Effect of nutritional supportive therapy on children with advanced cancer.

The parameter of weight/height ratio as a percentage of the 50th percentile is a basic measure for nutritional status in pediatric oncology and measures adequately response to therapeutic intervention.

Nonhomologous synapsis and reduced crossing over in a heterozygous paracentric inversion in Saccharomyces cerevisiae.

Homologous chromosome synapsis ("homosynapsis") and crossing over are well-conserved aspects of meiotic chromosome behavior. The long-standing assumption that these two processes are causally related has been challenged recently by observations in Saccharomyces cerevisiae of significant levels of crossing over (1) between small sequences at nonhomologous locations and (2) in mutants where synapsis is abnormal or absent. In order to avoid problems of local sequence effects and of mutation pleiotropy, we have perturbed synapsis by making a set of isogenic strains that are heterozygous and homozygous for a large chromosomal paracentric inversion covering a well marked genetic interval and then measured recombination. We find that reciprocal recombination in the marked interval in heterozygotes is reduced variably across the interval, on average to approximately 55% of that in the homozygotes, and that positive interference still modulates crossing over. Cytologically, stable synapsis across the interval is apparently heterologous rather than homologous, consistent with the interpretation that stable homosynapsis is required to initiate or consummate a large fraction of the crossing over observed in wild-type strains. When crossing over does occur in heterozygotes, dicentric and acentric chromosomes are formed and can be visualized and quantitated on blots though not demonstrated in viable spores. We find that there is no loss of dicentric chromosomes during the two meiotic divisions and that the acentric chromosome is recovered at only 1/3 to 1/2 of the expected level.

Immunologic evaluation in the nutritional assessment of children with cancer.

Eighty-one newly diagnosed untreated pediatric cancer patients (48 hematopoeitic malignancies, 17 solid tumors, 16 benign diseases) were evaluated with immunologic and nutritional parameters. The mean absolute lymphocyte count was adequate in the three groups. Reduced T-lymphocytes were seen in the solid tumors. Mitogenic response of hematopoietic and solid tumor patients' lymphocytes was low. Correlation of immunologic, dietary, and nutritional factors showed that for patients with solid tumors there was a positive significant correlation between weight/height percent and lymphocyte reactivity to phytohemagglutinin, concanavalin A, and pokeweed mitogen (p less than .05). Iron intake showed a significant positive correlation with in vitro mitogen reactivity for the solid tumor group (p less than .05) and benign diseases (p less than 0.01). Immune derangements found among patients with hematopoietic malignancies can be due to replacement of normal bone marrow with malignant cells. In solid tumor patients mitogen reactivity appears to be a reflection of nutritional state, and dietary iron is a possible factor.

Nutritional parameters in children with cancer.

An analysis of commonly used nutritional parameters was made for 277 pediatric cancer patients. It is apparent that standard nutritional assessment parameters in the pediatric cancer patient may be difficult to interpret because of the disease state as well as of the treatment. On the basis of the findings of this study, dietary histories to determine caloric and protein adequacy and a measurement of weight/height percent may, in fact, be the most reliable indicators of nutritional status.

Energy and nutrient intake of children with cancer.

Two hundred seventy-seven pediatric cancer patients received a nutritional assessment. Initial dietary intakes of patients with no prior treatment indicated a diet similar to that of the general population. The caloric intake was 75% of the RDA in a group of patients with non-malignant diseases and 80% of the RDA in the groups of patients with solid tumors and hematopoietic malignancies. Protein intake was greater than 100% of the RDA for all groups. Dietary iron was the nutrient lowest in intake, with a range of 70% to 78% of the RDA. At six-month evaluations, no significant changes occurred except for an increase in iron, niacin, riboflavin, and protein intakes in the group with solid tumors.

Use of thyroxine-binding prealbumin in the nutritional assessment of children with cancer.

The level of thyroxine-binding prealbumin was evaluated in 87 pediatric cancer patients ages 1 through 16 years whose cancer was newly diagnosed but untreated, and 39 children with benign disease or no disease. There was no difference in levels of thyroxine-binding prealbumin between the patients with either malignant or benign disease, nor was there a difference between diagnostic categories. Prealbumin values did correlate with age. When the data were compared, there was a correlation between nutritional status and prealbumin level when the total population (N = 126) was age corrected, but not within the malignant disease group by itself. This confirms data that suggest malnutrition in children with cancer is not a result of protein depletion.

Hereditary cancer syndromes: nursing's role in identification and education.

Cancer often clusters in a particular family. Such clusterings may be due to chance but also may result from common environmental factors, from heredity, or from an interaction of the two. This article focuses on those families with hereditary cancer; specifically, cancers of the breast, skin, and colon. Key indicators for each site have been identified to aid in hereditary cancer diagnosis. Surveillance and management strategies differ with each hereditary cancer necessitating varying approaches. The educational and support needs of families provide clear opportunities for the oncology nurse.

Early hospital discharge and the timing of newborn metabolic screening.

Cost containment measures have reduced dramatically the length of stay for normal newborns, in some cases jeopardizing the ability to obtain appropriate newborn screens. In our hospital, we found that an unacceptable number of patients had mistakenly been screened before 24 hours of age. As pressures to shorten hospitalization increase, health-care providers must examine the impact of such changes on their ability to obtain adequate newborn screens. Potential solutions include continued vigilance in gathering specimens after 24 hours of age, interpretation of time-sensitive tests in an age-adjusted manner, and repeating newborn screens after 24 hours of age.

Update in pediatric dentistry.

The pediatric nurse practitioner advises families in proper oral hygiene, fluoride supplementation, prevention of damaging oral habits and tooth decay, and the need for children to see a pediatric dentist. This article presents the issues of oral health for children from infancy through adolescence. Common pathologic conditions, oral trauma, and the use of sealants in children are also described.

Hypertension in children.

Early identification of children at risk for hypertension, proper evaluation, and appropriate management is important to prevent the serious long-term complications associated with the condition. This article defines primary and secondary hypertension in children, describes accurate blood pressure measurement techniques in children, presents the evaluation of a child with hypertension, and discusses therapy and prevention.

Shaken baby syndrome: identification and prevention for nurse practitioners.

Shaken baby syndrome is a less widely recognized form of physical child abuse. It is defined as vigorous manual shaking of an infant who is being held by the extremities or shoulders, leading to whiplash-induced intracranial and intraocular bleeding and no external signs of head trauma; often identifying shaken baby syndrome is difficult because of the lack of obvious external signs. Shaken baby syndrome should be considered in infants with seizures, failure to thrive, vomiting associated with lethargy or drowsiness, respiratory irregularities, coma, or death. With the increased awareness of child abuse, more attention has been focused on morbidity and death caused by the violent shaking of infants. This article describes the clinical findings of shaken baby syndrome, explores the characteristics of families at risk for abuse, and discusses implications for nurse practitioners.

Eye trauma in children: epidemiology, management, and prevention.

Eye injuries in children are frequently evaluated by nurse practitioners. The child with serious eye trauma is quickly assessed and referred to an ophthalmologist. However, many of the cases are managed in the ambulatory setting. Appropriate and swift management of eye trauma is essential to ensuring optimal outcome for the child. In addition, pediatric nurse practitioners play a critical role in educating children, families and the public about the prevention of eye trauma, particularly the use of protective eyewear. This article discusses the epidemiology, assessment, and prevention of eye trauma in children.

Providing better access to health care: a pediatric nurse practitioner WIC-based clinic for one-stop health care.

The University of Texas Women, Infants, and Children (WIC) Well Child Clinic was established in January 1992 to provide high-quality "user-friendly" health care to children in Houston, Texas. As the name implies, the traditional services of the WIC nutritional program are coupled with primary care to offer more comprehensive and greater access to care. The services are provided by pediatric nurse practitioners and focus on health maintenance, with an emphasis on anticipatory guidance and immunizations. Acute care and management of chronic illness are also provided. The clinic serves as a teaching site for pediatric nurse practitioner and medical students. This article addresses the rationale for and planning of a WIC-based clinic and the implementation of the plan and addresses issues concerning reproducibility in other settings.

Childhood cancers: incidence, etiology, diagnosis, and treatment.

Treatment advances over the last few decades have dramatically increased survival for children with cancer. More than half the children treated for cancer are now cured. Consequently, professionals working with these children are beginning to focus on minimizing the adverse effects of cancer and its treatment as well as helping families cope with a chronic, life-threatening illness. This article presents an overview of the incidence, etiology, diagnosis, and treatment of common childhood cancers. Approaches to care, efforts to prevent acute and late toxic effects, and nursing management of children with malignancies are discussed.

High expectations. Nurses who work with children who might die.

A pediatric oncology nurse, by strengthening her base from which to practice, can continue to work effectively with children who might die. This strengthening process involves developing a heightened awareness toward children's as well as her own thoughts about illness and death. It involves adapting cognitively, emotionally, and philosophically to working with children who may die.

The Texas Skin Cancer/Melanoma Project.

The Texas Skin Cancer/Melanoma Project, cosponsored by the Texas Dermatological Society and the Texas Division of the American Cancer Society, was organized to promote awareness of skin cancer. Through a well-orchestrated effort, the citizens of Texas were educated about prevention and early detection. On one day, statewide screening was conducted at 55 sites and 11,151 patients were screened. Polls conducted before and after the project show that the level of knowledge and concern about skin cancer increased following the project. Skin cancer is ideal for such a public education and screening project.