Use of diabetes technologies in the primary school environment: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to map the literature on the use of diabetes technologies in the primary school environment by children with type 1 diabetes (T1D) and/or their parents.

INTRODUCTION

T1D is a complex chronic disorder that is one of the fastest growing diseases in childhood. Technological advances in recent times have seen a growth in the use of diabetes technologies. Despite these advances, having T1D still creates challenges for parents' and children's school experiences. Furthermore, the literature on the use of diabetes technologies during the primary school day is under-investigated.

INCLUSION CRITERIA

This review will consider peer-reviewed primary research studies or systematic reviews that include children with T1D aged 6 to 12 years who use diabetes technologies in the primary school environment and/or their parents.

METHODS

This review will be conducted in accordance with JBI methodology for scoping reviews and will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Following an initial limited search, a full search strategy was developed using index terms and key text words. This strategy will be used across relevant databases, including Embase, MEDLINE (Ovid), CINAHL (EBSCOhost), and Web of Science Core Collection for the full scoping review. There will be no limitations on language or year. Two reviewers will independently screen titles, abstracts, and full-text articles and extract relevant data using the JBI data extraction instrument. Data will be presented in a descriptive manner, supported by tables and charts, and accompanied by a narrative summary.

Assessment and management of scalds and burns in children

In childhood, burn or scald injuries are comparatively common, and the greatest risk is to infants and toddlers. The extent and severity of injuries can vary greatly, which can significantly affect recovery and outcome. To provide high quality nursing care to the child who has sustained a burn injury and the family, the children's nurse should understand the pathophysiology of the trauma and the associated physical and psychological suffering. Evidence-based nursing management of these aspects is an essential component of recovery. Children's nurses working in hospitals, schools or in the community can engage with parents, families, school staff and children to provide information, advice, and health and safety promotion for burn prevention.

The relationship between body mass index and health-related quality of life in urban disadvantaged children

INTRODUCTION

The study's aim was to establish, for children living in urban disadvantage, the nature and extent of the relationship between body mass index (BMI) and health-related quality of life (HRQoL), including the role of individual and family factors in influencing this relationship.

METHODS

Within the context of a longitudinal design, 255 children aged 7-12 years (50 % male) self-reported their HRQoL (Kidscreen-27) and had their height and weight measured at year one and two. One parent/guardian for each child was also assessed at year one with the OSLO Social Support Scale and Hospital Anxiety and Depression Scale. Regression analysis was also conducted.

RESULTS

BMI was weakly inversely associated with 'total HRQoL' (r = -.15, p < .05), 'physical well-being' and 'autonomy and parent relations'. Significant differences were found between normal weight and obese children on all but the latter dimension. Neither weight group, however, fell below the average European HRQoL range. BMI predicted physical well-being a year later and vice versa, whilst autonomy and parent relations also predicted BMI a year later. In terms of 'overweight' children (38 %), those approaching adolescence had poorer physical and school well-being than younger children, and those whose parents had moderate-to-severe levels of depression fared worse on school well-being than children whose parents were not depressed.

CONCLUSION

The findings suggest that obesity programmes could aim to prevent/reduce obesity and optimise HRQoL in urban disadvantaged preadolescent children whilst also targeting parental mental health difficulties. Future research should examine mediators of the effect of BMI on HRQoL.

Bicycle helmet wearing in a sample of urban disadvantaged primary school children

Bicycle helmet wearing is currently not legally enforced in Ireland and little is known about the self-reported practice amongst young children. The principal aim of this study was to assess self-reported helmet wearing amongst a sample (n = 314) of primary school children (aged 8-13 years) attending disadvantaged schools in Dublin. Approximately 86% of the sample owned a bike and provided a response to the question on helmet use. The findings indicate that helmet wearing is not a widespread practice (50.4%; 136/270 report never wearing helmets). As children get older, reported practice is also less likely with 67% (27/40) of 12/13 year-olds compared to 38% (31/81) of 8/9 year-olds reporting never wearing protective headgear. Regardless of age, more girls (61%; 82/135) than boys (39%; 52/135) indicated always/sometimes using helmets when cycling. Conversely, the findings show that (mandatory) seatbelt wearing is standard practice for the majority (93%; 252/270). The findings relating to helmet wearing add further to the debate around the mandatory introduction of protective headgear for cyclists.

Baseline results of the first healthy schools evaluation among a community of young, Irish, urban disadvantaged children and a comparison of outcomes with international norms

BACKGROUND

In 2008, the Irish Government initiated a pilot Healthy Schools Programme based on the World Health Organization Health Promoting Schools Model among children attending schools officially designated as urban and disadvantaged. We present here the first results on physical and emotional health and the relationship between childhood depression and demographic and socioeconomic factors.

METHODS

The Healthy Schools Programme evaluation was a 3-year longitudinal outcome study among urban disadvantaged children aged 4 to 12 years. Physical and psychological health outcomes were measured using validated, international instruments at baseline. Outcomes at baseline were compared with international norms and where differences were found, results were statistically modeled to determine factors predicting poor outcomes.

RESULTS

A total of 552 children responded at baseline, representing over 50% of all eligible children available to participate from 7 schools. Findings at baseline revealed that in general, children did not differ significantly from international norms. However, detailed analysis of the childhood depression scores revealed that in order of importance, psychological well-being, the school environment, social support, and peer relations and age were statistically significant predictors of increased childhood depression in children under 12 years of age.

CONCLUSION

Future health and well-being studies in schools among urban disadvantaged children need to broaden their scope to include measures of depression in children under 12 years of age and be cognisant of the impact of the school environment on the mental and emotional health of the very young.

Measuring and modelling body mass index among a cohort of urban children living with disadvantage

AIM

To report on baseline outcomes of body mass index, eating habits and physical activity of a cohort of urban disadvantaged children from a longitudinal evaluation of a school based, health promoting initiative.

BACKGROUND

The healthy schools programme was developed for implementation in schools located in disadvantaged areas of Dublin, Ireland.

DESIGN

A prospective, cohort study design was implemented.

METHOD

A 3-year longitudinal evaluation was conducted in five intervention and two comparison schools between 2009-2011. Data were collected on each participating child to determine their eating habits, levels of physical activity and body mass index at year 1 (baseline), year 2 and year 3. Independent t-tests were used to compare mean values, chi-square and Fishers exact tests were used to compare proportions at baseline.

RESULTS

Participation rates were over 50%. Older children reported eating on average more fruit and vegetables than younger children; breakfast was often eaten on the way to, or in school and in one age group 16.7% of intervention children reported they did not eat breakfast that day. Levels of physical activity varied with over 70% of younger children stating they never played a sport. In intervention schools over one quarter of all children were either overweight or obese. A comparison was conducted between the proportion of 9-year olds overweight and obese in our disadvantaged cohort and a national random sample of 8500 9-year olds and no important differences were observed.

CONCLUSION

Baseline results indicate that body mass index rates particularly among pre adolescent, urban disadvantaged girls are of concern.

What are pre-registration nurses taught about caring for children?

Nurse education curricula have to be continually reviewed to ensure that content remains applicable to contemporary healthcare developments. In this article, the authors report the findings of a research study that investigated the children's nursing component taught in all non-children's BSc Nursing degree programmes in Irish colleges. The aim of the study was to identify how European Union directives and national curriculum guidelines are interpreted in colleges, and to clarify the preparation that non-children's pre-registration nursing students receive with respect to caring for children. The authors explored aspects related to children's nursing in all non-children's undergraduate pre-registration programmes, including curriculum content and its delivery, assessments and practice experiences. Data were collected by a specifically designed questionnaire based on the Requirements and Standards for Nurse Education Programmes (An Bord Altranais, 2005a; b). A university ethics committee provided ethical approval. The response rate was 54% (n=7), and data were analysed using SPSS 16 and content analysis. The authors' findings illustrated that the requirements and standards of all nursing programmes are interpreted in a variety of ways regarding children's nursing. Nationally, nursing content related to children needs to be reviewed in all nursing programmes to ensure consistency among providers. Healthcare requirements for children and families need to be heightened within curricula for all disciplines.

Phase II study of bevacizumab in combination with cetuximab plus irinotecan in irinotecan-refractory colorectal cancer (CRC) patients who have progressed on a bevacizumab-containing regimen (The BOND 2.5 Study)

4087

Background: We previously showed that adding bevacizumab (bev) to cetuximab (cetux) plus irinotecan (IRI) in bev-naïve, IRI-refractory CRC patients is feasible, and yielded a favorable response rate and time to tumor progression (TTP) compared with historical controls (Saltz: JCO, 2007). Since most CRC patients now receive a bev-containing regimen prior to cetux, we evaluated the addition of bev to cetux plus IRI (CBI) in patients with metastatic CRC who had previously progressed on chemo + bev. Methods: All patients were naïve to cetux. The importance of KRAS mutation was not appreciated when the trial was designed and this has not yet been evaluated. Patients received IRI at the same dose and schedule as last received prior to study, Cetux 400 mg/m2 loading dose, then weekly at 250 mg/m2, plus Bev 5 mg/kg given every two weeks or 7.5 mg/kg given every three weeks. Results: 33 received treatment. Median age was 58 (range 29–85). Median number of prior regimens was 2 (range 1–2). Median performance status was ECOG 1 (range 0–1). Patients received a median of 2 cycles (range 1–15). Grade 3/4 Toxicities: Acneiform Rash 18%, hypomagnesemia 6%, hypophosphatemia 6%, Neutropenia 15%, Diarrhea 6%. One patient developed neutropenic fever and one patient had a hypersensitivity reaction to cetux. At a median follow up of 32 months (range 21–32 months) in 33 evaluable patients, we observed 3 (9%) partial responses and 11 (33%) patients with stable disease for > 4 months. Median TTP was 3.9 months (95% CI: 1.3 - 6.8). Median survival was 10.6 months (95% CI: 6.6 - 13.8). Conclusions: The toxicity profile was similar to what would have been expected from the individual agents alone. Recognizing the limitations of cross-study comparisons, the response rates and TTP seen with CBI in patients who have previously progressed on bev do not appear to be as encouraging as the 37% response rate and 7.3 months TTP seen in the BOND 2 trial of bev-naïve CRC patients. Ongoing randomized trials, including SWOG 0600, will be needed to definitively determine the contribution of continued use of bev after progression on a bev-containing regimen. Supported by Genentech.

[Table: see text]

Molecular markers associated with response and clinical outcome to cetuximab/bevacizumab/irinotecan (CBI) versus cetuximab/bevacizumab (CB) in irinotecan-refractory colorectal cancer (BOND2)

4113

Background: Phase II (BOND2) trial of Cetuximab/Bevacizumab/Irinotecan (CBI) vs Cetuximab/Bevacizumab (CB) has shown that bevacizumab added to the efficacy of cetuximab and cetuximab/irinotecan in irinotecan-refractory bevacizumab-naïve CRC patients. We tested whether expression levels of genes involved in angiogenesis (VEGF, IL-8), the EGFR pathway (EGFR, COX2) and DNA repair (ERCC1) are associated with clinical outcome. Patients and Methods: This randomized phase II trial enrolled 81 patients. Treatment plan as: Arm A received IRI at the same dose and schedule as last received prior to study, plus Cetuximab 400 mg/m2 loading dose, then weekly at 250 mg/m2, plus Bevacizumab 5 mg/kg given every other week. Arm B received the same as arm A, but without IRI. FFPE samples for 35 out of 81 patients (M:W 24:11, median age 56 (29–80) enrolled in the BOND2 study were tested. Patients received either with CBI (n=18, Arm A) or with CB (n=17, Arm B). FFPE tissues were dissected using laser-captured microdissection and analyzed EGFR, ERCC1, VEGFA, VEGFR2, COX2, Cyclin D1, IL-8, and NRP1 mRNA expression using a quantitative real-time RT-PCR. Gene expression values are expressed as ratios between the target gene and internal reference gene. Results: All eight genes and treatment arm were considered in the CART analysis. The classification tree for response, progression-free survival, and overall survival are evaluated. The expression levels of VEGFR2 and NRP1 classified patients in 3 response groups with response rate range from 61% to 0%. Patients who were classified as responders (Group I; VEGFR2=0.65 and NRP1<2.285) were at a lower risk for progression, compared with patients who were classified as non- responders (Group II; VEGFR2=0.65 and NRP1=2.285 and Group III; VEGFR2<0.65). The expression levels of NRP1 and ERCC1, and EGFR and VEGFR2 were chosen to classify patients into 3 groups with distinct risk of progression-free survival and overall survival, respectively. Conclusion: These data suggest that gene expression levels may be molecular markers of response for patients with mCRC treated with CBI or CB. Prospective studies are needed to validate these preliminary findings.

No significant financial relationships to disclose.

Pharmacogenomic analysis of a randomized phase II trial (BOND 2) of cetuximab/bevacizumab/irinotecan (CBI) versus cetuximab/bevacizumab (CB) in irinotecan-refractory colorectal cancer

4128

Background: Phase II CBI VS CB trial has shown that bevacizumab added the efficacy of cetuximab and cetuximab/irinotecan in irinotecan-refractory bevacizumab-naïve CRC patients. We tested the germline polymorphisms involved in angiogenesis pathway(VEGF, IL-8, TGF-β), EGFR pathway (EGFR, COX-2, CyclinD1,E-cadherin,FCGR2A,3A), DNA repair pathway(ERCC1, XRCC1, XPD) and drug metabolism pathway (GSTP1, UGT1A1) to evaluate their association with clinical outcome. Here we expand our gene polymorphisms data involving EGFR pathway (EGF, FCGR2B, Survivin, ADAMS10/17), Angiogenesis pathway (Neuropilin-1, HIF-1, Tissue factor) and irinotecan metabolism pathway(ABCB1,OATPC). Methods: Genomic DNA was extracted from blood samples. 65 out of 81 patients enrolled in the BOND 2 trial were available for molecular correlates study. these 65 patients include 44 men, 21 women, median age 58 years (range 24–86). Patients received either with CBI (n=31) (Arm A) or with CB (n=34) (Arm B). In Arm A, 12 pts (43%) had PR, the median TTP was 7.1 months, and the median survival was 18.0 months. In Arm B, 9 pts (27%) had PR, the median TTP was 4.6 months, and the median survival was 10.3 months. PCR-RFLP based technique was used to determine polymorphisms. Univariate analysis (Fisher’s exact test for response; log-rank test for TTP and OS) was performed to examine associations between polymorphisms and clinical outcome. Results: For Arm B, we found significant associations between HIF-1 polymorphism and tumor response (P=0.017), between HIF-1, FCGR2B polymorphisms and TTP, and between OATPC polymorphism and OS (P values < 0.05). For Arm A, we found a trend in association between EGF polymorphism and tumor response (P=0.08). Conclusions: These data suggest that germline polymorphisms may be potential molecular markers for clinical outcome for patients with mCRC treated with CBI or CB. Prospective studies are needed to confirm these preliminary findings.

[Table: see text]

Bevacizumab 5mg/kg can be safely infused over 10 minutes

4135

Background: Bevacizumab is a humanized monoclonal antibody that targets VEGF. Due to concerns for potential infusion- related hypersensitivity reactions (HSRs), initial phase I trials used an initial 90, 60, 30 minute infusion sequence. We sought to determine if the initial prolonged infusion was still necessary and in addition, if, on the basis of available clinical experience, an infusion time of less than 30 minutes could be safely used. Methods: We used computerized pharmacy records to identify all patients who received bevacizumab at our institution in the first two years of commercial availability (2/1/04- 6/30/06). Our institutional adverse drug reaction reporting program was utilized to identify any infusion reactions possibly related to bevacizumab and patient medical records were reviewed for confirmation Results: A total of 1,077 patients were treated with 10,606 doses of bevacizumab, and 765 of these patients received a 5 mg/kg dose (total of 8,494 doses). No HSRs occurred with the 90, 60, 30 minute infusion sequence in the first 202 patients. The standard infusion rate was then modified to 30 minutes for all bevacizumab doses. No HSRs were encountered. The infusion was again modified to a rate of 0.5 mg/kg/min. Of the 370 patients who received a total of 2,311 doses of bevacizumab at 5 mg/kg over 10 minutes, six (1.6 %) experienced events of minor clinical consequence that were felt to be possibly consistent with non-serious HSRs Conclusions: 90 and 60 minute initial infusion times are unnecessary. Use of a standard infusion rate of 0.5 mg/kg/min is safe, logical, justifiable, and is the current policy at our institution.

No significant financial relationships to disclose.

Phase I trial of preoperative cetuximab with concurrent continuous infusion 5-fluorouracil and pelvic radiation in patients with local-regionally advanced rectal cancer

3560

Background: Cetuximab, a chimeric anti-EGFR monoclonal antibody, has clinical activity in colorectal cancer with demonstrated safety, efficacy and additive synergy with radiation in solid tumors (head & neck, lung). A pilot trial was therefore designed to investigate the safety of cetuximab in combination with standard neoadjuvant protracted infusion 5-FU and radiation therapy in ultrasound T3–4 (uT3–4) or clinical T4 (cT4) or locally recurrent rectal adenocarcinoma. Secondary objectives of clinical activity were assessed by R0 resection and pathologic complete response (CR) rates. Methods: uT3–4 or cT4 or locally recurrent rectal adenocarcinoma patients received cetuximab 400mg/m2 day 1 (250mg/m2 weekly thereafter) and 5-FU IVCI (225mg/m2) over 5.5 weeks with concurrent pelvic radiation (5040cGy), and cetuximab (250mg/m2 Qweek) for 4 additional weeks, followed by surgical resection 1–3 weeks later. Results: Total Treated: 20 patients (ages 27 - 72), 19 uT3 patients, 1 Local Recurrence patient. Cetuximab Therapy (10 planned treatments): Too early 2 pts, ≥ 8 doses 12 pts, 5 - 8 doses 2 pts, < 5 total doses 4pts* (*cetuximab not given due to: 1 pt - acute cholecystitis from cholelithiasis; 1 pt - Grade 3 radiation perineal toxicity; 2 pts - treatment non-compliance). Radiation Therapy - 18 pts completed, 2 pts too early. Grade 3/4 Toxicities: Diarrhea 10%, Acneiform Rash (outside RT field) 15%, Stomatitis 5%, Radiation Field Dermatitis 5%, Transaminitis 5%. Surgical Outcomes: (17 pts completed surgery): R0 Resection 100%, Pathologic CR 12%. Conclusions: Cetuximab in combination with protracted infusion 5-FU and concurrent radiation is feasible without synergistic or unexpected toxicities. Further randomized investigation of this regimen in the neoadjuvant setting for rectal cancer is warranted.

No significant financial relationships to disclose.

Simplification of bevacizumab (bev) administration: Do we need 90, 60, or even 30 minute infusion times?

3542

Background: Bev is a humanized monoclonal antibody that targets VEGF. Due to concerns of infusion related hypersensitivity reactions, phase I trials of bev used an initial 90 minute infusion of bev, a 60 minutes for on the next dose, and 30 minutes for all doses thereafter. This has remained the administration schedule throughout development and registration. No significant infusion-related toxicities were reported in the pivotal phase III registration trial. We postulated therefore that bev could be safely given without initially prolonged infusion times. Methods: We obtained an IRB waiver of authorization to review the records of patients at Memorial Sloan Kettering Cancer Center (MSKCC) who were treated with bev in the first 3 months of commercial availability (cut-off date 5/15/05). Our institutional adverse drug reaction reporting program was utilized to identify any infusion reactions related to bev. Additionally, patient medical records were reviewed for further confirmation. Results: Following initial commercial availability of bev in February 2004, 202 consecutive colorectal cancer (CRC) patients were treated with bev (5 mg/kg) at MSKCC starting as a 90 minute, then 60 minute, then 30 minute infusion. No hypersensitivity reactions were seen. A decision was then made to establish an institutional practice of using 30 minute infusion times for all doses, including initial doses, of bev. Subsequently, 212 consecutive CRC patients were treated with bev 5 mg/kg, initially as a 30 minute infusion. No infusion reactions were observed. Conclusions: Administration of the initial dose of bev over 30 minutes appears to be safe and well-tolerated. This has been the standard initial infusion time at MSKCC for 5 mg/kg, 10 mg/kg and 15 mg/kg doses of bev. Based on our favorable experience with 30 minute infusions of 15 mg/kg (0.5 mg/kg/minute), as of Nov ’05 we have changed our institutional guidelines such that all non-protocol patients receiving bev are initiated at the infusion rate of 0.5 mg/kg/minute. Thus, our standard 5 mg/kg doses of bev are given over 10 minutes, 10 mg/kg doses are given over 20 minutes, and 15 mg/kg doses are given over 30 minutes. Active quality assurance and safety monitoring are maintained throughout. Data will be updated for the meeting.

[Table: see text]

A phase II trial of farnesyl protein transferase inhibitor SCH 66336, given by twice-daily oral administration, in patients with metastatic colorectal cancer refractory to 5-fluorouracil and irinotecan

BACKGROUND

ras genes encode Ras proteins that are important for signal transduction in cancer cells. Farnesyl protein transferase (FPTase) is an enzyme that is responsible for a critical post-translational modification of Ras.

PATIENTS AND METHODS

We report the results of a phase II trial of SCH 66336, an FPTase inhibitor, in patients with metastatic colorectal cancer. This is the first reported experience of an FPTase inhibitor in this disease. All patients were considered refractory to first- and second-line therapy. A total of 21 evaluable patients were treated with a starting dose of 200 mg b.i.d. given continuously.

RESULTS

The major side-effects were fatigue (grade 1 in 42%, grade 2 in 42% and grade 3 in 14%), diarrhea (grade 1 in 23% and grade 3 in 42%) and nausea (grade 2 in 16%). Elevations in serum creatinine (grade 2 or 3) were observed in 19% of patients and appeared to be related to dehydration induced by diarrhea. Significant hematological toxicity was not observed (only grade 1 thrombocytopenia in 19% and grade 2 or 3 anemia in 28%). Pharmacological studies revealed adequate mean pre-dose plasma concentrations in this group of patients on day 15 of therapy. No objective responses were observed, although stable disease was seen in three patients for several months. Administration of SCH 66336 was accompanied by gastrointestinal toxicity.

CONCLUSIONS

Future development of this compound cannot be recommended as monotherapy in this disease.

Phase I study of topoisomerase I inhibitor exatecan mesylate (DX-8951f) given as weekly 24-hour infusions three of every four weeks

Exatecan mesylate (DX-8951f) is a topoisomerase I inhibitor that has increased solubility and antitumor activity compared with other topoisomerase I inhibitors. The purpose of this study was to establish a safe dose of DX-8951f given as a weekly 24-h infusion 3 of every 4 weeks. DX-8951f was administered as a 24-h continuous infusion in escalating doses. Twenty-seven patients were treated with 81 courses of the drug. Dose-limiting toxicities included neutropenia, thrombocytopenia, and inability to administer all three doses in the first cycle. In minimally pretreated patients, a dose of 0.8 mg/m(2) was tolerable. In patients who were heavily pretreated, a slightly lower dose, 0.53 mg/m(2), was tolerated without any severe toxicities. Nonhematological toxicities were mild and consisted of mild diarrhea, asthenia, mild nausea, and constipation. Pharmacokinetic parameters could be well described with a one-compartment model in most patients, although the application of the one-compartment model probably resulted in an underestimated elimination half-life. In conclusion, the recommended Phase II dose for DX-8951f administered as a weekly 24-h infusion on a 3-of-4 week schedule is 0.8 mg/m(2) in minimally pretreated patients and 0.53 mg/m(2) in patients who are heavily pretreated.

Nursing strategies for patients on oral chemotherapy

Oncology nurses play a pivotal role in educating the cancer patient who is about to commence oral chemotherapy. Increasing numbers of patients are receiving oral chemotherapy at home, and with this move to oral self-administration, there has been a critical shift in responsibility of management from the provider to patient. Oral regimens pose new challenges in patient selection and education. Recognition of factors that affect patient compliance will be particularly important with oral chemotherapy. Strategy tools for the patient and provider will need to be developed to ensure optimal compliance and safety.