item questionnaire rating on a 0–5 scale was developed. Twenty-four experts from 8 hospitals in 6 provinces of China were consulted for three rounds. Consensus for each item in the first round was defined as: the rating mean was > 3 and the coefficient of variation (CV) was < 0.5. Consensus for each item in the second round was defined as CV < 0.3. Consensus among experts was defined as: P value of Kendall's coefficient of concordance (W) < 0.05. After three rounds of consultation, a two-part tool was developed: the Immune Status Scale (ISS) and the Checklist of Risk Factors of Infection (CRFI). There were 5 items in the ISS and 14 in the CRFI. Based on the ISS score, nurses could stratify children into the low-risk and high-risk groups. For high-risk children, nurses should screen risk factors of infection every day by the CRFI, and twice weekly for low-risk children. Further study is needed to verify this tool's efficacy.
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Affiliation(s)
- Yufeng Zhou
- Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, JIangsu 211166, China
| | - Yan Cui
- Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, JIangsu 211166, China;
| | - Hong Wang
- Department of Respiratory, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Fang Wang
- Department of Paediatric, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chao Lu
- Department of Paediatric, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yan Shen
- Department of Paediatric, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Taylor RM, Feltbower RG, Aslam N, Raine R, Whelan JS, Gibson F. Modified international e-Delphi survey to define healthcare professional competencies for working with teenagers and young adults with cancer. BMJ Open 2016; 6:e011361. [PMID: 27142859 PMCID: PMC4861123 DOI: 10.1136/bmjopen-2016-011361] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To provide international consensus on the competencies required by healthcare professionals in order to provide specialist care for teenagers and young adults (TYA) with cancer. DESIGN Modified e-Delphi survey. SETTING International, multicentre study. PARTICIPANTS Experts were defined as professionals having worked in TYA cancer care for more than 12 months. They were identified through publications and professional organisations. METHODS Round 1, developed from a previous qualitative study, included 87 closed-ended questions with responses on a nine-point Likert scale and further open-ended responses to identify other skills, knowledge and attitudes. Round 2 contained only items with no consensus in round 1 and suggestions of additional items of competency. Consensus was defined as a median score ranging from 7 to 9 and strength of agreement using mean absolute deviation of the median. RESULTS A total of 179 registered to be members of the expert panel; valid responses were available from 158 (88%) in round 1 and 136/158 (86%) in round 2. The majority of participants were nurses (35%) or doctors (39%) from Europe (55%) or North America (35%). All 87 items in round 1 reached consensus with an additional 15 items identified for round 2, which also reached consensus. The strength of agreement was mostly high for statements. The areas of competence rated most important were agreed to be: 'Identify the impact of disease on young people's life' (skill), 'Know about side effects of treatment and how this might be different to those experienced by children or older adults' (knowledge), 'Honesty' (attitude) and 'Listen to young people's concerns' (aspect of communication). CONCLUSIONS Given the high degree of consensus, this list of competencies should influence education curriculum, professional development and inform workforce planning. Variation in strength of agreement for some competencies between professional groups should be explored further in pursuit of effective multidisciplinary team working.
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Affiliation(s)
- Rachel M Taylor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
- School of Health and Social Care, London South Bank University, London, UK
| | - Richard G Feltbower
- Division of Epidemiology & Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - Natasha Aslam
- NIHR University College London Hospitals Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Jeremy S Whelan
- NIHR University College London Hospitals Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health and Social Care, London South Bank University, London, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Gibson F, Vindrola-Padros C, Hinds P, Nolbris MJ, Kelly D, Kelly P, Ruccione K, Soanes L, Woodgate RL, Baggott C. Building the Evidence for Nursing Practice: Learning from a Structured Review of SIOP Abstracts, 2003-2012. Pediatr Blood Cancer 2015; 62:2172-6. [PMID: 26179361 DOI: 10.1002/pbc.25652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/03/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND The focus of work submitted to an international conference can reflect the changing landscape of a specialty and prove important for identifying trends, uncovering gaps, and providing new directions for nurse-led research and clinical practice. We present an analysis of trends in presentations in the nursing program at the SIOP congress from 2003 to 2012 based on all accepted abstracts. PROCEDURE A total of 462 abstracts were analyzed. A data extraction form was used to ensure consistency of data retrieved. Paired researchers were assigned 2 years of abstracts for assessment: approximately 80-100 abstracts each. Data were entered into REDCap data management software. RESULTS Most abstracts came from presenters affiliated with institutions in Europe and North America with a noticeably significant under-representation from developing countries. There was an equal representation of papers focused on empirical research with family members and clinical practice focused on the professional role, although this varied in some years. Analysis of research methodology revealed a predominance of surveys, with a recent increase in qualitative and mixed method studies. Out of all abstracts only 18% were subsequently published. CONCLUSIONS Gaps have been identified, such as the limited involvement of nurses in developing countries, and lack of studies self-reporting from children. Much needs to be done to promote a greater diversity of research frameworks and more dynamic research designs. The small percentage of abstracts from nurses that are eventually published may hinder translation of the findings into clinical practice.
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Affiliation(s)
- Faith Gibson
- Children and Young People's Cancer Care, Centre for Outcomes and Experiences Research in Children's Health, Illness, and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust and London South Bank University, London, UK
| | | | - Pamela Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Medical Center, Washington, DC
| | - Margaretha J Nolbris
- Queen Silvia Children's Hospital, Centrum for Children's Rights, Gothenburg, Sweden
| | - Daniel Kelly
- Research and Innovation/RCN Chair of Nursing Research, School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Paula Kelly
- Child and Adolescent Nursing Florence Nightingale Faculty of Nursing, and Midwifery Kings College London, Honorary Senior Research Associate Louis Dundas Centre for Children's Palliative Care University College London, London, UK
| | - Kathy Ruccione
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Professor of Clinical Pediatrics, Keck School of Medicine of the University of Southern California, California
| | - Louise Soanes
- Teenage Cancer Trust Nurse Consultant for Adolescents and Young Adults, The Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Roberta L Woodgate
- Canadian Institutes of Health Research Applied Chair in Reproductive, Child and Youth Health Services and Policy Research and Professor, Faculty of Health Sciences, College of Nursing, University of Manitoba, Canada
| | - Christina Baggott
- Clinical Research Nurse Practitioner-Pediatric Oncology, Cancer Clinical Trials Office, Stanford University, Palo Alto, California
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International Society of Pediatric Oncology (SIOP): Developmental goals 2014-2016: Communication update. Pediatr Blood Cancer 2015; 62:1117-8. [PMID: 25809741 DOI: 10.1002/pbc.25478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 01/25/2015] [Indexed: 11/09/2022]
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Twycross A, Parker R, Williams A, Gibson F. Cancer-Related Pain and Pain Management: Sources, Prevalence, and the Experiences of Children and Parents. J Pediatr Oncol Nurs 2015; 32:369-84. [PMID: 25736032 DOI: 10.1177/1043454214563751] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Advances in treatment mean children are increasingly cared for by their parents at home, leading to a shift in responsibility from health care professionals to parents. Little is known about parents' pain management experiences and the etiology of pain experienced by children with cancer especially when at home. A rapid review of the literature was undertaken investigating children's cancer-related pain, with emphasis on the management of pain outside the health care setting. Electronic databases were searched and a quality assessment was conducted. Forty-two articles were included. Despite advances in pain management techniques, children with cancer regularly cite pain as the most prevalent symptom throughout the cancer trajectory. The source of pain is usually treatment side effects or painful procedures. Parents find dealing with their child's pain distressing and demanding and may hold misconceptions about pain management. Findings indicate a need for more robust research into parental pain management leading to the development of effective pain management resources for parents.
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Affiliation(s)
| | | | - Anna Williams
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Faith Gibson
- London South Bank University, London, UK Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Adamson PC, Houghton PJ, Perilongo G, Pritchard-Jones K. Drug discovery in paediatric oncology: roadblocks to progress. Nat Rev Clin Oncol 2014; 11:732-9. [PMID: 25223555 PMCID: PMC4637819 DOI: 10.1038/nrclinonc.2014.149] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Approval of new cancer drugs for paediatric patients generally occurs after their development and approval for treating adult cancers. As most drug development occurs in the industry setting, the relatively small market of paediatric oncology does not provide the financial incentives for companies to actively pursue paediatric oncology solutions. Indeed, between 1948 and January 2003 the FDA approved 120 new cancer drugs, of which only 30 have been used in children. This slow rate of development must be addressed in a meaningful way if we are to make progress in the most pressing settings in childhood cancer. In this Viewpoint article, the key opinion leaders in the field weigh in and offer practical advice on how to address this issue.
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Affiliation(s)
- Peter C Adamson
- The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, CTRB 10060, Philadelphia, PA 19104, USA
| | - Peter J Houghton
- The Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | | | - Kathy Pritchard-Jones
- Institute of Child Health, Cancer Section, University College London, 30 Guilford Street, London WC1N 1EH, UK
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Rivera-Luna R, Shalkow-Klincovstein J, Velasco-Hidalgo L, Cárdenas-Cardós R, Zapata-Tarrés M, Olaya-Vargas A, Aguilar-Ortiz MR, Altamirano-Alvarez E, Correa-Gonzalez C, Sánchez-Zubieta F, Pantoja-Guillen F. Descriptive Epidemiology in Mexican children with cancer under an open national public health insurance program. BMC Cancer 2014; 14:790. [PMID: 25355045 PMCID: PMC4228174 DOI: 10.1186/1471-2407-14-790] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 10/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background All the children registered at the National Council for the Prevention and Treatment of Childhood Cancer were analyzed. The rationale for this Federal Government Council is to financially support the treatment of all children registered into this system. All patients are within a network of 55 public certified hospitals nationwide. Methods In the current study, data from 2007 to 2012 are presented for all patients (0–18 years) with a pathological diagnosis of leukemia, lymphoma and solid tumors. The parameters analyzed were prevalence, incidence, mortality, and abandonment rate. Results A diagnosis of cancer was documented in 14,178 children. The incidence was of 156.9/million/year (2012). The median age was 4.9. The most common childhood cancer is leukemia, which occurs in 49.8% of patients (2007–2012); and has an incidence rate of 78.1/million/year (2012). The national mortality rate was 5.3/100,000 in 2012, however in the group between 15 to 18 years it reaches a level of 8.6. Conclusions The study demonstrates that there is a high incidence of childhood cancer in Mexico. In particular, the results reveal an elevated incidence and prevalence of leukemia especially from 0 to 4 years. Only 4.7% of these patients abandoned treatment. The clinical outcome for all of the children studied improved since the establishment of this national program.
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Affiliation(s)
- Roberto Rivera-Luna
- Head of the Division of Pediatric Hem/Oncology, National Institute of Pediatrics (NIP), Coordinator for the Technical Committee of the National Council for the Prevention and Treatment of Childhood Cancer, Mexico City, Mexico.
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Vassal G, Fitzgerald E, Schrappe M, Arnold F, Kowalczyk J, Walker D, Hjorth L, Riccardi R, Kienesberger A, Jones KP, Valsecchi MG, Janic D, Hasle H, Kearns P, Petrarulo G, Florindi F, Essiaf S, Ladenstein R. Challenges for children and adolescents with cancer in Europe: the SIOP-Europe agenda. Pediatr Blood Cancer 2014; 61:1551-7. [PMID: 24706509 PMCID: PMC4285788 DOI: 10.1002/pbc.25044] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 03/03/2014] [Indexed: 12/24/2022]
Abstract
In Europe, 6,000 young people die of cancer yearly, the commonest disease causing death beyond the age of 1 year. In addition, 300,000-500,000 European citizens are survivors of a childhood cancer and up to 30% of them have severe long-term sequelae of their treatment. Increasing both cure and quality of cure are the two goals of the European paediatric haematology/oncology community. SIOPE coordinates and facilitates research, care and training which are implemented by the 18 European study groups and 23 national paediatric haematology/oncology societies. SIOPE is the European branch of the International Society of Paediatric Oncology and one of the six founding members of the European Cancer Organisation. SIOPE is preparing its strategic agenda to assure long-term sustainability of clinical and translational research in paediatric malignancies over the next 15 years. SIOPE tackles the issues of equal access to standard care and research across Europe and improvement of long term follow up. SIOPE defined a comprehensive syllabus for training European specialists. A strong partnership with parent, patient and survivor organisations is being developed to successfully achieve the goals of this patient-centred agenda. SIOPE is advocating in the field of EU policies, such as the Clinical Trials Regulation and the Paediatric Medicine Regulation, to warrant that the voice of young people is heard and their needs adequately addressed. SIOPE and the European community are entirely committed to the global agenda against childhood cancers to overcome the challenges to increasing both cure and quality of cure of young people with cancer.
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Affiliation(s)
- Gilles Vassal
- Direction of Clinical Research, Gustave Roussy and Université Paris-SudVillejuif, France
| | | | - Martin Schrappe
- University Medical Centre Schleswig-Holstein, Campus KielKiel, Germany
| | - Frédéric Arnold
- Union Nationale des Associations de Parents d'Enfants atteints de Cancer ou Leucémie (Unapecle)Montpellier, France
- International Confederation of Childhood Cancer Parent Organizations (ICCPO)Nieuwegein, The Netherlands
| | - Jerzy Kowalczyk
- Department of Paediatric Haematology Oncology and Transplantology, Medical UniversityLublin, Poland
| | - David Walker
- Children's Brain Tumour Research Centre, Faculty of Medicine and Health Sciences, University of NottinghamNottingham, United Kingdom
| | - Lars Hjorth
- Department of Paediatrics, Skåne University Hospital, Clinical Sciences, Lund UniversityLund, Sweden
| | - Riccardo Riccardi
- Division of Paediatric Oncology, Policlinico Universitario “A. Gemelli”Roma, Italy
| | - Anita Kienesberger
- International Confederation of Childhood Cancer Parent Organizations (ICCPO)Nieuwegein, The Netherlands
| | | | - Maria Grazia Valsecchi
- Centre of Biostatistics for Clinical Epidemiology, Department of Health Science, University of Milano-BicoccaMonza, Italy
| | - Dragana Janic
- School of Medicine, University of Belgrade, and University Children's HospitalBelgrade, Serbia
| | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital SkejbyAarhus, Denmark
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of BirminghamBirmingham, United Kingdom
| | | | | | | | - Ruth Ladenstein
- Children's Cancer Research Institute, St. Anna Kinderkrebsforschung e.V., Children's Cancer Research InstituteWien, Austria
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Wiernikowski JT, MacLeod S. Regulatory and logistical issues influencing access to antineoplastic and supportive care medications for children with cancer in developing countries. Pediatr Blood Cancer 2014; 61:1513-7. [PMID: 24753431 DOI: 10.1002/pbc.25049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/07/2014] [Indexed: 11/05/2022]
Abstract
Globally there are numerous impediments, both logistical, regulatory and more recently global drug shortages, hindering pediatric access to therapeutic drugs of all types. Efforts to reduce barriers are ongoing and are especially important in low and middle income countries and for children requiring treatment of conditions such as those encountered in pediatric oncology characterized by the risk of life threatening treatment failures. Progress has been made through the efforts of the World Health Organization and regulators in the US and Europe to encourage the development of therapeutic agents for use in pediatrics and measures taken have fostered the availability of stronger pediatric data to guide therapeutic decisions. Nonetheless, pharmaceuticals remain a global commodity, subject to regulation by the World Trade Organization and this has often had detrimental effects in low and middle income countries. This article emphasizes the need for closer international collaboration to address the barriers currently impeding access to antineoplastic and supportive care medicines for children.
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Affiliation(s)
- John T Wiernikowski
- Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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