ABSTRACT
Objective: The development of the Transition Readiness Inventory (TRI) item pool for adolescent and young adult childhood cancer survivors is described, aiming to both advance transition research and provide an example of the application of NIH Patient Reported Outcomes Information System methods. Methods: Using rigorous measurement development methods including mixed methods, patient and parent versions of the TRI item pool were created based on the Social-ecological Model of Adolescent and young adult Readiness for Transition (SMART). Results: Each stage informed development and refinement of the item pool. Content validity ratings and cognitive interviews resulted in 81 content valid items for the patient version and 85 items for the parent version. Conclusions: TRI represents the first multi-informant, rigorously developed transition readiness item pool that comprehensively measures the social-ecological components of transition readiness. Discussion includes clinical implications, the application of TRI and the methods to develop the item pool to other populations, and next steps for further validation and refinement.
Subject(s)
Cancer Survivors/psychology , Transition to Adult Care/organization & administration , Adaptation, Psychological , Adolescent , Factor Analysis, Statistical , Female , Humans , Male , Personality Assessment , Psychometrics , Reproducibility of Results , Young AdultABSTRACT
Over 90% of children with chronic conditions survive into adulthood necessitating primary care teams to care for adults with pediatric-onset chronic conditions. This study explores practice supports and barriers to care for this population via qualitative techniques. Using in depth interviews with twenty-two healthcare providers practice supports identified include: formalizing intake processes, interoperable electronic medical records, and leveraging care coordination. Barriers identified included: definition of the medical team, lack of appropriate medical records, time and administrative burden, lack of training, and financial constraints. Themes may be utilized to design interventions and improve care coordination for patients with pediatric-onset chronic conditions.
Subject(s)
Chronic Disease/therapy , Delivery of Health Care/organization & administration , Primary Health Care/methods , Transition to Adult Care/organization & administration , Adolescent , Age of Onset , Attitude of Health Personnel , Chronic Disease/epidemiology , Chronic Disease/psychology , Cross-Sectional Studies , Female , Humans , Interviews as Topic , Male , Needs Assessment , Patient Outcome Assessment , Patient-Centered Care/organization & administration , Pediatrics , Philadelphia , Qualitative Research , Young AdultABSTRACT
The natural amino acids tyrosine (Tyr) and phenylalanine (Phe) were labeled with carbon-11 via a modified Bucherer-Strecker synthesis. A rapid reaction of the sodium bisulfite adduct of the aldehyde precursor with ammonia provided the precursor for radiosynthesis. [(11)C]Cyanide displacement followed by base hydrolysis afforded the corresponding (11)C-labeled amino acids. The purification and chiral separation were simply achieved by using a combination of solid-phase extraction and chiral HPLC to afford individual enantiomers of each amino acid. The decay corrected radiochemical yields for each of the enantiomers were 12-16% with respect to the [(11)C]cyanide after 40-45 min of radiosynthesis. Radiochemical purity of the products was >97% (typically >99%), enantiomeric excess was >98% with the specific radioactivity 2-3 Ci/micromol at the end of bombardment. Because of its simplicity and wide applicability, the described procedure could be the method of choice to produce [(11)C]amino acids for PET studies.
Subject(s)
Carbon Radioisotopes/chemistry , Phenylalanine/chemistry , Radiopharmaceuticals/chemical synthesis , Tomography, Emission-Computed/methods , Tyrosine/chemistry , Isotope Labeling/methods , StereoisomerismABSTRACT
PURPOSE: This study explored self-reported substance use and factors associated with use among adolescents with and without cancer. METHODS: Adolescents (aged 13-19) receiving cancer treatment at a Mid-Atlantic children's hospital (n=103) and healthy peers (n=98) answered questions about substance use (drinking or drug use in past 4 months) and psychosocial variables. Parents completed demographic and family functioning questionnaires. RESULTS: Healthy adolescents reported more substance use (n=17) than adolescents with cancer (n=8). Associates of substance use in adolescents with cancer included more avoidant and substance use-related coping, less positive affect, worse parent-reported family functioning, and less nausea. CONCLUSION: Substance use and its health implications in adolescent oncology need enhanced awareness, intervention and prevention efforts, and further research.