A Specific, Measurable, Achievable, Relevant, Timed (SMART) Nursing Project Reduces Anxiety, Depression, and Post-Traumatic Stress Disorder in Parents of Childhood or Adolescent Osteosarcoma Patients.

Specific, measurable, achievable, relevant, timed (SMART) principle improves the nursing utility by setting individual goals for participants and helping them to achieve these goals. Our study intended to investigate the impact of a SMART nursing project on reducing mental stress and post-traumatic stress disorder (PTSD) in parents of childhood or adolescent osteosarcoma patients. In this randomized, controlled study, 66 childhood or adolescent osteosarcoma patients and 126 corresponding parents were enrolled and divided into SMART or normal care (NC) groups at a 1:1 ratio. All parents received a 3-month corresponding intervention and a 6-month interview. Our study revealed that the self-rating anxiety scale score at the 3rd month (M3) (P < 0.05) and the 6th month (M6) (P < 0.01), and anxiety rate at M3 (P < 0.05) and M6 (P < 0.05) were lower in parents in SMART group vs. NC group. The self-rating depression scale score at M3 and M6, and depression rate at M3 and M6 were lower in parents in SMART group vs. NC group (all P < 0.05). Impact of events scale-revised score at the 1st month (M1) (P < 0.05), M3 (P < 0.05), and M6 (P < 0.01) were lower in parents in SMART group vs. NC group. By subgroup analyses, the SMART nursing project showed better impacts on decreasing anxiety, depression, and PTSD in parents with an undergraduate education or above than in those with a high school education or less. Conclusively, SMART nursing project reduces anxiety, depression, and PTSD in parents of childhood or adolescent osteosarcoma patients, which is more effective in those with higher education.

Papel do enfermeiro junto aos pacientes com osteossarcoma e familiares / Role of the nurse in relation to osteosarcoma patients and their family

Objetivo: identificar o papel dos enfermeiros no processo de educação em saúde junto aos pacientes com osteossarcoma e famíliares. Método: trata-se de estudo qualitativo, descritivo, relato de caso, com a incursão empírica junto à rotina dos enfermeiros do Instituto Nacional do Câncer (INCA). Consideram-se que participaram 20 enfermeiros que possuem relação direta com a rotina de cuidados dos pacientes com osteossarcoma. Usou-se como instrumento de coleta de dados um questionário com 11 indagações objetivas. Resultados: ressalta-se que é necessário oferecer o entendimento da realidade na prática da educação em saúde na rotina dos enfermeiros do INCA. Conclusão: conclui-se que, entre os enfermeiros do INCA e os enfermos e seus familiares há a verdadeira prática da educação em saúde justamente quando se estabelece a transmissão de conhecimentos e a melhora na qualidade de vida dos jovens assistidos com osteossarcoma.(AU)

Objective: to identify the role of nurses in the health education process among osteosarcoma and family patients. Method: this is a qualitative, descriptive study, case report, with the empirical incursion next to the routine of the nurses of the National Cancer Institute (NCI). Twenty nurses are considered to be directly related to the care routine of patients with osteosarcoma. A questionnaire with 11 objective inquiries was used as instrument of data collection. Results: it is necessary to offer the understanding of reality in the practice of health education in the routine of NCI nurses. Conclusion: it is concluded that, among the NCI nurses and the patients and their families, there is a real practice of health education, precisely when it is established the transmission of knowledge and the improvement in the quality of life of the young people assisted with osteosarcoma.(AU)

Objetivo: identificar el papel de los enfermeros en el proceso de educación en salud junto a los pacientes con osteosarcoma y familiares. Método: se trata de un estudio cualitativo, descriptivo, relato de caso, con la incursión empírica junto a la rutina de los enfermeros del Instituto Nacional del Cáncer (INCA). Se considera que participaron 20 enfermeros que tienen relación directa con la rutina de atención de los pacientes con osteosarcoma. Se utilizó como instrumento de recolección de datos un cuestionario con 11 indagaciones objetivas. Resultados: se resalta que es necesario ofrecer el entendimiento de la realidad en la práctica de la educación en salud en la rutina de los enfermeros del INCA. Conclusión: se concluye que entre los enfermeros del INCA y los enfermos y sus familiares hay la verdadera práctica de la educación en salud justamente cuando se establece la transmisión de conocimientos y la mejora en la calidad de vida de los jóvenes asistidos con osteosarcoma.(AU)

Tough courage: Oncology Nursing Forum addresses childhood cancer then and now.

Cancer is a devastating diagnosis for anyone, but none more so than for children and their parents--so many questions to be asked, so much information to sift through and absorb, and so many difficult decisions to be made. It is no wonder that a diagnosis of childhood cancer is often met with fear, anger, guilt, and feelings of being overwhelmed, yet also a determined resilience on the part of families to do whatever it takes to help their child get well again (Rishel, 2010).

A 15-year-old male with persistent knee pain.

Most children and adolescents who present with extremity pain in the emergency department (ED) have minor injuries or musculoskeletal problems that are easily diagnosed and managed. A history of a child or teenager with persistent extremity pain lasting more than a few weeks or pain that wakes the child at night is of clinical concern and requires investigation. There are serious clinical etiologies that must be included in the differential diagnosis of this group of patients. It is essential to take the time during the initial screening examination to determine the real reason for each patient ED visit and review previous medical care.

[Teaching a teenager approaching the end of life]. / Enseigner auprès de l'adolescent en fin de vie.

When a teenager is diagnosed with a life-threatening condition, priority is given to the provision of care, but the continuation of the adolescent's education is also encouraged, through the hospital school. Thereby, like all children of his age, Issem, suffering from an osteosarcoma, will sit his secondary school exams and will be supported to the end by his teachers. Personal accounts.

Caring for children and adolescents with osteosarcoma: a nursing perspective.

The nurse plays a vital role in caring for patients with osteosarcoma. From the very outset when the disease is explained to the patient and his/her family, the nurse provides comfort and support, as well as enhances and explains the information provided by the physician. All aspects of medical care are addressed, and he/she is frequently the first line of communication when the patient telephones and requests information or wishes to report a problem to the physician. He/She arranges and coordinates appointments to suit the patient's medical, and often social needs to provide comprehensive care with attention to detail. This communication will provide a perspective of the role assumed by the nurse in his/her effort to ensure total care of the patient and the family.

Improving outcomes in difficult bone cancers using multimodality therapy, including radiation: physician and nursing perspectives.

Principles of therapy are similar for Ewing's sarcoma and osteosarcoma. Chemotherapy or surgery alone cures few patients. Multimodality measures are needed for durable response. Quality of life and function are very important short- and long-term considerations. The spine, sacrum, pelvis, ankle, hand, mediastinum, pulmonary hilum, and chest wall are examples of bone cancer locations for which surgery is difficult. Patients with positive margins may need radiation and may experience systemic therapy delay, recurrence, loss of function, or any combination of these. When radiation is used as a means of local control, concomitant chemotherapy can increase its effectiveness. Options for difficult Ewing's sarcoma and osteosarcoma situations and multimodality solutions, including 1 mCi/kg of samarium and proton therapy, are discussed. Combination radiation and chemotherapy regimens are summarized, and organization of patients, caregivers, and medical teams for multimodality therapy is described, along with tools used in our institution that aid in this process.

Osteogenic sarcoma of the sacral spine: an interdisciplinary team challenge.

A child with osteogenic sarcoma of the sacral spine has complex nursing and interdisciplinary team needs. The course of one patient is discussed, both from the patient and family's perspective and that of her inter-disciplinary care team. The need for a coordinated, holistic approach to care that involves advance planning, continual reassessment of goals, and clear communication among the team members and consulting services is clearly demonstrated.

Solid tumors in children.

Solid tumors make up about 30% of all pediatric cancers. The most common types of solid tumors in children include brain tumors, neuroblastoma, rhabdomyosarcoma, Wilms' tumor, and osteosarcoma. This article reviews the etiology and treatment of these diseases, and discusses the differences between adult and pediatric solid tumors.

Osteosarcoma nursing care guidelines: a tool to enhance the nursing care of children and adolescents enrolled on a medical research protocol.

Clinical trials dominate the therapeutic approaches used in pediatric oncology with the majority of pediatric oncology patients receiving treatment on medical research protocols. These protocols detail the medical treatment that enrolled patients will receive. Nursing care is not described in these documents. However, nursing care must complement the medical care as written in the medical research protocol. Administering treatments safely, assessing treatment responses, educating patients and families, and communicating with the entire health care team are some of the essential nursing responsibilities that must be carefully orchestrated. Nursing care guidelines, as described here, were created to provide the careful balance between the medical research protocol and associated nursing care. These guidelines describe the nursing actions and considerations involved in caring for pediatric oncology patients enrolled on a particular medical research protocol. The purpose of this article is to describe the process used to create and evaluate nursing care guidelines.

Exposure of oncologic nurses to methotrexate in the treatment of osteosarcoma.

Methotrexate is a therapeutic agent used widely for osteosarcoma. We used an extremely sensitive high-performance liquid-chromatography assay to evaluate 112 urine samples obtained from 28 hospital employees during high-dose therapy with methotrexate and during routine care of patients. The highest cumulative urinary excretion was observed when methotrexate infusions were handled in a workbench from which a portion of filtered air was emitted into the room. Remarkable urine contaminations were identified for personnel, including 1 administrative employee who had "stood by" for 2 h in the room where infusions were prepared. Lower methotrexate concentrations were detected in the urine of nurses whose exclusive function was to care for patients. The urine burden in oncologic nurses decreased after a central pharmacy unit was installed. Methotrexate was excreted in the sweat of patients who were under high-dose therapy, and its elimination half-life was 11.1 h (mean maximal concentration = 1.7 micrograms/ml [n = 51). The maximal burden in spontaneous vomit from these patients was 441.5 micrograms/ml, and it declined to 0.24 micrograms/ml 19.5 h after infusion was completed. No methotrexate was detected in personnel who prepared 20-g methotrexate infusions in the central pharmacy unit. We demonstrated that occupational safety depended not only on technical precautions, but on the skills of specifically trained personnel.

Care of the adolescent undergoing an allograft procedure.

During the last 25 years, substantial progress has been made in the detection and treatment of bone tumors in adolescents and young adults. Due to more effective chemotherapy treatments, patients are now surviving these illnesses and living quality lives. In the past, the only surgical option for treatment of these tumors was amputation. Today, however, limb-sparing procedures such as allograft implantation, together with effective chemotherapy treatments, provide patients with another treatment option. The allograft procedure includes removing the tumor and affected bone and replacing it with bone procured from deceased donors. During the following 2 years, the body does the work of incorporating the allograft and replacing it, at least in part, with new host bone. After a long rehabilitation process, the patient will have a functioning limb. Nursing care of the adolescent undergoing allograft procedure encompasses meeting important physical and psychosocial needs. Adolescents are often still dealing with the emotional and physical stress of having cancer and chemotherapy or chemotherapy side effects at the time of surgery. They are concerned not only with their immediate recovery but also with their long-term prognosis. All treatment modalities, including allograft surgery, impinges on the normal developmental tasks of adolescents. The nursing challenge is to help the adolescent balance the limits of their illness and recovery with normal developmental needs.

The terminally ill patient on an acute psychiatric unit. A case study.

1. As mental health professionals, we frequently fail to realize that we are subject to the same emotions and coping mechanisms as the lay community. 2. At times it seems safer to focus on a patient's medical condition than to deal with difficult, unresolved psychological issues. 3. By using existing resources within our institution, our interdisciplinary team faced many of their unresolved issues about death, such as countertransference, and were able to then help our patient through his final stage of life.