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Ibeziako P, Kaufman K, Campbell E, Zou B, Samsel C, Qayyum Z, Caracansi A, Ray A. Reducing Pediatric Mental Health Boarding and Increasing Acute Care Access. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00044-2. [PMID: 38583523 DOI: 10.1016/j.jaclp.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/17/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND There have been notable increases in pediatric mental health boarding in the United States in recent years, with youth remaining in emergency departments or admitted to inpatient medical/surgical units, awaiting placement in psychiatric treatment programs. OBJECTIVES We aimed to evaluate the outcomes of interventions to reduce boarding and improve access to acute psychiatric services at a large tertiary pediatric hospital during a national pediatric mental health crisis. METHODS Boarding interventions included expanding inpatient psychiatric beds and hiring additional staff for enhanced crisis stabilization services and treatment initiation in the emergency department and on inpatient medical/surgical units for boarding patients awaiting placement. Post-hoc assessment was conducted via retrospective review of patients presenting with mental health emergencies during the beginning of intervention implementation in October-December 2021 and one year later (October-December 2022). Inclusion criteria were patients ≤17 years who presented with mental health-related emergencies during the study period. Exclusion criteria were patients ≥18 years and/or patients with >100 days of admission awaiting long-term placement. Primary outcome was mean length of boarding (LOB). Secondary outcome was mean length of stay (LOS) at the hospital's acute psychiatry units. RESULTS One year after full intervention implementation (October-December 2022), mean LOB decreased by 53% (4.3 vs 9.1 days, P < 0.0001) for boarding patients discharged to high (e.g., inpatient, acute residential) and intermediate (e.g., partial hospital, in-home crisis stabilization programs) levels of care, compared to October-December 2021. Additionally, mean LOS at all the 24-hour acute psychiatry treatment programs was reduced by 27% (20.0 vs 14.6 days, P = 0.0002), and more patients were able to access such programs (265/54.2% vs 221/41.9%, P < 0.0001). Across both years, youth with aggressive behaviors had 193% longer LOB (2.93 ± 1.15, 95% CI [2.23, 3.87]) than those without aggression, and youth with previous psychiatric admissions had 88% longer LOB than those without (1.88 ± 1.11, 95% CI [1.54, 2.30]). CONCLUSIONS The current study shows decreased LOB and improved access for youth requiring acute psychiatric treatment after comprehensive interventions and highlights challenges with placement for youth with aggressive behaviors. We recommend a call-to-action for pediatric hospitals to commit sufficient investment in acute psychiatric resources to address pediatric mental health boarding.
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Affiliation(s)
- Patricia Ibeziako
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA.
| | - Katy Kaufman
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA
| | - Emily Campbell
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA
| | - Billy Zou
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Chase Samsel
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Zheala Qayyum
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Annmarie Caracansi
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Aliza Ray
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA
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Bhasin S, Brown J, Dorste A, Samsel C, Vrooman LM, Muriel AC. Measuring neurobehavioral side effects of corticosteroids in pediatric acute lymphoblastic leukemia: A scoping review. Pediatr Blood Cancer 2024; 71:e30881. [PMID: 38263506 DOI: 10.1002/pbc.30881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
Corticosteroids are essential to curative acute lymphoblastic leukemia (ALL) treatment, yet have significant neuropsychiatric side effects that decrease quality of life for patients and families. We conducted a scoping review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to describe the existing measurement tools used to evaluate neurobehavioral side effects of corticosteroids in pediatric ALL. From various databases and registers, 4047 studies were identified. Twenty-four articles met inclusion criteria. Clinical assessment was most used to evaluate these symptoms. Twelve validated measures were identified. Existing data about neuropsychiatric side effects of corticosteroids in pediatric ALL are extremely heterogeneous, creating challenges for standardized assessment and management.
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Affiliation(s)
- Shreya Bhasin
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua Brown
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Dorste
- Medical Library, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chase Samsel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lynda M Vrooman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna C Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Samsel C, Reichman JR, Barreto JA, Brown DW, Hummel K, Sleeper LA, Blume ED. The experience of fathers of children hospitalised with advanced heart disease. Cardiol Young 2024:1-5. [PMID: 38196389 DOI: 10.1017/s1047951123004390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND There are little reported data on the perspectives of fathers caring for children with chronic conditions. Although survival of children with advanced heart disease has improved, long-term morbidity remains high. This study describes the experience and prognostic awareness of fathers of hospitalised children with advanced heart disease. METHODS Cross-sectional survey study of parents caring for children hospitalised with advanced heart disease admitted for ≥ 7 days over a one-year period. One parent per patient completed surveys, resulting in 27 father surveys. Data were analysed using descriptive methods. RESULTS Nearly all (96%) of the fathers reported understanding their child's prognosis "extremely well" or "well," and 59% felt they were "very prepared" for their child's medical problems. However, 58% of fathers wanted to know more about prognosis, and 22% thought their child's team knew something about prognosis that they did not. Forty-one per cent of fathers did not think that their child would have lifelong limitations, and 32% anticipated normal life expectancies. All 13 fathers who had a clinical discussion of what would happen if their child got sicker found this conversation helpful. Nearly half (43%) of the fathers receiving new prognostic information or changes to treatment course found it "somewhat" or "a little" confusing. CONCLUSIONS Fathers report excellent understanding of their child's illness and a positive experience around expressing their hopes and fears. Despite this, there remain many opportunities to improve communication, prognostic awareness, and participation in informed decision-making of fathers of children hospitalised with advanced heart disease.
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Affiliation(s)
- Chase Samsel
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | | | - Jessica A Barreto
- Department of Cardiology, Boston Children's Hospital, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - David W Brown
- Department of Cardiology, Boston Children's Hospital, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Kevin Hummel
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
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Miller MK, Blume ED, Samsel C, Elia E, Brown DW, Morell E. Parent-Provider Communication in Hospitalized Children with Advanced Heart Disease. Pediatr Cardiol 2022; 43:1761-1769. [PMID: 35538320 DOI: 10.1007/s00246-022-02913-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
Communication between parents and providers of children with cardiac disease is essential to parental decision-making. This study explored how parents of hospitalized children with advanced heart disease perceived communication with their child's providers. We performed a prospective survey study of parents and physicians of children with advanced heart disease age 30 days to 19 years admitted to the hospital for > 7 days over a 1-year period at a single institution (n = 160 parent-provider pairs). Descriptive statistics were primarily used and Fisher exact tests and kappa statistics were used to assess agreement. All parents rated communication with their child's care team as excellent, very good, or good, but 56% of parents reported having received conflicting information. Parental perception of "too many" people giving them information was associated with overall poorer communication and less preparedness for decision-making. One-third (32%) of parents felt unprepared for decision-making, despite 88% feeling supported. Parents and physicians showed poor agreement with respect to overall adequacy of communication, receipt of conflicting information, and evaluation of the most effective way for parents to receive information. Interventions involving physician communication training and proactive assessment of parent communication preferences may be beneficial.
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Affiliation(s)
- Mary Katherine Miller
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Chase Samsel
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - Eleni Elia
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - David W Brown
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Emily Morell
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
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Baweja R, Arshad SH, Samsel C, Friedberg RD. Chronic Pain and Its Impact on Child Mental Health: Management Challenges and Clinical Guidance for Child and Adolescent Psychiatrists. J Am Acad Child Adolesc Psychiatry 2022; 61:1411-1414. [PMID: 35483656 DOI: 10.1016/j.jaac.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/27/2022] [Accepted: 04/18/2022] [Indexed: 11/15/2022]
Abstract
Chronic pain refers to recurrent or persistent pain that extends beyond the expected time of healing. In addition to the negative impact of chronic pain on a child's overall well-being and functioning in social and academic settings, chronic pain negatively impacts family functioning, caregiver well-being, and a family's financial resources.1 Furthermore, youth with chronic pain frequently meet criteria for psychiatric disorders, such as mood and anxiety disorders, posttraumatic stress disorder, and disruptive disorders, and chronic pain increases the risk for suicidal behaviors and substance use on a long-term basis.1,2 Comorbid psychiatric symptoms and behaviors among youth with chronic pain often add additional discomfort, dramatically reduce quality of life, exacerbate pain symptoms, and delay or prevent recovery.1 Many youth do not receive ideal, multidisciplinary care.
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Affiliation(s)
- Raman Baweja
- Penn State College of Medicine, Hershey, Pennsylvania.
| | | | | | - Robert D Friedberg
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Los Altos, California
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6
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Molloy MA, DeWitt ES, Morell E, Reichman JR, Brown DW, Kobayashi R, Sleeper LA, Elia EG, Samsel C, Blume ED. Parent-Reported Symptoms and Perceived Effectiveness of Treatment in Children Hospitalized with Advanced Heart Disease. J Pediatr 2021; 238:221-227.e1. [PMID: 34217766 DOI: 10.1016/j.jpeds.2021.06.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/09/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To characterize parent-reported symptom burden and effectiveness of symptom management in children hospitalized with advanced heart disease. STUDY DESIGN Prospective survey study of 161 parents whose child was admitted to a single institution with advanced heart disease between March 2018 and February 2019 using the Survey about Caring for Children with Heart Disease. RESULTS Of the 161 patients, 54% were under 2 years old with a diagnosis of single ventricle physiology (39%), pulmonary hypertension (12%), and other congenital heart disease (28%). Over one-half (56%) of parents reported that their child was experiencing a high degree ("a great deal"/"a lot") of symptoms. The most frequently reported symptoms were pain (68%), fatigue (63%), and breathing difficulties (60%). Of the symptoms that were treated, parents perceived successful treatment to be least likely for their child's sleep disturbance (24%), depression (29%), and fatigue (35%). Parents who reported their child's functional status as New York Heart Association class III/IV were more likely to report that their child was experiencing "a great deal" of symptoms, compared with those who reported class I/II (51% vs 19%, P < .001). Parents who reported their child was experiencing a high degree of suffering from fatigue were also more likely to report a high symptom burden (P < .001). CONCLUSIONS Parents of children with advanced heart disease reported high symptom burden with a broad spectrum of symptoms. Parents reported fatigue and psychiatric symptoms frequently and rarely reported treatment as successful. Parents' view of their child's symptom burden was concordant with their perception of their child's functional status.
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Affiliation(s)
| | - Elizabeth S DeWitt
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Emily Morell
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | | | - David W Brown
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Ryan Kobayashi
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Eleni G Elia
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Chase Samsel
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
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Muriel AC, Burgers DE, Treyball AN, Vrooman LM, Adolf E, Samsel C. Risk factors for steroid-induced affective disorder in children with leukemia. Pediatr Blood Cancer 2021; 68:e28847. [PMID: 33305874 DOI: 10.1002/pbc.28847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/24/2020] [Accepted: 11/21/2020] [Indexed: 11/06/2022]
Abstract
Corticosteroids are essential to treating childhood acute lymphoblastic leukemia (ALL), and can cause significant neuropsychiatric side effects. This retrospective chart review is a preliminary exploration of characteristics associated with psychiatry consultation and steroid-induced affective disorder (SIAD) during ALL treatment. Of 125 ALL patients (ages 1-10 years), 56 (44.8%) received psychiatry consultation. Thirty-nine (31.2%) of the total cohort were diagnosed with SIAD. SIAD was significantly associated with family psychiatric history, but not with steroid exposure, CNS radiation, sociodemographic factors, developmental delay, Trisomy 21, or prior psychiatric history. Gathering family psychiatric history may help identify children at increased risk of SIAD.
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Affiliation(s)
- Anna C Muriel
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Darcy E Burgers
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Annika N Treyball
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Lynda M Vrooman
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Esmeralda Adolf
- Dana-Farber Cancer Institute, Boston, Massachusetts.,University of Colorado Denver, Denver, Colorado
| | - Chase Samsel
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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8
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Irwin SA, Fairman N, Samsel C, Hirst JM, Webb JA, Trachsel M. Psychological and Psychiatric Aspects of Palliative and End-of-Life Care. Psychooncology 2021. [DOI: 10.1093/med/9780190097653.003.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This chapter provides an overview of broad areas of overlap and potential synergy between the fields of psycho-oncology and palliative care. Content is aimed primarily at psycho-oncology providers—in particular, new learners or practitioners, who may have little familiarity with the field of palliative care. The chapter provides definitions that describe the two fields, highlights conceptual and practical areas of commonality, and reviews several psychological and psychiatric considerations that are particularly pertinent to taking care of patients in palliative care settings. As palliative care integration increasingly becomes the norm in oncologic care, there will be growing opportunities for palliative care and psycho-oncology providers to explore and develop models of collaboration and partnership that enhance the care of shared patients.
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Samsel C, Tapsak S, Thomson K, McKenna K, McGregor K, Forbes P, Ibeziako P. Psychotropic medication use trends in a large pediatric and young adult solid organ transplant population. Pediatr Transplant 2019; 23:e13380. [PMID: 30786113 DOI: 10.1111/petr.13380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/08/2019] [Accepted: 01/18/2019] [Indexed: 01/30/2023]
Abstract
INTRODUCTION This study describes psychotropic medication use in a pediatric and young adult solid organ transplant population. METHODS We conducted a retrospective review of the lifetime incidence of psychotropic medication use and associated characteristics in patients seen over a 6-year period at a large pediatric transplant center utilizing univariate and multivariate statistical analyses. RESULTS The lifetime incidence of psychotropic medication use was 36.5% in 393 patients. Transplant psychiatry provided psychopharmacological consultation to 21.9% of patients. Controlling for age and sex, there were significant associations between psychotropic use and thoracic organ disease (heart/lung) (AOR = 2.14; 95% CI: 1.2-3.8; P = 0.01), White race (P = 0.0002), histories of depressive/mood disorders (AOR = 3.68; 95% CI: 1.8-7.7; P = 0.0005), attention/learning disorders (AOR = 3.30; 95% CI: 1.6-6.9; P = 0.001), acute and post-traumatic stress disorders (AOR = 10.54; 95% CI: 2.6-42.8; P = 0.001), and experiencing bullying (AOR = 2.16; 95% CI: 1.03-4.55; P = 0.04). In unadjusted tests, significant associations were found between lifetime psychotropic usage and patient anxiety history (OR = 2.26; 95% CI: 1.5-3.5; P = 0.0002), end-of-life disease progression (OR = 3.04; 95% CI: 1.7-5.4; P = 0.0002), family psychiatric history (OR = 2.17; 95% CI: 1.4-3.4; P = 0.0007), and adherence concerns (OR = 2.67; 95% CI: 1.7-4.1; P < 0.0001). DISCUSSION The lifetime incidence of psychotropic medication use among pediatric and young adult transplant patients is substantial. Patients with thoracic organ disease, end-of-life illness, individual/family psychiatric histories, trauma, and bullying histories have particularly high rates. Integrating child psychiatry as part of pediatric transplant teams should be an important consideration for the care of these patients.
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Affiliation(s)
- Chase Samsel
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Boston Children's Hospital Pediatric Transplant Center, Boston, Massachusetts.,Dana-Farber Cancer Institute Department of Psychosocial Oncology and Palliative Care, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sara Tapsak
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Katharine Thomson
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Kristine McKenna
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Boston Children's Hospital Pediatric Transplant Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Kerry McGregor
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Peter Forbes
- Boston Children's Hospital Clinical and Translational Research Program, Boston, Massachusetts
| | - Patricia Ibeziako
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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10
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DeWitt E, Balkin E, Reichman J, Moynihan K, McDermott J, Miller M, Wolfe J, Sleeper L, Samsel C, Blume E. Parent-Reported Symptoms and Effectiveness of Treatment in Children Hospitalized with Advanced Heart Disease. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Samsel C, Kearney J, Meadows AL, Abrams A, Hirst JM, Muriel AC. Reply to: Comment on: Olanzapine for chemotherapy-induced nausea: Lessons learned from child and adolescent psychiatry. Pediatr Blood Cancer 2019; 66:e27490. [PMID: 30270495 DOI: 10.1002/pbc.27490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Chase Samsel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Boston Childrens Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Julia Kearney
- Departments of Psychiatry and Palliative Care, Memorial Sloan Kettering Cancer Center, New York
| | - Amy L Meadows
- University of Kentucky College of Medicine, Lexington, Kentucky.,Departments of Psychiatry and Pediatrics, Kentucky Children's Hospital, Lexington, Kentucky
| | - Annah Abrams
- Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeremy M Hirst
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California
| | - Anna C Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Boston Childrens Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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12
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Samsel C, Kearney J, Meadows AL, Abrams A, Hirst JM, Muriel AC. Olanzapine for chemotherapy-induced nausea: Lessons learned from child and adolescent psychiatry. Pediatr Blood Cancer 2018; 65:e27289. [PMID: 29932280 DOI: 10.1002/pbc.27289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Chase Samsel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Julia Kearney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Amy L Meadows
- Department of Psychiatry and Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky
- Kentucky Children's Hospital, Lexington, Kentucky
| | - Annah Abrams
- Harvard Medical School, Boston, Massachusetts
- Department of Pediatric Psychosocial Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeremy M Hirst
- Department of Psychiatry and Palliative Care, University of California San Diego School of Medicine, San Diego, California
| | - Anna C Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Abstract
Comorbid behavioral and physical health conditions are accompanied by troubling symptom burden, functional impairment, and treatment complexity. Pediatric subspecialty care clinics offer an opportunity for the implementation of integrated behavioral health (BH) care models that promote resiliency. This article reviews integrated BH care in oncology, palliative care, pain, neuropsychiatry, cystic fibrosis, and transplantation. Examples include integrated care mandates, standards of care, research, and quality improvement by child and adolescent psychiatrists (CAPs) and allied BH clinicians. The role of CAPs in integrated BH care in subspecialty care is explored, focusing on cost, resource use, financial support, and patient and provider satisfaction.
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Affiliation(s)
- Chase Samsel
- Department of Psychiatry, 300 Longwood Avenue, Boston Children's Hospital, Boston, MA 02115, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, SW360A, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Monique Ribeiro
- Department of Psychiatry, 300 Longwood Avenue, Boston Children's Hospital, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Anesthesiology, Perioperative and Pain Medicine, 333 Longwood Avenue, Boston Children's Hospital, Boston, MA 02115, USA
| | - Patricia Ibeziako
- Department of Psychiatry, 300 Longwood Avenue, Boston Children's Hospital, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - David R DeMaso
- Department of Psychiatry, 300 Longwood Avenue, Boston Children's Hospital, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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14
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Samsel C, Muriel AC. Risk factors and treatment for steroid-related mood and behavior symptoms in preschool children with leukemia: A case series. Pediatr Blood Cancer 2017; 64:343-345. [PMID: 27615378 DOI: 10.1002/pbc.26220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/25/2016] [Accepted: 07/30/2016] [Indexed: 11/08/2022]
Abstract
Treatment of pediatric acute lymphoblastic leukemia (ALL) relies on systemic corticosteroids for remission; however, they can cause significant mood and behavior changes that interfere with quality of life and may increase risk for injury. This case series reports on preschool children with preexisting developmental and psychiatric risk factors who presented with behavioral side effects that required intervention. Identification of these vulnerable children may provide opportunities for early intervention, anticipatory guidance, and effective treatment to minimize behavioral side effects and improve quality of life and safety during ALL treatment.
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Affiliation(s)
- Chase Samsel
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Anna C Muriel
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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15
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Brand S, Wolfe J, Samsel C. The Impact of Cancer and its Treatment on the Growth and Development of the Pediatric Patient. Curr Pediatr Rev 2017; 13:24-33. [PMID: 27848890 PMCID: PMC5503788 DOI: 10.2174/1573396313666161116094916] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/08/2016] [Accepted: 12/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cancer treatment can have profound effects on the growth and development of pediatric patients. Different models of psychosocial development and behavioral treatment approaches aid children receiving medical treatment. Providing education, anticipatory guidance, and individualized support to child and their families is a psychosocial standard. OBJECTIVE Clarify the different models of psychosocial development and applicable psychosocial interventions to better prepare and tailor cancer treatment to pediatric patients. METHODS Authors reviewed existing evidenced-based literature in oncology, psychology, developmental, and psychiatric while drawing on case examples and expert knowledge to illustrate the impact of cancer treatment on pediatric patients, analyze developmentally individualized needs, and describe facilitative interventions. RESULT Pediatric patients of all ages cope and adjust better to all phases of treatment when their care is delivered in a developmentally-informed and psychosocially thoughtful way. CONCLUSION Providers can comprehensively prepare their patients and families for treatment better by utilizing a psychosocially- and developmentally-informed framework while meeting individualized unique needs of patients. An integrated multidisciplinary psychosocial support team is facilitative in anticipating and meeting the needs of pediatric cancer patients and has recently become a psychosocial standard of care.
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Affiliation(s)
- Sarah Brand
- Dana-Farber Cancer Institute, 450 Brookline Avenue, SW360E, Boston, MA 02115. United States
| | - Joanne Wolfe
- Department of Medicine, Boston Children`s Hospital, MA. United States
| | - Chase Samsel
- Harvard Medical School, Boston, MA. United States
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16
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Guvenek-Cokol PE, Gallagher K, Samsel C. Medical Traumatic Stress: A Multidisciplinary Approach for Iatrogenic Acute Food Refusal in the Inpatient Setting. Hosp Pediatr 2016; 6:693-698. [PMID: 27803075 DOI: 10.1542/hpeds.2016-0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Perihan Esra Guvenek-Cokol
- Child Psychiatry Fellowship Program and.,Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,McLean Hospital, Belmont, Massachusetts
| | - Katherine Gallagher
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas; and
| | - Chase Samsel
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; .,Harvard Medical School, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
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17
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Samsel C, Lechner BE. End-of-life care in a regional level IV neonatal intensive care unit after implementation of a palliative care initiative. J Perinatol 2015; 35:223-8. [PMID: 25341197 DOI: 10.1038/jp.2014.189] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/28/2014] [Accepted: 09/02/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We hypothesized that the implementation of a neonatal palliative care initiative will result in improved markers of end-of-life care. STUDY DESIGN A retrospective and prospective chart review of neonatal intensive care unit deaths was performed for 24 months before, 16 months during and 24 months after the implementation of palliative care provider education and practice guidelines (n=106). Ancillary care, redirection of care, palliative medication usage and outcome meetings in the last 48 h of life and basic demographic data were compared between epochs. Parametric and nonparametric analysis was performed. RESULT There was an increase in redirection of care and palliative medication usage and a decrease in variability of use of end-of-life interventions (P=0.012, 0.022 and <0.001). CONCLUSION The implementation of a neonatal palliative care initiative was associated with increases in palliative interventions for neonates in their final 48 h of life, suggesting that such an initiative may enhance end-of-life care.
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Affiliation(s)
- C Samsel
- 1] Department of Neonatology, Women and Infants Hospital, Providence, RI, USA [2] Triple Board Residency Program, Brown University and Rhode Island Hospitals, Providence, RI, USA
| | - B E Lechner
- 1] Department of Neonatology, Women and Infants Hospital, Providence, RI, USA [2] Warren Alpert Medical School of Brown University, Providence, RI, USA
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18
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Gaynon PS, Baum ES, Samsel C, Sather H. Microcomputer-assisted data management for multiinstitutional pediatric clinical cancer trials. Am J Pediatr Hematol Oncol 1987; 9:33-41. [PMID: 3473944 DOI: 10.1097/00043426-198721000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Microcomputer assisted data management techniques, utilized in the oversight of two multiinstitutional trials for children with previously untreated acute lymphoblastic leukemia and unfavorable prognostic features, are presented. In the first study, such oversight hastened identification of unexpectedly prolonged delays, so that treatment could be successfully modified. In the second study, inferiority of one therapy was rapidly demonstrated, and after careful review that therapy was halted. Performance monitoring is discussed in terms of consideration of the overall quality of a clinical trial, namely, how complete are the data submitted and how precisely was protocol therapy administered; measurement of the quality of institutional participation, and identification of deficiencies in reporting or performance in the records of individual patients.
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