Implementation of Psychosocial Screening into Diabetes Clinics: Experience from the Type 1 Diabetes Exchange Quality Improvement Network.

PURPOSE OF REVIEW: Although advances in diabetes technology and pharmacology have significantly and positively impacted diabetes management and health outcomes for some, diabetes care remains burdensome and can be challenging to balance with other life priorities. The purpose of this article is to review the rationale for assessment of psychosocial domains in diabetes care settings and strategies for the implementation of psychosocial screening into routine practice. Survey data from the Type 1 Diabetes Exchange Quality Improvement Network is highlighted. RECENT FINDINGS: Implementation of psychosocial screening requires identifying the population; selecting validated tools to assess target domains; determining frequency of screening and mode of survey delivery; and scoring, interpreting, documenting, and facilitating referrals such that these processes are part of clinical workflows. Recognizing the influence of psychosocial factors for people with diabetes (PWD), professional society guidelines for comprehensive diabetes care recommend the integration of psychosocial screening into routine care.

Pulmonary embolism in an adolescent with COVID-19 pneumonia / Tromboembolismo pulmonar en un adolescente con neumonía COVID-19

Abstract Background: Pulmonary embolism (PE) is a complication reported in the adult population with coronavirus disease 2019 (COVID-19); however, its documentation in the pediatric population is limiteda. Case report: We report the case of a 15-year-old male with obesity and Down syndrome who was admitted for severe COVID-19 pneumonia. On day 7 of admission, he presented with chest pain, hemoptysis, respiratory distress, and marked elevation of D-dimer. Pulmonary CT angiography found an extensive thrombus in the right lower lobar artery. He received treatment with enoxaparin and rivaroxaban and had a favorable clinical outcome. In the tomographic control 1 month after treatment, thrombus was not evidenced and was successfully resolved. Conclusions: There are few reports of PE in children with COVID-19. Prompt diagnosis and early anticoagulant treatment are important to avoid life-threatening complications.

Resumen Introducción: El tromboembolismo pulmonar es una complicación reportada en la población adulta con COVID-19; sin embargo, en la población pediátrica, su descripción es limitada. Caso clínico: Se reporta el caso de un varón de 15 años con antecedente de obesidad y síndrome de Down que fue hospitalizado por neumonía COVID-19 severa. En el séptimo día de hospitalización presentó dolor torácico, hemoptisis, dificultad respiratoria y elevación del dímero D. En la angiotomografía pulmonar se encontró un extenso trombo en la arteria lobar inferior derecha. Recibió tratamiento con enoxaparina y rivaroxabán evolucionando favorablemente. La resolución al mes de tratamiento fue existosa, ya que el control tomográfico no evidenció más el trombo. Conclusiones: El tromboembolismo pulmonar es una complicación poco reportada en niños con neumonía COVID-19. El diagnóstico oportuno y tratamiento anticoagulante es importante para evitar complicaciones mortales.

Pronóstico kinesiológico cardiorrespiratorio: un enfoque biopsicosocial / Cardiorespiratory Kinesiological Prognosis: a biopsychosocial approach

La kinesiología, fisioterapia o terapia física, se ha desarrollado de manera permanente a través de una perspectiva biopsicosocial, en la que identificar el contexto biomédico del usuario, junto con sus limitaciones en la actividad y restricciones en la participación es esencial para una atención individualizada del usuario en su contexto. Entidades como la Asociación Americana de Terapia Física (American Physical Therapist Association, APTA) y la Conferencia Mundial de Terapia Física (World Confederation for Physical Therapy, WCPT) o actualmente conocida como Fisioterapia Mundial (World Physiotherapy, WP), conceden como aspecto propio del kinesiólogo o fisioterapeuta la acción de diagnosticar, evaluar, tratar y pronosticar las disfunciones de usuarios con necesidades de atención en salud. Sin embargo, algunas de estas competencias profesionales no están del todo definidas para su aplicación en la práctica clínica. El presente artículo de comunicación profesional entrega las bases conceptuales en la que se sostienen los hitos necesarios para esta-blecer una propuesta metodológica de elaboración del pronóstico kinesiológico funcional basado en el área cardiorrespiratoria con un enfoque biopsicosocial según la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF). Esto, con la finalidad de que el pronóstico funcional sea incorporado como parte de la formación curricular en la profesión, así como dentro de un proceso continuo en la práctica kinesiológica

Kinesiology, Physiotherapy or Physical Therapy has been permanently developed on a biopsychosocial perspective. Identifying the user's biomedical context, along with his or her activity limitations and participation restrictions, is essential for individualized attention to the user in his or her context. Entities such as the American Physical Therapy Association and the World Confederation for Physical Therapy, or currently known as World Physiotherapy, give the kinesiologist or physical therapist the task of diagnosing, evaluating, treating, and predicting the dysfunctions of users with health care needs. However, some of these professional compe-tencies are not wholly defined for application in clinical practice, and less, in the curricular formation of the physiotherapy students. This article gives helpful concepts to elaborate a biopsychosocial cardiorespiratory functional prognosis for Kinesiology, based on the International Classification of Functioning, Disability, and Health (ICF), to incorporate as part of the curricular formation in the profession and within a continuous process in kinesiological practice

Asociación entre el Material Particulado y la Función Pulmonar durante el Ejercicio en Sujetos Físicamente Activos / Association between particulate matter and lung function during exercise in physically active subjects

Introducción: El material particulado (MP) es una mezcla de partículas potencialmente peligrosas debido a su capacidad de penetrar el sistema respiratorio. La cantidad de MP que ingresa al organismo depende de su concentración ambiental, tiempo de exposición y la ventilación pulmonar. Esta última aumenta fisiológicamente durante el ejercicio físico. Objetivo: Determinar la asociación entre el MP y la función pulmonar. Métodos: Los participantes completaron un protocolo de actividad física en condiciones ambientales con concentraciones de MP habituales durante 4 días consecutivos (24-km). La función pulmonar fue evaluada antes (día-0) y después de una exposición aguda (día-1, post 6-km) y exposición prolongada (día-4, post 24-km). Para determinar la correlación entre los niveles de MP y las variables de función pulmonar, se aplicó la prueba de correlación de Spearman. El nivel de significancia se estableció en p<0.05. Resultados: La función pulmonar, evaluada a través de las variables de espirometría de volumen espiratorio forzado al primer segundo (VEF1), su relación con la capacidad vital forzada (VEF1/CVF) y flujo espiratorio medio (FEF25-75%), se asoció inversamente con las concentraciones de MP en el día-1 (p<0.05), pero no en el día-4 (p>0.05). Conclusión: Este estudio encontró que a mayor dosis efectiva de MP inhalado, mayor es la disminución en variables de función pulmonar evaluadas con espirometría. Este efecto fue más notorio posterior a la exposición aguda que a la exposición prolongada, infiriendo una posible habituación por parte del sistema respiratorio a la inhalación permanente de material particulado.

Introduction: Particulate matter (PM) is a mixture of potentially dangerous particles due to its ability to penetrate the respiratory system. The amount of PM that enters the body depends on its environmental concentration, the exposure time and pulmonary ventilation. The latter increase physiologically during physical exercise. Objective: To determine the association between MP and lung function in physically active young adults during physical exercise. Methods: the subjects completed a physical activity protocol in environmental conditions with habitual PM concentrations for four consecutive days (24-km). Lung function was evaluated before (day-0) and after acute exposure (day-1, post-6-km) and prolonged exposure (day-4, post-24-km). To determine the correlation between MP levels and lung function variables, the Spearman correlation test was applied. The level of significance was established at p <0.05. Results: Lung function, evaluated through the spirometry variables of forced expiratory volume in the first second (FEV1), its relationship with forced vital capacity (FEV1 / FVC) and mean expiratory flow (FEF25-75%) was inversely associated with MP concentrations on day-1 (p<0.05), but not on day-4 (p>0.05). Conclusion: This study found that the higher the effective dose of inhaled PM, the greater the decrease in lung function variables evaluated with spirometry. This effect is more noticeable after acute exposure than after prolonged exposure, inferring the respiratory system's possible habituation to permanent inhalation of particulate matter.

Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack: The SUCCEED Randomized Clinical Trial.

Importance: Few stroke survivors meet recommended cardiovascular goals, particularly among racial/ethnic minority populations, such as Black or Hispanic individuals, or socioeconomically disadvantaged populations. Objective: To determine if a chronic care model-based, community health worker (CHW), advanced practice clinician (APC; including nurse practitioners or physician assistants), and physician team intervention improves risk factor control after stroke in a safety-net setting (ie, health care setting where all individuals receive care, regardless of health insurance status or ability to pay). Design, Setting, and Participants: This randomized clinical trial included participants recruited from 5 hospitals serving low-income populations in Los Angeles County, California, as part of the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) clinical trial. Inclusion criteria were age 40 years or older; experience of ischemic or hemorrhagic stroke or transient ischemic attack (TIA) no more than 90 days prior; systolic blood pressure (BP) of 130 mm Hg or greater or 120 to 130 mm Hg with history of hypertension or using hypertensive medications; and English or Spanish language proficiency. The exclusion criterion was inability to consent. Among 887 individuals screened for eligibility, 542 individuals were eligible, and 487 individuals were enrolled and randomized, stratified by stroke type (ischemic or TIA vs hemorrhagic), language (English vs Spanish), and site to usual care vs intervention in a 1:1 fashion. The study was conducted from February 2014 to September 2018, and data were analyzed from October 2018 to November 2020. Interventions: Participants randomized to intervention were offered a multimodal coordinated care intervention, including hypothesized core components (ie, ≥3 APC clinic visits, ≥3 CHW home visits, and Chronic Disease Self-Management Program workshops), and additional telephone visits, protocol-driven risk factor management, culturally and linguistically tailored education materials, and self-management tools. Participants randomized to the control group received usual care, which varied by site but frequently included a free BP monitor, self-management tools, and linguistically tailored information materials. Main Outcomes and Measures: The primary outcome was change in systolic BP at 12 months. Secondary outcomes were non-high density lipoprotein cholesterol, hemoglobin A1c, and C-reactive protein (CRP) levels, body mass index, antithrombotic adherence, physical activity level, diet, and smoking status at 12 months. Potential mediators assessed included access to care, health and stroke literacy, self-efficacy, perceptions of care, and BP monitor use. Results: Among 487 participants included, the mean (SD) age was 57.1 (8.9) years; 317 (65.1%) were men, and 347 participants (71.3%) were Hispanic, 87 participants (18.3%) were Black, and 30 participants (6.3%) were Asian. A total of 246 participants were randomized to usual care, and 241 participants were randomized to the intervention. Mean (SD) systolic BP improved from 143 (17) mm Hg at baseline to 133 (20) mm Hg at 12 months in the intervention group and from 146 (19) mm Hg at baseline to 137 (22) mm Hg at 12 months in the usual care group, with no significant differences in the change between groups. Compared with the control group, participants in the intervention group had greater improvements in self-reported salt intake (difference, 15.4 [95% CI, 4.4 to 26.0]; P = .004) and serum CRP level (difference in log CRP, -0.4 [95% CI, -0.7 to -0.1] mg/dL; P = .003); there were no differences in other secondary outcomes. Although 216 participants (89.6%) in the intervention group received some of the 3 core components, only 35 participants (14.5%) received the intended full dose. Conclusions and Relevance: This randomized clinical trial of a complex multilevel, multimodal intervention did not find vascular risk factor improvements beyond that of usual care; however, further studies may consider testing the SUCCEED intervention with modifications to enhance implementation and participant engagement. Trial Registration: ClinicalTrials.gov Identifier: NCT01763203.

Características clínicas, de laboratorio y radiológicas de pacientes pediátricos hospitalizados con COVID-19: serie de casos / Clinical, laboratory and radiological characteristics of pediatric patients hospitalized with COVID-19: case series

RESUMEN De toda la población infectada por el SARS-CoV-2, la población pediátrica representa del 1 al 5%, siendo un reto caracterizarla clínicamente. Presentamos cinco casos de pacientes pediátricos con diagnóstico de COVID-19; el rango de edad fue de 1 a 14 años, tuvieron manifestaciones clínicas variadas, tres de ellos presentaron fiebre, tos y dificultad respiratoria, otro fiebre y dermatosis, y un adolescente con diarrea y vómitos asociado al síndrome de Guillain-Barré. Los exámenes de laboratorio revelaron elevación de lactato deshidrogenasa, dimero-D y ferritina. El patrón radiológico más frecuente fue el engrosamiento peribronquial perihiliar. Todos los casos tuvieron evolución clínica y radiológica favorable. La diversidad en las presentaciones clínicas en niños debe considerarse para un diagnóstico temprano de la enfermedad.

ABSTRACT Children represent 1 to 5% of the entire SARS-CoV-2 infected population, and it is challenging to identify them based on clinical characteristics. We present 5 cases of pediatric patients diagnosed with COVID-19; the age range was from 1 to 14 years. They had different clinical characteristics, three of them presented fever, cough and respiratory distress, another one fever and dermatosis, and the other patient had diarrhea and vomiting associated with Guillain-Barre syndrome. Laboratory tests revealed elevated lactate dehydrogenase, D-dimer, and ferritin. The most frequent radiological pattern was perihilar peribronchial thickening. All cases had favorable clinical and radiological evolution. Diverse clinical characteristics should be considered for early diagnosis of COVID-19 in children.

Síndrome inflamatorio multisistémico asociado a COVID-19 en niños: serie de casos en un hospital pediátrico de Perú / COVID-19-associated multisystem inflammatory syndrome in children: case series at a pediatric hospital in Peru

RESUMEN La pandemia de COVID-19 ha traído una nueva afección grave e inusual denominada Síndrome Inflamatorio Multisistémico en niños, de la cual aún hay mucho por conocer. Presentamos una serie de 8 casos atendidos en el Instituto Nacional de Salud del Niño, Lima Perú. La edad media fue 5,1 años. La presentación clínica incluyó fiebre, problemas gastrointestinales agudos, afectación ocular y mucocutánea. Cuatro cumplieron criterios para Enfermedad de Kawasaki clásica. Todos tuvieron serología positiva para SARS-CoV-2, hemograma patológico, marcadores inflamatorios elevados y pruebas de coagulación alteradas. Cinco casos presentaron hipertransaminasemia y tres retención nitrogenada. Cuatro casos cumplieron criterios para Síndrome de Activación Macrófagica. Todos recibieron inmunoglobulina intravenosa, corticoides y ácido acetil salicílico. Ninguno desarrolló aneurismas coronarios. Solo uno presentó miocarditis, shock y requirió ingreso a Unidad de Cuidados Intensivos. La mayoría evolucionaron favorablemente. En todo niño con fiebre, síntomas gastrointestinales y dermatológicos; asociado a exposición al SARS-CoV-2, debe investigarse compromiso multisistémico.

ABSTRACT During the COVID-19 pandemic, a new, severe and unusual condition called Multisystem Inflammatory Syndrome in children emerged, from which there is still much to learn. We report 8 children admitted to Instituto Nacional de Salud del Niño, in Lima, Perú. Their mean age was 5,1 years. Their clinical presentation included fever, acute gastrointestinal symptoms, ocular and mucocutaneous involvement. Four patients met criteria for classic Kawasaki Disease. All the patients had positive serology for SARS-CoV-2, abnormal complete blood counts and coagulation tests, and elevated inflammatory markers. Five had elevated liver enzymes and three had kidney involvement. Four patients met criteria for Macrophage Activation Syndrome. All of them received intravenous immune globulin, corticosteroids and aspirin. No coronary aneurysms were identified. Only one developed miocarditis, shock and was admitted to the Pediatric Intensive Care Unit. Most patients recovered successfully. Every child with fever, gastrointestinal and dermatological symptoms, associated with prior exposure to SARS-CoV-2, should be investigated for multi-systemic compromise.

Razonamiento clínico en kinesiología mediante aprendizaje basado en casos / Clinical reasoning in kinesiology by case-based learning

Introducción: En cursos clínicos con gran número de estudiantes, las experiencias clínicas con pacientes reales son limitadas, dificul-tando el logro de objetivos de aprendizaje. La didáctica aprendizaje basado en casos (ABC) promueve el pensamiento crítico y trabajo coolaborativo, aspectos esenciales para desarrollar competencias profesionales. El objetivo de este estudio fue reportar si la incorpo-ración de la metodología ABC en una asignatura clínica curricular promueve el razonamiento clínico en la formación en kinesiología. Metodología: En la asignatura curricular "evaluación cardiorrespiratoria en kinesiología", 10 grupos de 7 estudiantes desarrollaron casos clínicos de temas disciplinares seleccionados bajo criterio de jueces por expertos del área, y lo presentaron al resto de sus compañeros. Un académico guió la reflexión del tema tratado en el ABC, fomentando la discusión entre los estudiantes. Al finalizar la asignatura se evaluó la percepción de la didáctica educativa mediante encuesta y logro de objetivos de aprendizaje con indicadores académicos. Resultados: Los estudiantes reportaron gran satisfacción con la metodología, mayor preparación para actividades de campo clínico y mejoras en sus habilidades comunicacionales. El promedio obtenido en las interrogaciones y en las actividades clínicas fue superior a versiones previas de la asignatura, aumentando el porcentaje de aprobación y satisfacción con el curso. Conclusión: La incorporación de la didáctica de ABC fomentó el razonamiento clínico, reflexión y habilidades comunicacionales mejorando el rendimiento académico y promoviendo competencias profesionales. Como producto final se elaboró un libro de descarga libre con los temas tratados en los ABC, titulado: "Identificando problemas kinesiológicos: aprendizaje basado en casos".

Introduction: In clinical courses with a large number of students, clinical experiences with real patients are limited, difficult to achieve the learning objectives. The 'Case-Based Learning' (CBL), like educational methodology, promotes critical thinking and improve collaborative work, which are essential aspects of the development of professional skills. The objective of this study was to report how the incorporation of the CBL methodology in a clinical course promoted the clinical reasoning in kinesiology students. Methodology: In the curriculum subject ten groups of seven students analyzed different clinical cases and presented them to their classmates. The CBL topics were selected by academic experts, who also guided and encouraged the discussion among the students. An online survey at the end of the course assessed perceptions students participated in this methodology. The final academic indicators assessed the learning objectives of the course achieved by students that participated with this methodology. Results: The students reported high satisfaction with the CBL methodology. They showed better preparation for clinical experiences and an improvement in their communication skills. The final marks obtained in the interrogations and the clinical practice activities were higher than in previous years. There was an increase in academic approval and student satisfaction with the course. Conclusion: The incorporation of the CBL methodology enhanced clinical reasoning, reflection, and communication skills, improving academic performance, and promoting professional skills. The topics covered in the CBLs conformed a free download book, entitled: «Identifying kinesiology problems: case-based learning.

Fichas clínicas simuladas en kinesiología / Simulated clinical records in kinesiology

Introducción: la normativa actual de docencia clínica regula el desarrollo de actividades curriculares disminuyendo el tiempo de con-tacto estudiante-paciente, requiriendo entre otras destrezas del estudiante la lectura eficiente de información clínica. La simulación permite desarrollar competencias clínicas en los estudiantes de ciencias de la salud. El objetivo de este estudio es describir la experiencia de talleres de fichas clínicas simuladas (FCS) en estudiantes curriculares y reportar indicadores de logro de objetivos de aprendizaje relacionados al reconocimiento de las partes de la ficha clínica e identificación y extracción de información relevante. Metodología: en una asignatura de carácter mínimo previo al encuentro de estudiantes con pacientes reales, se desarrollaron cuatro talleres de FCS en grupo pequeño. Un académico guió la actividad consistente en responder cuestionarios de ubicación de información presente en las FCS. Al finalizar la asignatura, se evaluó la percepción de la didáctica educativa y logro de objetivos de aprendizaje en tutores clínicos y estudiantes mediante encuesta. Resultados: los estudiantes reportaron alta satisfacción con la metodología, facilidad para extraer información relevante y mayor tiempo de contacto clínico con pacientes reales. Los tutores clínicos informaron que los estudiantes logran reconocer las partes de la ficha clínica. Ambos consideran que el tiempo ideal para lectura de ficha clínica es de 10 a 20 minutos.Conclusión: la incorporación de talleres de fichas clínicas simuladas desarrolló habilidades clínicas de reconocimiento de las partes que componen la ficha clínica, optimizando el tiempo necesario para identificar y extraer información relevante a diferentes escenarios clínicos.

HPV16-E6 Oncoprotein Activates TGF-ß and Wnt/ß-Catenin Pathways in the Epithelium-Mesenchymal Transition of Cataracts in a Transgenic Mouse Model.

OBJECTIVE: This work aimed to determine if cataractous changes associated with EMT occurring in the K14E6 mice lenses are associated with TGF-ß and Wnt/ß-catenin signaling activation. MATERIALS AND METHODS: Cataracts of K14E6 mice were analysed histologically; and components of TGF-ß and Wnt/ß-catenin signaling were evaluated by Western blot, RT-qPCR, in situ RT-PCR, IHC, or IF technics. Metalloproteinases involved in EMT were also assayed using zymography. The endogenous stabilisation of Smad7 protein was also assessed using an HDAC inhibitor. RESULTS: The K14E6 mice, which displayed binocular cataracts in 100% of the animals, exhibited loss of tissue organisation, cortical liquefaction, and an increase in the number of hyperproliferative-nucleated cells with mesenchymal-like characteristics in the lenses. Changes in lenses' cell morphology were due to actin filaments reorganisation, activation of TGF-ß and Wnt/ß-catenin pathways, and the accumulation of MTA1 protein. Finally, the stabilisation of Smad7 protein diminishes cell proliferation, as well as MTA1 protein levels. CONCLUSION: The HPV16-E6 oncoprotein induces EMT in transgenic mice cataracts. The molecular mechanism may involve TGF-ß and Wnt/ß-catenin pathways, suggesting that the K14E6 transgenic mouse could be a useful model for the study or treatment of EMT-induced cataracts.

Insights on the mechanism of action of immunostimulants in relation to their pharmacological potency. The effects of imidazoquinolines on TLR8.

Imidazoquinolines are powerful immunostimulants (IMMS) that function through Toll-like receptors, particularly TLR7 and TLR8. In addition to enhancing the immune response, IMMS also function as antineoplastic drugs and vaccine adjuvants. These small compounds display almost the same molecular structure, except in some cases in which atom in position 1 varies and changes the imidazole characteristics. A variable acyclic side chain is also always attached at atom in position 2, while another chain may be attached at atom in position 1. These structural differences alter immune responses, such as the production of interferon regulatory factor and nuclear factor-κB (IRF-NFκB). In this work, quantum mechanics theory and computational chemistry methods were applied to study the physicochemical properties of the crystal binding site of TLR8 complexed with the following six IMMS molecules: Hybrid-2, XG1-236, DS802, CL075, CL097 and R848 (resiquimod). The PDB IDs of the crystals were: 4R6A, 4QC0, 4QBZ, 3W3K, 3W3J, and 3W3N respectively. Thus, were calculated, the total energy, solvation energy, interaction energy (instead of free energy) of the system and interaction energy of the polar region of the IMMS. Additionally, the dipole moment, electrostatic potential, polar surface, atomic charges, hydrogen bonds, and polar and hydrophobic interactions, among others, were assessed. Together, these properties revealed important differences among the six TLR8-immunostimulant complexes, reflected as different interaction energies and therefore different electrostatic environments and binding energies. Remarkably, the interaction energy of a defined polar region composed of the highly polarized N3, N5 atoms and the N11 amino group, acted as a polar pharmacophore that correlates directly with the reported immunopharmacological potency of the six complexed molecules. Based on these results, it was concluded that accurate physicochemical analysis of the crystal binding site could reveal the binding energy (measured as interaction energy) and associated molecular mechanism of action between IMMS and TLR8. These findings may facilitate the development and design of improved small molecules with IMMS properties that are targeted to the TLR system and have enhanced pharmacological effectiveness and reduced toxicity.

Pain experience in children with advanced cancer.

BACKGROUND: It is important for health care professionals to understand the pain experience in children with advanced cancer. There has been increased attention to this topic, but systematic studies are limited. OBJECTIVE: To examine pain symptoms and management in children with advanced cancer using child self-report and nurse documentation. METHODS: A prospective, longitudinal method was used to collect data from 62 children over a 5-month period. Children were English and Spanish speaking, ages 6 to 17 years, with advanced cancer. Nurses also provided data. RESULTS: Across all interviews, pain was reported 56% of the time by all children. Nurses documented pain only 23% of the time. Children most frequently reported head pain (31%), followed by abdomen, lower back, leg, and feet pain (20% to 30%). Children consistently reported more intense pain compared with nurses. Nonopioids were used more frequently (45%) than opioids (32%), and nurses' perception of pain intensity was more highly correlated with administration of opioids (r = .72, P < .001). Children who died during their participation in this study received more opioids over time. Pain intensity was relatively stable over time. Nurses noted ethnicity related differences with higher pain levels for Caucasian children, who received analgesics more frequently. DISCUSSION: The children consistently reported pain. Child self-report and nurse documentation of pain differed, as did pain management among children who died compared with those who did not. Ethnicity differences in the identification and management of pain by nurses begs further study. Overall, nurses were aware of and responsive to pain and pain management.

Symptoms in children with advanced cancer: child and nurse reports.

BACKGROUND: Systematic studies on the specific symptom experience in children with advanced cancer are limited. OBJECTIVE: The objective of the study was to examine the common symptoms and to explore commonly occurring symptoms over time. METHODS: A prospective and longitudinal study design was used. Data were collected at 10 data points from 60 children over a 5-month period. Children ranged from 6 to 17 years old, spoke English or Spanish, were diagnosed with advanced cancer, and were receiving healthcare in 1 of 4 Southern California hospitals. Nurses' documentations of symptoms were examined. RESULTS: The study sample was composed of children 6 to 12 years old (52%) and 13 to 17 years old (48%); 42% were female, and 58% were male. Fifty-five percent were Latino, and 30% were Caucasian. Pain, nausea, drowsiness, and energy loss were reported by children in more than 50% of the interviews. Children's and nurses' reports of symptoms were similar except children reported significantly more frequency and intensity of pain. CONCLUSION: Children with advanced cancer were able to report and describe their symptoms. There were few differences by gender, age, and ethnicity. IMPLICATIONS FOR PRACTICE: It is important that children's symptoms are clearly communicated to nurses, and these study findings may be used to anticipate and manage the symptoms experienced by children with advanced cancer.