ABSTRACT
PTLD is a serious complication of both solid organ and BMT. This study assessed whether (18) F-FDG PET, when added to CT scan, had additional value in the initial evaluation of PTLD in pediatric patients and whether PET/CT at baseline can reliably guide biopsy. This retrospective study evaluated 34 consecutive pediatric patients (14 female), aged 3.5-17.0 yr (mean age: 9.9 yr, s.d.: 4.9 yr), who had undergone (18) F-FDG PET/CT from May 2007 to December 2014 at initial diagnosis of PTLD following heart (n = 13), lung (n = 8), kidney (n = 4), liver (n = 3), liver and bowel (n = 3), and bone marrow (n = 3) transplantation. PTLD was diagnosed histopathologically in 33 patients and was based on clinical findings, elevated EBV, and imaging and follow-up results in one patient. On lesion-based analysis, (18) F-FDG PET showed more lesions than conventional CT scan (168 vs. 134), but CT revealed 22 lesions negative on PET. On per patient analysis, PET detected more lesions in 13 patients, CT identified more abnormalities in seven, and both showed the same number of lesions in 14. Adding (18) F-FDG PET to CT scans upstaged the disease in seven patients (20.5%). A combination of (18) F-FDG PET and CT was also useful in guiding biopsy, being positive in 36 of 39 samples (92.3%). These findings indicated that (18) F-FDG PET and CT are complementary at initial staging of pediatric PTLD and that (18) F-FDG PET/CT scanning can guide biopsies.
Subject(s)
Lymphoproliferative Disorders/diagnosis , Multimodal Imaging/methods , Organ Transplantation , Positron-Emission Tomography/methods , Postoperative Complications/diagnosis , Tomography, X-Ray Computed/methods , Adolescent , Child , Child, Preschool , Female , Fluorodeoxyglucose F18 , Follow-Up Studies , Humans , Lymphoproliferative Disorders/etiology , Male , Radiopharmaceuticals , Retrospective StudiesABSTRACT
OBJECTIVES: Early psychosocial screening may guide interventions and ameliorate the adverse psychosocial effects of childhood cancer. The revised psychosocial assessment tool provides risk information - Universal (typical distress), Targeted (additional specific distress), and Clinical (severe distress) - about the child with cancer and his or her family. This pilot study investigated the benefits of providing a summary of family psychosocial risk information to the medical team treating the newly diagnosed child (Experimental Group, EG). METHOD: We conducted a pilot randomized control trial with a sample of 67 parents, comparing the EG to the control group (CG) on parental perception of family psychosocial difficulties (revised psychosocial assessment tool risk levels), child behavior (behavior assessment scale for children-2), pediatric quality of life (PedsQL), and parental anxiety (state-anxiety scale of the state-trait anxiety inventory ), 2-4 weeks after diagnosis (Time 1) and 6 months later (Time 2). RESULTS: Compared to the CG, participants in the EG had significantly reduced targeted and clinical risk (p < 0.001), and improved pain related PedsQL at Time 2 (p < 0.05). Scores for PedsQL total and nearly all subscales improved over time in both groups (p < 0.05 to p < 0.001). No changes in behavior scores were noted. CONCLUSION: Preliminary findings suggest that providing a summary of the Psychosocial Assessment Tool to the treating team shortly after diagnosis may help reduce family wide psychosocial risk 6 months later and improve quality of life related to pain for children who are undergoing treatment for cancer.
Subject(s)
Anxiety/psychology , Child Behavior/psychology , Family Health , Parents/psychology , Quality of Life , Risk Assessment/methods , Stress, Psychological/diagnosis , Adaptation, Psychological , Adolescent , Adult , Canada , Child , Child, Preschool , Female , Humans , Male , Mass Screening/instrumentation , Middle Aged , Neoplasms , Pilot Projects , Surveys and QuestionnairesABSTRACT
BACKGROUND: The Psychosocial Screening Tool (PAT) was developed and validated with a sample of caregivers of children newly diagnosed with cancer in the United States. This study aimed to assess cultural adaptation (Phase 1) and validity and reliability of the revised PAT (PATrev) with a Canadian sample (Phase 2). PROCEDURE: In Phase 1, a convenience sample of seven parents of children who were treated for cancer and six pediatric oncology healthcare experts participated. In Phase 2, 67 parents of children newly diagnosed with cancer from 4 Canadian pediatric cancer centers participated. To assess reliability and validity of the PATrev, parents completed behavioral (BASC-2) and quality of life (PedsQL) instruments about the child and an anxiety inventory (STAI) about themselves. RESULTS: The PAT required minor changes to be culturally adapted for the Canadian population. The PATrev had strong inter-rater (0.77) test-retest (0.75), and internal consistency reliability (0.85), as well as moderate to strong validity comparing PATrev child's problems and PedsQL total (-0.49), PedsQL anxiety (-0.47), BASC-2 internalizing (0.64), behavioral (0.63), and adaptive scores (-0.56). PATrev discriminative validity was confirmed with BASC-2 scores (AUR scores of 0.70-0.74). PATrev parental stressors were strongly correlated to STAI scores (0.53). Finally, agreement between PATrev child's problems and parental anxiety scores was moderate (0.47). CONCLUSION: This study supports the original PAT, demonstrates PATrev is a reliable and valid psychosocial screening tool, and provides unique evidence regarding early psychosocial risk in the family, which have important implications for guiding psychosocial practice.
Subject(s)
Caregivers/psychology , Neoplasms/psychology , Parents/psychology , Psychometrics/instrumentation , Adult , Area Under Curve , Canada , Child , Female , Humans , Male , Middle Aged , ROC Curve , Reproducibility of ResultsSubject(s)
Dyslexia/therapy , Education, Special , Eye Movements , Child , Humans , Reinforcement, VerbalABSTRACT
Informal feedback from parents indicates that children seem to improve following an asthma camp experience. However, documentation of efficacy is lacking. Data were collected over the course of 3 consecutive years to assess factors that might account for improvements following an asthma camp experience. The sample consisted of 125 children, aged 10-13 years, who had asthma. The Child Behavior Checklist, Self-Perception Profile for Children, Punnett Adjustment to Camp Scale, and an asthma health education test were utilized. Intercorrelations among the measures were summarized by means of principal-components analysis. Implications to improve the camping experience based on these findings were discussed.
Subject(s)
Asthma/therapy , Camping , Adolescent , Adolescent Behavior , Asthma/psychology , Attitude to Health , Child , Child Behavior , Evaluation Studies as Topic , Female , Health Resorts , Humans , Male , Sex FactorsABSTRACT
A meta-analysis was performed of available studies that document response to antidepressant medications in the pediatric population, based upon guidelines developed in a methodological review of adult antidepressant response (Greenberg, Borstein, Greenberg, & Fisher, 1992). The 27 studies accessed through standard medical and psychological data bases were assessed against the following criteria: degree of blindness, placebo group design, rating issues, sample size, inclusion criteria, and other methodological issues. Serious methodological flaws emerged in all areas, as well as an inverse relationship between positive findings and the presence of adequate experimental controls. Recommendations are made for improvements in experimental methodology, and caution is urged in the absence of well-controlled studies.