Universal assessment and tiered intervention: A model of care to meet the pediatric oncology psychosocial standard of care for school support.

OBJECTIVE: The feasibility and acceptability of a tiered intervention model of school intervention services was investigated in response to the publication of evidence-based Psychosocial Standards of Care for Children with Cancer and their Families. METHOD: Children with newly diagnosed malignancy or transitioning to long-term survivorship care were eligible. Families received universal school needs assessment and intervention targeted at the level of risk identified. Academic risk and resource utilization data collected over 1 year were used to evaluate model feasibility and surveys evaluated family and medical provider satisfaction with the model. RESULTS: One hundred and eight children were enrolled and had academic risk assessed at enrollment as high (25%), moderate (44.4%) or low (30.6%) risk. School liaison staff time spent providing intervention was related to the level of risk. 54.6% of patients reported a decrease in risk status at the end of 1 year of intervention. Parents (94%) and medical providers (100%) chose responses of "agree" or "strongly agree" when asked if they were satisfied with the intervention received over the year. CONCLUSIONS: The tiered model of care identifies the students with the highest need for intervention, allows for more targeted use of resources, and successfully meets the Psychosocial Standard of Care for academic needs.

[Extragastrointestinal stromal tumors: a report of 4 cases]. / Les tumeurs stromales extradigestives: à propos de quatre observations.

Gastrointestinal stromal tumors (GIST) are mesenchymal tumors that arise from the wall of the gastrointestinal tract expressing CD117 and/or the CD34. Similar tumors were described in the soft tissue of the abdomen and are so-called extragastrointestinal stromal tumors (EGIST). We report 4 new cases of EGIST. The tumors occurred in 2 women and 2 men, who ranged in age from 42 to 71 years. Three tumors arose from the soft tissue of the abdominal cavity, and the remainder arose from the retroperitoneum. They ranged in size from 10 to 27 cm. Three cases were composed purely of short fusiform cells tumors, the last case showed an epithelioid pattern. All the tumors expressed CD117. One patient presented with local recurrence and metastasis, one was lost to the follow-up and two patients were doing well. Immunohistochemistry is useful in distinguishing EGIST from other mesenchymal tumors. Intra-abdominal aggressive fibromatosis may express actin and CD117 but catenin is also positive, leiomyosarcoma expresses the actin and/or desmin but CD117 is usually negative, retroperitoneal dedifferentiated liposarcoma is CD117 negative and PS100 positive, inflammatory myofibroblastic tumor is negative for CD117 and CD34. The solitary fibrous tumor expresses CD34 and is negative to CD117. Some tumors expressing CD117 such desmoplastic round cell tumor should not be confused with EGIST. On the occasion of these four observations, we will discuss the clinical aspects and the main differential diagnoses of this tumor.

[Study of the incidence and cost of nosocomial infections in general surgery]. / Etude de l'incidence et approche du surcout des infections nosocomiales en chirurgie generale.

Nosocomial infection incidence and its cost were study. We have identified 61 infected patients and 75 infectious episodes, is an incidence of 9.4% infected for 100 hospitalized by trimester. Operative site infections are the most frequent (60%), operative site infection (9.1%), inferior respiratory ways infections (2.2%). Incriminated germs are represented essentially by negative gram Bacillus (77.3%) with predominance of enterobacterias (59%). Invasive technique usage, surgery types and contamination classes have been identified as risk factors of nosocomial infection occurrence. The supplementary stay duration estimated by simple comparison between infected group and no-infected one is 9.3% days, responsible of an over cost of 336 TD by infected patient and 273 TD by infectious episode. The curative antibiotic costs have been estimated at 70 TD by infected patient being equivalent to two hospitalization days and to 57 TD by infectious episode.

[Inspiratory aid with facial masks during acute respiratory failure without hypercapnia]. / Aide inspiratoire par masque facial dans l'insuffisance respiratoire aiguë non hypercapnique.

This prospective study assessed, in 10 conscious patients without a history of chronic respiratory disease, the feasibility of mechanical pressure support ventilation with PEEP by face mask for the treatment of acute respiratory failure without hypercapnia. Pressure support level was determined to obtain a VT of 5 to 10 mL.kg-1 and a decrease of respiratory rate of more than 20%. FIO2 and PEEP levels were determined to obtain a SpO2 > 92% and a PaO2 > 70 mmHg. The efficiency of the technique was assessed through the time course of respiratory rate, PaO2, PaCO2 and SaO2. The technique was efficient in all patients and tracheal intubation was not required. During face mask ventilation, a significant decrease in respiratory rate and an increase in PaO2 and SaO2 were observed. Pressure support ventilation with PEEP by face mask is an efficient technique for the treatment of acute non hypercapnic respiratory failure in conscious and cooperative patients.

[Gastroduodenal intussusception on gastric tumor]. / Invagination gastro-duodénale sur tumeur gastrique.

Gastroduodenal intussusception is a rarely documented condition. A distinction has to be made between complete gastroduodenal intussusception (CGDI) and either prolapse of a pedunculated tumor through the pylorus or mucosal prolapse through the pylorus. CGDI usually occurs secondary to a pedunculated benign gastric tumor. More rarely the tumor is malignant. We report a case of CGDI associated with gastric adenocarcinoma. We emphasize diagnostic difficulties that can be generated by CGDI.