RESUMEN
Parents who have experienced the death of a child from cancer have unique bereavement needs. This study evaluated the possibility of instituting a home-based bereavement visit from the oncology team following a child's death. Parents completed a brief anonymous questionnaire measuring preferences regarding visit logistics and content. The majority (84%) of the 31 participants agreed that a home-based bereavement program is desirable. Qualitative analysis of parental comments revealed common themes including processing grief, practical suggestions for visit, recognition of individual differences, perceived risks and benefits of visit, connections with medical staff, and unmet needs for support. In conclusion, a home visit program may satisfy needs for additional support while alleviating barriers to other types of bereavement care.
Asunto(s)
Actitud Frente a la Muerte , Aflicción , Neoplasias/psicología , Padres/psicología , Relaciones Profesional-Familia , Apoyo Social , Espiritualidad , Adaptación Psicológica , Adolescente , Adulto , Anécdotas como Asunto , Niño , Preescolar , Femenino , Pesar , Humanos , Lactante , Masculino , Persona de Mediana Edad , Relaciones Padres-Hijo , Encuestas y Cuestionarios , Adulto JovenAsunto(s)
Reanimación Cardiopulmonar/ética , Servicios Médicos de Urgencia/ética , Cardiopatías Congénitas/terapia , Hernias Diafragmáticas Congénitas , Diagnóstico Prenatal/ética , Órdenes de Resucitación/ética , Conducta de Elección/ética , Comunicación , Decepción , Femenino , Cardiopatías Congénitas/diagnóstico , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/ética , Cuidados para Prolongación de la Vida/ética , Masculino , Paternalismo/ética , Embarazo , Relaciones Profesional-Familia/ética , Estados UnidosRESUMEN
The increasing survival of adolescents with cancer, achieved through intensive therapy, is often associated with sterility. For most teenagers, the ability to have biological children is psychologically and socially important. Methods of preserving fertility, some standard and other experimental, have proliferated, but their use raises ethical issues. This review poses three hypothetical cases, describes the preservation methods, and identifies and analyzes the ethical issues. The discussion asks what needs to be told, who decides what to do, when can a pediatrician refuse to follow a family's choice, and what is the pediatrician's role as advocate for adolescents.
Asunto(s)
Medicina del Adolescente/métodos , Antineoplásicos/efectos adversos , Toma de Decisiones , Infertilidad/inducido químicamente , Adolescente , Medicina del Adolescente/ética , Criopreservación , Humanos , Padres , Factores SexualesAsunto(s)
Defensa del Niño/ética , Hockey/lesiones , Consentimiento Informado/ética , Pediatría/ética , Relaciones Profesional-Familia/ética , Adolescente , Adulto , Niño , Comunicación , Fibrosis Quística/terapia , Conflicto Familiar/ética , Femenino , Humanos , Intubación Intratraqueal , Traumatismos de la Rodilla/rehabilitación , Relaciones Padres-Hijo , Respiración Artificial/ética , Estados UnidosAsunto(s)
Códigos de Ética , Ética Médica , Pediatría , Guías de Práctica Clínica como Asunto , Niño , Comités de Ética , Humanos , Sociedades Médicas , Estados UnidosRESUMEN
BACKGROUND: A 3(1/2)-year-old girl with Stage 4 neuroblastoma received multiple blood components and was subsequently diagnosed with Chagas disease, which is caused by Trypanosoma cruzi. STUDY DESIGN AND METHODS: All blood donors of the units that were transfused were requested to return to the collection facility for a blood sample to be tested for antibodies to T. cruzi. RESULTS: One first-time donor was found to be positive for the presence of T. cruzi antibodies. This donor was originally from Bolivia and immigrated to the United States 17 years previously. She had not returned to her native country since her emigration. CONCLUSIONS: This is the seventh reported case of Chagas disease transmission by blood transfusion in the United States and Canada. Although this would not be expected to occur in New England, it did, and this case demonstrates the significance of the immune status of patients as it relates to transfusion-acquired infections, the impact of geographic mobility in disease transmission, and the need for a licensed screening test for Chagas disease for the US blood supply.
Asunto(s)
Enfermedad de Chagas/etiología , Reacción a la Transfusión , Trypanosoma cruzi , Animales , Enfermedad de Chagas/parasitología , Enfermedad de Chagas/patología , Preescolar , Resultado Fatal , Femenino , HumanosRESUMEN
BACKGROUND: Chemotherapy-resistant neuroblastoma is a difficult disease to treat with poor survival. OBSERVATIONS: We treated a patient with neuroblastoma who had progressed on conventional chemotherapy. This 5-year-old girl with chemotherapy-resistant neuroblastoma developed Chagas disease at the start of salvage chemotherapy for which she was also started on nifurtimox. The neuroblastoma response to these treatments resulted in clinical remission. In vitro, treatment of a neuroblastoma cell line with nifurtimox resulted in decreased cell viability whereas no effect was seen on an endothelial cell line. CONCLUSIONS: Nifurtimox shows promise as a potential new treatment for neuroblastoma and warrants further testing.