Impact of expected parental death on the health of adolescent and young adult children: A systematic review of the literature.

BACKGROUND: Few studies of health impacts of parental death focus on the developmental stage of adolescence and young adulthood and in particular, expected parental death from terminal illness. AIM: To systematically review the health impact of expected parental death on adolescent and young adult children aged 15-25 years and provide a basis for further research and clinical practice. DESIGN: Systematic review registered on PROSPERO (CRD42017080282). DATA SOURCES: Pubmed, PsycINFO, CINAHL, MEDLINE and Cochrane databases were searched with no restrictions on publication date with the last search in March 2021. Eligible articles included studies of adolescent and young adult children (defined by age range of 15-25 years) exposed to parental death due to terminal illness, and with reported health outcomes (physical, psychological or social). Articles were reviewed using the QualSyst tool. RESULTS: Ten articles met the inclusion criteria. Adolescent and young adult children reported poor family cohesion and communication with associated negative psychological outcomes. They reported distrust in the health care provided to their terminally ill parent, increased psychological distress and risk of unresolved grief, anxiety and self-harm. Some experience was positive with posttraumatic growth identified. CONCLUSIONS: This review specifically analysed the health impact of expected parental death on adolescent and young adult children. It highlights their need for age-appropriate psychosocial support and clear information during parental illness, death and bereavement.

Hypertonic packs to reverse blindness caused by facial lymphoedema in the setting of head and neck cancer - A case report.

BACKGROUND: Severe, cancer-related facial oedema can impair vision. It can result from lymphatic and/or venous obstruction due to disease and/or treatment related fibrosis. There is very limited data on the use of directly applied hypertonic packs for the relief of periorbital oedema. CASE: A 63 year old man with recurrent laryngeal squamous cell carcinoma developed functional blindness secondary to periorbital oedema in the setting of severe facial swelling. This was refractory to maximal facial lymphatic massage available in the community setting. POSSIBLE COURSES OF ACTION: Management dilemmas included what non-medical interventions may relieve his periorbital oedema and thereby restore his vision outside of daily lymphatic massage from a qualified physiotherapist. FORMULATION OF MANAGEMENT PLAN: The patient agreed to an initial dry hypertonic pack with a great functional improvement of his vision. He was taught how to do this so that he could repeat ad libitum. OUTCOME: The patient had previously expressed that his most distressing thought was the prospect of becoming functionally blind prior to dying. The provision of an easy additional therapy to relieve his visual obstruction provided him with much comfort. He passed away peacefully a few weeks later. LESSONS: The case demonstrates that application of a dry hypertonic pack can relieve periorbital oedema in the setting of facial oedema in cases which are refractory to the combination of self-massage, cold-compress application, and daily lymphatic massage by a certified physiotherapist. RESEARCH AVENUES: A case series to define incidence of adverse effects and duration of treatment effectiveness.

Acquired tracheoesophageal fistula during treatment for pediatric acute lymphoblastic leukemia.

Management of pediatric malignancy can result in disruption of the integrity of the gastrointestinal mucosa through a variety of mechanisms. We describe a pediatric oncology patient who developed a tracheoesophageal fistula as a complication of treatment for acute lymphoblastic leukemia.