Improving Children's cancer pain management in the home setting: Development and formative evaluation of a web-based program for parents.

BACKGROUND AND METHODS: Despite advances in health care, the majority of children undergoing cancer treatment experience pain, particularly in the home setting. Mobile health tools provide a promising avenue to deliver pain management education and information to parents of children receiving cancer treatment. The current study describes the development and formative evaluation of a novel intervention, Cancer-Tailored Intervention for Pain and Symptoms (C-TIPS), which provides empirically-based pharmacological and non-pharmacological pain management information and coping skills training to parents of pediatric cancer patients. C-TIPS is a web-based application including a tailoring algorithm, customization tools, guided diaphragmatic breathing training, relaxation practice, and educational material (COPE modules). Thirty parents of children undergoing chemotherapy treatment for cancer participated in this initial mixed methods pilot study. Participants completed quantitative measures assessing their stress and relaxation ratings and satisfaction with C-TIPS. Formative evaluation and qualitative data were collected using individual and group interviews. RESULTS: Parents reported high satisfaction with both the educational and skills training modules of C-TIPS (ps < 0.001). Parent self-reported stress significantly reduced (p = 0.004) and relaxation increased (p = 0.05) following participation with the skills training module. CONCLUSIONS: C-TIPS is a feasible and well-received web-based intervention that promises to improve pain management in children undergoing cancer treatment, improve stress management in parents, and increase parents' knowledge and understanding of their child's cancer treatment. Results from the current study will help make improvements to C-TIPS in preparation for a randomized-controlled trial of this innovative program.

From Pulmonary Surfactant, Synthetic KL4 Peptide as Effective siRNA Delivery Vector for Pulmonary Delivery.

Pulmonary delivery of small interfering RNA (siRNA) has huge potential for the treatment of a wide range of respiratory diseases. The ability of naked siRNA to transfect cells in the lungs without a delivery vector has prompted the investigation of whether an endogenous component is at least partially responsible for the cellular uptake of siRNA, and whether a safe and efficient delivery system could be developed from this component to further improve the transfection efficiency. Surfactant protein B (SP-B), a positively charged protein molecule found in lung surfactant, is one of the possible candidates. While the role of SP-B in siRNA transfection remains to be determined, the SP-B mimic, synthetic KL4 peptide, was investigated in this study as a potential siRNA carrier. KL4 is a 21-residue cationic peptide that was able to bind to siRNA to form nanosized complexes. It mediated siRNA transfection effectively in vitro on human lung epithelial cells, A549 cells, and BEAS-2B cells, which was comparable to Lipofectamine 2000. When commercial pulmonary surfactant (Infasurf) was added in the transfection medium, the gene silencing effect of siRNA in cells transfected with Lipofectamine 2000 was completely abolished, whereas those transfected with KL4 remained unaffected. At 4 °C, KL4 failed to deliver siRNA into the cells, indicating that an energy-dependent process was involved in the uptake of the complexes. Chlorpromazine (inhibitor of chathrin-mediated endocytosis), but not nystatin (inhibitor of caveolae-mediated endocytosis), inhibited the uptake of KL4/siRNA complexes, suggesting that they entered cells through clathrin-mediated endocytosis. There was no sign of cytotoxicity or immune response caused by KL4 and KL4/siRNA complexes. Overall, this study demonstrated that synthetic KL4 peptide is a promising candidate for siRNA carrier for pulmonary delivery and could be a potential platform for delivering other types of nucleic acid therapeutics.

Pain buddy: A novel use of m-health in the management of children's cancer pain.

BACKGROUND: Over 12,000 children are diagnosed with cancer every year in the United States. In addition to symptoms associated with their disease, children undergoing chemotherapy frequently experience significant pain, which is unfortunately often undertreated. The field of m-Health offers an innovative avenue for pain assessment and intervention in the home setting. The current study describes the development and initial evaluation of a tablet-based program, Pain Buddy, aimed to enhance pain management and foster improved quality of life in children ages 8-18 years undergoing cancer treatment. METHODS: An animated avatar-based tablet application was developed using state-of-the-art software. Key aspects of Pain Buddy include daily pain and symptom diaries completed by children, remote monitoring of symptoms by uploading patient's data through internet to a cloud server, cognitive and behavioral skills training, interactive three-dimensional avatars that guide children through the program, and an incentive system to motivate engagement. Twelve children between the ages of 8 and 18 participated in a pilot study of Pain Buddy. RESULTS: Children were highly satisfied with the program. Pain and appetite disturbances were most frequently endorsed. Symptom trigger alerts to outside providers were largely related to clinically significant pain. Children infrequently used analgesics, and reported using some non-pharmacological pain management strategies. CONCLUSION: Pain Buddy appears to be a promising tool to improve pain and symptom management in children undergoing cancer treatment. Results from the current study will inform future improvements to Pain Buddy, in preparation for a randomized controlled trial to assess the efficacy of this innovative treatment.

Psychosocial Interventions for Youth With Bipolar Disorders: Combining Clinicians' and Caregivers' Perspectives.

Despite efforts that have been made to develop and evaluate psychosocial interventions for youth with bipolar spectrum disorders (BPSDs), there has been limited evidence regarding treatment delivery and consumer experiences in clinical settings. Two parallel web-based surveys were conducted to assess clinicians' experiences with providing psychosocial treatments to youth with BPSD, and caregivers' experiences with accessing and receiving care for their youth with BSPD. Clinicians who were members of the American Psychological Association's Division 53 listserv were invited to report on (1) their training in and knowledge of BPSD among youth; (2) types of treatments they had provided and their perceived effectiveness; (3) treatment-related challenges; and (4) further training opportunities or resources they desire. Caregivers who were members of the Balanced Mind Foundation listserv were invited to participate in a separate survey. They were asked to report on both negative and positive experiences they had in their most recent experience with accessing and receiving psychosocial treatment for their youth with BPSD. Overall, the majority of clinician respondents reported receiving training in providing psychosocial treatments to youth with BPSD, though most reported desiring further training and greater access to resources (e.g., treatment manuals, workshops, case consultation). Caregivers indicated overall positive experiences with psychosocial treatments for their youth with BPSD. Positive experiences included those associated with nonspecific factors of therapy, and negative experiences included content-related factors and barriers to accessing treatments. Implications for enhancing treatment delivery and overall experience of psychosocial interventions among youth with BPSD are discussed.