Grieving lost selves: Throop's concept of presencing forth of an absence.

IMPACT: This article expands on C.J. Throop's concept of "presencing forth of an absence" introduced in his 2010 article "Latitudes of loss: on the vicissitudes of empathy," applying it to elucidate personal stories of grief, including an experience of the ambiguous loss of a child. The author provides a novel framework for the intersubjective experience of the grieving person. The author offers pediatric healthcare providers fresh insight into the experience of patient families.

Adding a Parent to the Brain Tumor Team: Evaluating a Peer Support Intervention for Parents of Children With Brain Tumors.

Childhood brain tumors often present profound challenges to patients and families. To address these challenges, the California Chapter of the Pediatric Brain Tumor Foundation provides hospital-based support services to parents of children with brain tumors from a Veteran Parent (VP). This mixed-methods, cross-sectional study was designed to evaluate the effectiveness of the intervention using validated tools to compare parental resilience and impact of illness on the family between parents who met with the VP and those who did not. Two-tailed t tests assessed significant differences in scores on the PedsQL Family Impact module and Connor-Davidson Resilience Scale (CD-RISC-25). Additional qualitative data gleaned from focus groups with stakeholders (health care providers and parents) were analyzed using key constructs of social support theory with Atlas.ti. Although there were no significant differences in overall scores on the PedsQL Family Impact module or CD-RISC-25 between groups, parents in the intervention group scored better on items related to handling difficult decisions and painful feelings. Overarching themes emerged from focus groups around participants' experiences with the program and included informational and emotional support, peer parent relatedness, changed outlook, and empowerment. Results reveal the impact of peer parent support and need for emotional and instrumental support.

Tablet/Capsule Size Variation Among the Most Commonly Prescribed Medications for Children in the USA: Retrospective Review and Firsthand Pharmacy Audit.

INTRODUCTION: Children are frequently asked to take tablets and capsules of different sizes and shapes to manage acute and chronic medical conditions. Medication size is an important factor that contributes to compliance, yet few studies detail size variation or pediatric pharmacy inventory. OBJECTIVE: This study assesses the available sizes and size variations of common inpatient and outpatient pediatric medications and provides an inventory of the tablet and capsule sizes available in a children's inpatient hospital pharmacy. METHODS: We derived the most frequently prescribed oral medications from US national databases, including the IMS, Vector One(®): National (VONA) and Pediatric Health Information System (PHIS). We analyzed a composite list using the National Library of Medicine Pillbox website, which provides size measurements. Medications from a children's inpatient pharmacy were audited and hand measured for comparison. RESULTS: We created a list of the top 15 most prescribed inpatient and outpatient pediatric tablet/capsule medications and observed a wide variation in size: acetaminophen 500 mg ranged from 5 to 22 mm in length, median 15 mm. Common pediatric antibiotics were larger and ranged from 8 to 25 mm in length, median 17 mm. Hand-measured samples from the inpatient pharmacy were often the larger pill sizes, despite smaller alternatives being available. CONCLUSIONS: We observed a marked variation in the sizes of common pediatric tablet/capsule medications, and pharmacies that serve children may not stock the most child-friendly medications. Tablet/capsule size does not appear to be considered when decisions about tablet and capsule medication selections are made. These results should increase awareness of these sizes and affect how physicians prescribe, how pharmacies order inventory, and how insurers and pharmaceutical companies pay for and produce pediatric medications.

Worsening bradycardia following antithymocyte globulin treatment of severe aplastic anemia.

Immunosuppressive regimens, which include antithymocyte globulin (ATG), are widely used for the treatment of severe aplastic anemia (SAA). However, bradycardia has been reported only as a rare side effect of ATG therapy in the manufacturer's product information and, in rare cases, in the adult literature. We present an adolescent with SAA and preexisting bradycardia who underwent immunosuppression therapy with ATG, methylprednisolone, and tacrolimus and developed profound sinus bradycardia with successive doses of ATG.

Sydowia polyspora associated with current season needle necrosis (CSNN) on true fir (Abies spp.).

Current season needle necrosis (CSNN) has been a serious foliage disorder on true fir Christmas trees and bough material in Europe and North America for more than 25y. Approximately 2-4 weeks after bud break, needles develop chlorotic spots or bands that later turn necrotic. The symptoms have been observed on noble fir (Abies procera), Nordmann fir (A. nordmanniana) and grand fir (A. grandis) on both continents. CSNN was reported as a physiological disorder with unknown aetiology from USA, Denmark, and Ireland, but was associated with the fungus Kabatina abietis in Germany, Austria and Norway. In 2007, a fungus that morphologically resembled K. abietis was isolated from symptomatic needle samples from Nordmann fir from Austria, Denmark, Germany, Norway, and USA. Sequencing of the internal transcribed spacer (ITS) region of ribosomal DNA of these cultures, plus a K. abietis reference culture from Germany (CBS 248.93), resulted in Hormonema dematioides, the imperfect stage of Sydowia polyspora, and thus the taxonomy is further discussed. Inoculation tests on Nordmann fir seedlings and transplants with isolates of S. polyspora from all five countries resulted in the development of CSNN symptoms. In 2009, S. polyspora was also isolated from symptomatic needles from Nordmann fir collected in Slovakia.

Utilization of an oversight committee structure and project management processes in digital radiology operations.

This paper describes the Mayo Clinic Rochester Radiology electronic imaging organization and the processes adopted to manage electronic imaging-related requests and projects.