Higher order genomic organization and epigenetic control maintain cellular identity and prevent breast cancer.

Cells establish and sustain structural and functional integrity of the genome to support cellular identity and prevent malignant transformation. In this review, we present a strategic overview of epigenetic regulatory mechanisms including histone modifications and higher order chromatin organization (HCO) that are perturbed in breast cancer onset and progression. Implications for dysfunctions that occur in hormone regulation, cell cycle control, and mitotic bookmarking in breast cancer are considered, with an emphasis on epithelial-to-mesenchymal transition and cancer stem cell activities. The architectural organization of regulatory machinery is addressed within the contexts of translating cancer-compromised genomic organization to advances in breast cancer risk assessment, diagnosis, prognosis, and identification of novel therapeutic targets with high specificity and minimal off target effects.

A process for delivering bad news: supporting families when a child is diagnosed.

A process for delivering bad news to families of children with a neurodegenerative disorder was developed to enhance the families' coping abilities and to lessen the impact of the devastating news. Its creation was guided by a review of the literature on parental satisfaction with and preferences for diagnosis delivery, published guidelines for breaking bad news, and the concepts of coping, grief, support, hope, and family-centered care. Nurses play a collaborative role in the implementation of this process that remains sensitive to the needs of each family. Their influence on how the interaction takes place and their support of the family both during and after they receive bad news are pivotal. Research to formally evaluate the outcomes of the interventions and strategies within the process is necessary.

Multiple sclerosis in childhood: understanding and caring for children with an "adult" disease.

Multiple sclerosis (MS) is rare in childhood but may occur more frequently than originally believed. In light of the complex nature of MS, the expanding availability of new MS treatments, and the developmental needs of pediatric patients, multidisciplinary care of pediatric patients with MS is a necessity. Our review of MS in childhood aims to increase the awareness of neuroscience nurses about MS in children and adolescents, and to expand the knowledge of pediatric nurses concerning this "adult" disease. Our experience in developing a multidisciplinary pediatric MS clinic that addresses both health and developmental needs of children with MS is presented and discussed. The nurse's role in the care of these children and their families through assessment, support, education, advocacy, referral and coordination of care is emphasized.

The psychosocial consequences of pediatric multiple sclerosis.

Although psychological distress and cognitive dysfunction are well documented in adults with multiple sclerosis (MS), they are poorly understood in children with the disease. Psychosocial difficulty experienced by children and adolescents with MS involves factors common to all chronic illnesses in children, as well as MS-specific factors. The psychosocial manifestations of the disease may affect the patient's self-image, role functioning, mood, and cognition to adversely affect schooling, interpersonal relationships, and treatment compliance. Furthermore, the impact of having a family member with MS may affect overall family functioning. Assessment and interventions for psychosocial and cognitive problems in pediatric MS should be multidisciplinary in nature and address the child's functioning at home, school, and among peers, as well as the effect on the family.

Chronically ill children coping with repeated hospitalizations: their perceptions and suggested interventions.

This qualitative research study used grounded theory methodology to learn from chronically ill children who are repeatedly hospitalized how they cope and how they feel others can assist them to cope with their recurrent hospital experiences. Six hospitalized children, ages 10 to 13 years, with various chronic conditions participated in an audiotaped interview, completed a drawing and kept a journal. The subjects identified their perceived stressors of hospitalization; revealed their use of both cognitive and behavioral coping strategies; described how hospital personnel, family, and friends enhanced their coping; and illustrated the impact of the hospital environment on their coping process. From comparison of the data, it is theorized that chronically ill children who are repeatedly hospitalized become adept at identifying and implementing a repertoire of coping strategies, accessing family and friends as resources in the coping process, developing patterns of coping with their parents, and utilizing the hospital environment to promote coping. Their coping is enhanced by familiarity and knowledge and by the respect and patience of gentle, supportive, and competent health care professionals.