Journal of pediatric hematology/oncology
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J. Pediatr. Hematol. Oncol. · Nov 2015
Multicenter StudyTransitioning Adolescents and Young Adults With Sickle Cell Disease From Pediatric to Adult Health Care: Provider Perspectives.
The transition from pediatric to adult health care is often challenging for adolescents and young adults with sickle cell disease (SCD). Our study aimed to identify (1) measures of success for the transition to adult health care; and (2) barriers and facilitators to this process. We interviewed 13 SCD experts and asked them about their experiences caring for adolescents and young adults with SCD. ⋯ Facilitators include a positive relationship with the provider, family support, and developmental maturity. Success in SCD transition is primarily determined by the patients' quality of relationships with their parents and providers and their developmental maturity and skills. Understanding these concepts will aid in the development of future evidence-based transition care models.
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J. Pediatr. Hematol. Oncol. · Aug 2014
Multicenter StudyPractice patterns of stroke screening and hydroxyurea use in children with sickle cell disease: a survey of health care providers.
Incidence of stroke in sickle cell disease (SCD) has declined with the use of transcranial Doppler ultrasound and chronic transfusion therapy. There is little information regarding their use in genotypes other than HbSS and HbSβ. Silent cerebral infarcts (SCIs) have been identified by magnetic resonance imaging (MRI) in SCD patients and it is believed that these may increase the risk of overt stroke. ⋯ Twenty-six percent of institutions prescribed hydroxyurea in patient found to have SCIs. Results indicate significant variation in stroke screening and hydroxyurea use often correlating with clinic size, number of physician providers, and geographic location. There are currently no evidence-based guidelines to support many of these practices.
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J. Pediatr. Hematol. Oncol. · Aug 2012
Multicenter StudyDemands and rewards associated with working in pediatric oncology: a qualitative study of Canadian health care providers.
Despite recent advances in the outcome of children with cancer, the demands on medical professionals caring for these patients can be intense. Our qualitative study explored the work-related demands and rewards experienced by Canadian pediatric oncology staff. ⋯ Our study identifies important demands and rewards associated with working in pediatric oncology. Future research could explore the relationship between work-related stress and job satisfaction and how these factors either cause or prevent burnout syndrome.
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J. Pediatr. Hematol. Oncol. · Dec 2011
Randomized Controlled Trial Multicenter Study Comparative StudyPolyethylene Glycol-conjugated L-asparaginase versus native L-asparaginase in combination with standard agents for children with acute lymphoblastic leukemia in second bone marrow relapse: a Children's Oncology Group Study (POG 8866).
Administration of L-asparaginase is limited by hypersensitivity reactions mediated by anti-asparaginase antibodies. To overcome this problem, native Escherichia coli L-asparaginase was conjugated to polyethylene glycol (PEG) to formulate PEG-L-asparaginase, a preparation with decreased immunogenicity and increased circulating half-life. In early trials, PEG-L-asparaginase was tolerated by patients known to be hypersensitive to the native E. coli product. ⋯ PEG asparaginase is a useful agent in patients with allergic reactions to native asparaginase.
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J. Pediatr. Hematol. Oncol. · Oct 2009
Multicenter Study Comparative StudyEvaluation of the effects of different transfusion trigger levels during the treatment of childhood acute lymphoblastic leukemia.
Differences in the triggering levels for red blood cell (RBC) and platelet (PLT) transfusions were analyzed in association to the amount and total costs of transfusions and the number of febrile episodes during childhood acute lymphoblastic leukemia (ALL) treatment. Transfusions are given with hemoglobin (Hb) < or =90 to 100 g/L and PLT count < or =20 to 30 x 10(9)/L in Tampere, and with Hb < or =80 g/L and PLT count < or =10 x 10(9)/L in Turku. Median pretransfusion PLT count was 48 x 10(9)/L in Tampere, and 16 x 10(9)/L in Turku. ⋯ The number of febrile episodes was associated with the treatment protocol (P=0.03), and age at diagnosis (P=0.07). Lower trigger levels did not cause more delays or complications in treatment. Clinical trials are, however, necessary to determine optimal criteria for supportive blood transfusions in childhood cancer patients.