Asking next-of-kin of recently deceased cancer patients to take part in research: 11 of 20 surveyed found it a positive experience

Implications for practice and research: These results will aid the development of protocols for screening bereaved individuals who are eligible for study participation. These results provide insight into bereaved participants' preferences for data collection methods (e.g., face-to-face, phone and self-completion postal surveys). The needs of non-cancer-related deaths and paediatric populations (e.g., bereaved child participants; childhood deaths) need consideration in future studies.

Robotic-assisted transabdominal cerclage (RoboTAC) in the non-pregnant patient

The use of cerclage, either through vaginal or abdominal routes, to assist in delaying pre-term delivery among select women with cervical insufficiency may be beneficial, but can also carry significant morbidity. Robotic-assisted transabdominal cervical cerclage (RoboTAC) in the non-pregnant patient has the ability to not only reduce associated morbidity, but also offer the same benefits as the more traditional laparotomy and laparoscopic approaches, while removing the risk to an in situ fetus. We report the use of robotic-assisted transabdominal cervical cerclage in 24 non-pregnant women. Feasibility of the procedure is discussed along with a description of the technical surgical details. In addition, limited pregnancy outcomes are presented. Our results suggest that RoboTAC is a safe alternative to the traditional laparotomy procedure with quicker recovery time.

Changes in parents after the death of a child from cancer

CONTEXT

Few studies have compared multiple perspectives of changes experienced by parents after a child's death.

OBJECTIVES

This study used interviews with bereaved parents and siblings to examine changes in parents during the first year after the death of a child from cancer.

METHODS

Mothers (n=36), fathers (n=24), and siblings (n=39) from 40 families were recruited from three hospitals in the U.S. and Canada three to 12 months after the death (M=10.7, SD=3.5). Semistructured interviews with open-ended questions were conducted in the home with each participating parent and sibling separately. Content analysis identified emerging themes, and frequencies were compared between each paired set of reports (mother vs. sibling, father vs. sibling, and mother vs. father).

RESULTS

Parents and siblings identified two major categories of change experienced by bereaved parents. These changes occurred in their personal lives (e.g., emotions, perspectives and priorities, physical state, work habits, coping/behaviors, spiritual beliefs, and feeling something is missing) and relationships (e.g., family, others). Ninety-four percent of the mothers, 87% of the fathers, and 69% of the siblings reported parental changes in at least one of these categories. Parents were more likely to report changes in priorities, whereas siblings reported more sadness in parents after the death.

CONCLUSION

Positive and negative changes in parents after the death of a child from cancer occur in both personal and relational domains. Additional research is needed to determine the impact of a child's death on bereaved parents over time and to develop strategies to promote healthy adjustment.

National survey of children's hospitals on legacy-making activities

OBJECTIVE

Many hospitals offer legacy-building activities for children with serious illnesses or their family members, yet legacy-making has received little empirical attention. This descriptive cross-sectional study examined healthcare provider perceptions of legacy-making activities (e.g., memory books) currently offered by hospitals to pediatric patients and their families.

METHODS

Healthcare providers in seventy-seven (100%) teaching children's hospitals across the United States completed an electronic survey.

RESULTS

Nearly all providers surveyed reported offering legacy-making activities to ill children and their families, with patients and families usually completing the activity together. Most activities were offered before a patient died and when cure is no longer being sought. Perceived outcomes included benefit to bereaved families and a tangible memento of their deceased child.

CONCLUSION

Legacy-making may enhance life and decrease suffering for dying children and their families. Healthcare professionals can facilitate opportunities for children and their families to build legacies. Additional research is needed to examine activities across different age groups and conditions, the best time to offer such activities, and associations with positive and negative outcomes for ill children, their family members, and the bereaved.

Parental Perceptions of Care of Children at End of Life

Objective:

Little is known regarding the perceptions of parents about end-of-life care for their children. This study describes parental perceptions of the care of hospitalized, terminally ill children in the areas of (1) clinical management, (2) interdisciplinary support, and (3) pain and symptom management.

Methods:

Through a mixed methods design, researchers interviewed a representative sampling of bereaved parents via telephone.

Results:

Data provided evidence of areas which lack satisfaction with elements of end-of-life care of hospitalized children.

Conclusion:

Parental satisfaction with their child’s care during end of life indicates need for improvement in pain management, communication, and parental involvement in decision making. While education cannot guarantee desired changes in attitudes or behaviors, it may provide the essential foundation of knowledge, skills, and ethical understanding needed by professional providers.

Operative complications and fetal morbidity encountered in 300 prophylactic transabdominal cervical cerclage procedures by one obstetric surgeon

This retrospective cohort study identifies complications associated with transabdominal cerclage (TAC). In 300 procedures performed over a 24 year time span, 11 (3.7%) surgical complications were encountered. Fetal loss (prior to 20 weeks) occurred in 4.1% of pregnancies. The median estimated blood loss among patients was 100 ml, with blood loss sufficient to require transfusion only once. Considering patients with classical indications, the gestational age at delivery was greater (37 weeks) after TAC than in the latest pre-TAC pregnancy (24 weeks) (p < 0.001). Lower uterine dehiscence in four patients and uterine rupture in one, underscore the advisability of early term delivery after fetal lung maturity is assured. A survival rate of 98.0% was calculated among infants that were delivered at >24 weeks' gestation. Our results demonstrate that complications encountered in placing a TAC were unusual and generally manageable. This communication may assist the surgeon to balance risks in individual clinical circumstances more adequately.

Peer relationships of bereaved siblings and comparison classmates after a child's death from cancer

OBJECTIVES

To compare peer relationships among bereaved siblings and matched classmates, and to examine gender, grade level, and time since death as moderators.

METHODS

Families were recruited from cancer registries at four hospitals 3-12 months after a child's death. Measures of social behavior and peer acceptance were completed by children in the classrooms of 105 bereaved siblings (ages 8-17 years). Teachers also reported on children's social behavior. Three classmates were matched for gender, race, and age to each bereaved sibling to form a comparison group (n = 311).

RESULTS

Teachers reported bereaved siblings were more prosocial than comparison classmates. Peers perceived bereaved boys as more sensitive-isolated and victimized, while bereaved siblings in elementary grades were perceived by peers as less prosocial, more sensitive-isolated, less accepted, and as having fewer friends. Peers and teachers viewed bereaved siblings in middle/high school grades as higher on leadership-popularity.

CONCLUSIONS

Bereaved siblings who were male and in elementary grades were more vulnerable to social difficulties, while those in middle/high school may exhibit some strengths. Ongoing research to inform the development of interventions for bereaved siblings is warranted.

Comparison of continuing bonds reported by parents and siblings after a child's death from cancer

Few studies have distinguished similarities and differences between continuing bonds as they appear in various bereaved populations, particularly parent versus sibling cohorts following a child's death. This mixed-method study compared how parents and siblings experienced continuing bonds in 40 families who lost a child to cancer. Thirty-six mothers, 24 fathers, and 39 siblings were recruited 3-12 months post-loss (M = 10.7, SD = 3.5). Nearly all participants (97%) reported engaging in purposeful bonds with deceased children, while only 14% reported nonpurposeful connections. Over half of participants (58%) experienced comforting effects from reminders of the deceased child, whereas only 10% of family members experienced discomforting effects. Mothers communicated with the deceased, thought about the deceased, and did things that the deceased child would have liked more often than siblings. Mothers also reported significantly more comforting effects than siblings. Additional research is needed to further delineate continuing bonds for different types of loss and examine associations with positive and negative outcomes for bereaved individuals.

A qualitative study of advice from bereaved parents and siblings

Despite a growing bereavement literature, relatively little is known about what families find helpful after a child's death and how best to assist them during the grieving process. In this qualitative study, the authors explored advice from 40 families (65 parents, 39 siblings) of children who died from cancer 6-19 months earlier. Content analysis emphasized the individual nature of grief and revealed advice that fit into three temporal categories: before the death, soon after, and long-term. Findings are discussed in the context of contemporary theory and provide insight into the development and timing of grief interventions.

Bereaved parents' and siblings' reports of legacies created by children with cancer

This qualitative study explored bereaved parents' and siblings' reports of legacies created by children with advanced cancer. Participants included 40 families of children who died from cancer, with 36 mothers, 27 fathers, and 40 siblings (ages 8-18 years). Individual interviews were completed at home approximately 10.68 months (SD = 3.48) after the child's death. Content analysis of interviews indicated that many children living with cancer did specific things to be remembered, such as making crafts for others, willing away belongings, writing letters to loved ones, and giving special gifts. Some children, particularly those who were very ill or died unexpectedly, did not intentionally do or say anything to be remembered. Legacies included bereaved individuals remembering children's qualities, concern for family, and beliefs about afterlife. Having advanced cancer appeared to motivate children to influence others' lives and prepare for their own deaths. Children's advice about how to live life inspired bereaved family members. Findings contribute to the current knowledge of legacy-making in children and offer implications for practice and future research.

Isolation and characterization of omnitherms and facultative anaerobes from Cape Canaveral soil samples

In a bacterial population profile of interplanetary spacecraft environments based upon temperature and oxygen requirements, several isolates demonstrated the ability to grow over a temperature range from 3 degrees C to 55 degrees C, and most grew aerobically and anaerobically. Because of the adaptability of these organisms, they may be of significance to planetary contamination. To verify that these were actively growing in this range of temperatures, they were streaked onto trypticase soy agar (TSA) and incubated at the extreme temperatures (3 degrees C and 55 degrees C). Isolated colonies were transferred to fresh TSA and immediately incubated at the opposite extreme temperatures. Almost all of the isolates grew quite well at both temperatures. Because these have been subcultured numerous times and still possess the ability to grow over a broad temperature range, this appears to be a stable characteristic. Many of these isolates possess the ability to grow anaerobically at 3, 32 and 55 degrees C. All of these organisms are sporeformers, and data are presented concerning their heat resistance and biochemical activity.

Anaerobic utilization of phosphite/phosphine as a sole source of phosphorus: implication to growth in the Jovian environment

The objective of the investigation was to isolate anaerobic micro-organisms which had the ability to utilize inorganic phosphorus in forms other than phosphate. The first part of this investigation was to isolate from Cape Canaveral soil micro-organisms capable of utilizing phosphite as their phosphorus source under anaerobic conditions. In an attempt to demonstrate this ability, a medium was prepared which contained hypophosphite as the phosphorus source. This was inoculated with soil samples, and growth was subcultured at least four times. To verify that these isolates could use hypophosphite, they were inoculated into defined hypophosphite medium, and samples were removed periodically and killed with formalin. Growth was determined by turbidity measurements and the sample was then filtered. The filtrate was separated by chromatography and the total amounts of hypophosphite, phosphate and phosphate in the filtrate were measured. By this procedure it appeared that the hypophosphite level began decreasing after 14 hr of incubation suggesting utilization of the hypophosphite under anaerobic conditions. The third part of this investigation used labeled (32P) hypophosphite in a defined medium; the cells were then lysed and the metabolic compounds separated by the use of paper chromatography and autoradiograms, demonstrating the presence of 32P in intermediate metabolic compounds. Similar investigations are now being performed with phosphine as the phosphorus source.

Evaluation of lactobacillus preparation on eterotoxigenic E. coli-induced rabbit ileal loop reactions

A commercially available lactobacillus-containing preparation has been used extensively in the treatment of diarrhea but few laboratory tests have been performed to determine the efficacy of this product. The rabbit ileal loop reaction was used here to determine the effect of the lactobacillus preparation and its ingredients on E. coli enterotoxin-induced loop fluid response. Enterotoxigenic E. coli cells grown overnight in shake cultures were washed and resuspended in saline to the original volume. They were then diluted in TSB suspensions of the lactobacillus preparation or its ingredients and injected into ileal loops. E. coli diluted in TSB served as positive controls. Fluid response was measured after 18 hours and the loop fluid ratio (LFR) (ml./cm.) of the lactobacillus preparations was compared to the positive controls. The positive controls always showed a high loop fluid ratio (greater than 1.1 ml./cm.) and negative saline controls showed no fluid response. The lactobacillus granules and tablets had low LFR's (0.08 and 0.05, respectively). Ingredients (whey, talc, sugar, evaporated milk, mineral oil) had variable LFR's (0.65, 0.78, 1.39, 1.46 and 1.54, respectively). Individual ingredients used to make this preparation show little antifluid response when used separately but the final product exhibits a significant antienterotoxin response.

Anaerobic utilization of phosphite and hypophosphite by Bacillus sp

A Bacillus sp. capable of utilizing phosphite and hypophosphite under anaerobic conditions was isolated from Cape Canerval soil samples. The organism was isolated on a glucose-mineral salts medium with phosphate deleted. Anaerobic cultivation of this isolate resulted in decreases in the hypophosphite or phosphite concentration, increases in turbidity, cell count, and dry-cell weight, and decreases in pH and glucose concentration. The optimum hypophosphite concentration for this isolate was 60 microgram/ml, whereas the optimum phosphate concentration was greater than 1,000 microgram/ml, suggesting that higher concentrations of hypophosphite may be toxic to this isolate. Hypophosphite or phosphite utilization was accompanied by little or no detectable accumulation of phosphate in the medium, and 32P-labeled hypophosphite was incorporated into the cell as organic phosphate. When phosphate was present in the medium, the isolate failed to metabolize phosphite. In the presence of phosphite and hypophosphite, the isolate first utilized phosphite and then hypophosphite.

Response of terrestrial microorganisms to a simulated Martian environment

Soil samples from Cape Canaveral were subjected to a simulated Martian environment and assayed periodically over 45 days to determine the effect of various environmental parameters on bacterial populations. The simulated environment was based on the most recent available data, prior to the Viking spacecraft, describing Martian conditions and consisted of a pressure of 7 millibars, an atmosphere of 99.9% CO2 and 0.1% O2, a freeze-thaw cycle of -65 degrees C for 16 h and 24 degrees C for 8 h, and variable moisture and nutrients. Reduced pressure had a significant effect, reducing growth under these conditions. Slight variations in gaseous composition of the simulated atmosphere had negligible effect on growth. The freeze-thaw cycle did not inhibit growth but did result in a slower rate of decline after growth had occurred. Dry samples exhibited no change during the 45-day experiment, indicating that the simulated Martian environment was not toxic to bacterial populations. Psychotrophic organisms responded more favorably to this environment than mesophiles, although both types exhibited increases of approximately 3 logs in 7 to 14 days when moisture and nutrients were available.

Evaluation of a new microquantity blood collector

A new device for collecting small amounts of blood from laboratory animals offer distinct advantages over standard syringes during the collection of serum or plasma.

Dry-heat resistance of selected psychrophiles

The dry-heat resistance characteristics of spores of psychrophilic organisms isolated from soil samples from the Viking spacecraft assembly areas at Cape Kennedy Space Flight Center, Cape Canaveral, Fla., were studied. Spore suspensions were produced, and dry-heat D values were determined for the microorganisms that demonstrated growth or survival under a simulated Martian environment. The dry-heat tests were carried out by using the planchet-boat-hot plate system at 110 and 125 degrees C with an ambient relative humidity of 50% at 22 degrees C. The spores evaluated had a relatively low resistance to dry heat. D(110 degrees C) values ranged from 7.5 to 122 min, whereas the D(123 degrees C) values ranged from less than 1.0 to 9.8 min.

Psychrophilic microorganisms from areas associated with the Viking spacecraft

Microorganisms capable of growth at 7 C were enumerated and isolated from soil samples from the manufacture and assembly areas of the Viking spacecraft. Populations ranging from 4.2 X 10(3) to 7.7 X 10(6)/g of soil were isolated from the 15 soil samples examined. Temperature requirements were determined, and those growing at 3 C, but not at 32 C, were designated as obligate psychrophiles in this investigation. Populations of soil bacteria, including aerobic sporeformers, ranging from 1.5 X 10(2) to 9.8 X 10(5)/g were capable of growth at 3 C, but not at 32 C. Bacterial isolates were identified to major generic groups. No psychrophilic sporeformers were isolated from soil from the manufacture area, but psychrophilic sporeformers ranged from 0 to 6.1 X 10(3)/g from soil from the assembly area.