Rehabilitation for limb salvage patients: kinesiological parameters and psychological assessment.

Osteosarcoma is the most frequently occurring primary malignant tumor of bone, especially in adolescence. Treatment involves either limb salvage surgery or amputation with neoadjuvant chemotherapy. This review article discusses the current treatment modalities for osteosarcoma and also compares the gait patterns and psychosocial profiles of patients treated with either limb salvage surgery or amputation for osteosarcoma. Contemporary orthopedic literature on therapeutic options for osteosarcoma patients is reviewed. Background information on the basic principles of kinesiology, with emphasis on studies of gait pattern differences among patients treated with limb salvage versus amputation, is presented. Finally, several studies of the psychologic profiles of patients after these two procedures for osteosarcoma are reviewed. Trends in contemporary orthopedic literature suggest that functional outcomes, in terms of kinesiologic parameters, are comparable for patients treated with either limb salvage or amputation. Both sets of patients reported quality-of-life problems, including difficulty retaining health insurance and finding appropriate employment, social isolation, and poor self-esteem. The management of patients with osteosarcoma includes not only an individualized surgical plan for each patient but also includes awareness of the patients' psychologic and social needs after surgery.

Impact of development on children's mourning.

PURPOSE: A qualitative approach was used to analyze the impact of development on the grief responses of 157 children from 88 families to the death of a parent from cancer. DESCRIPTION OF STUDY: Children from age 3 to 17 years were divided by developmental characteristics, derived from interview data, into five development-derived age categories. RESULTS: The responses of children in different categories clarified the impact of development on their distinct expressions of grief, attributes of the parent they mourned, and the parent's tasks in enhancing the reconstitution of the child and the family. CLINICAL IMPLICATIONS: This first attempt to find a way to segregate children into developmentally more homogenous subgroups led to the clarification of patterns of mourning behaviors that are clinically useful. The increased precision of findings, such as the way development affects the child's mourning and the related parental support they need, may help clinicians develop more specific interventions to help children cope with the death of a parent and guide parents in understanding their children's differing responses. The pivotal role of the surviving parent and the tasks required of that parent are important for healthcare professionals to understand and support.

Advancing social work practice in end-of-life care.

Insufficient training of health professionals has often been cited as a major barrier to improving the system of care for dying patients and for the bereaved. Although specific problems have been identified for physicians and nurses, the problems of social work in this substantive area have only recently been explored. This study used a practitioner survey, focus groups, and a survey of faculty of schools of social work to broaden the information base. Results suggested that not unlike the professions of medicine and nursing, social work knowledge and skill development in the care of the dying is uneven and not integrated sufficiently with theoretical concepts and research. Social workers felt unprepared for this work by their master's level training and unsupported by continuing education programs. They recognized few social work scholars who could function as role models by providing comprehensive training, knowledge building, innovation, and advocacy. A program for leadership development was created to test new approaches to professional development in the care of the dying and the bereaved.

Depressive distress among the spouses of terminally ill cancer patients.

Bereaved spouses comprise a population at risk for psychological distress. Evidence suggests that spouses 55 years of age and younger are at increased risk of morbid outcomes, including major depressive episodes. Although the emotional impact of the sudden loss of a spouse has been well studied, less attention has been paid to the psychological impact of loss that is foreseeable, as in the case of a serious illness. In this study, data were obtained from pre-death interviews with 103 well spouses of terminally ill cancer patients. Subjects were white, 55 years of age or younger, and living with the patient and their child(ren) aged 7 to 16 years old. Depressive distress was assessed using the Brief Symptom Inventory. Fifty eight percent of males and 42% of females had scores for depressive distress in a clinically significant range. Regression analyses revealed gender was the most important predictor of the level of depressive distress reported, followed by patient's functional status and whether the well spouse quit work as a result of the patient's illness. The number of children 18 years or younger living in the household was inversely related to the level of depressive distress. The results of this analysis suggest that a large proportion of well spouses of patients with cancer who are also the parents of school-aged children may experience significant depressive distress during the terminal phase of their spouse's illness. These findings are important for planning future programs and improving existing ones for the spouses of terminal cancer patients.

School and agency collaboration in a cost conscious health care environment.

The need to reduce costs in the health care system has initiated changes that challenge social workers as well as other professions to reassess their roles and functions. While such a reassessment would optimally emerge from collaboration between school and agency, productive communication between them has been limited. This paper suggests ways to initiate this important dialogue by focusing on areas of mutual interest and concern such as (1) the development of adaptations to a cost conscious environment, (2) reassessment of the generalist/specialist balance, and (3) restructuring supervision, consultation, and continuing education. It is suggested that such a focused dialogue might reduce the perceived "widening gap" in communication and empower both school and agency to respond to the crisis with greater creativity and effectiveness.

Developing a research unit within a hospital social work department.

This article describes the establishment of a research unit as an integral part of a hospital social work department on the basis of the authors' experience in a cancer center over a 13-year period. Methods are described for building support within the institution, for the process of initiating the unit, for deciding on study topics, and finally for bridging the gap between clinical and research staff. The evolution of the relationship between clinical and research staff was characterized by four different phases: curiosity, competitiveness, cooperation, and collaboration. A childhood bereavement project is used to exemplify the developmental processes and the ongoing interaction of research and clinical staff. The professional practice of all staff benefited from the increased academic rigor and productivity, although some staff remained unconvinced of the value of such a major research effort. The benefits and costs of the unit are also discussed.

Impact of parental terminal cancer on adolescents.

Psychological and emotional concerns of adolescents during a parent's terminal cancer are described. Compared to younger children, the adolescents' greater cognitive and emphatic capacities allowed them to be more aware of losses and of the parent's physical and emotional pain. Parental illness also precipitated conflict around issues of developmentally appropriate separation. The capacity to use intellectual defenses, search for meaning and deeper understanding, and seek help were potent coping abilities. Contrary to the prevailing view, most of the adolescents coped with stress without resorting to severe acting out.

Impact of parental terminal cancer on latency-age children.

The underlying psychological and emotional components of distress were examined in 87 children with a parent in the terminal phase of cancer. Common fears, concerns, misperceptions, and behavioral consequences are analyzed, as are more severe psychological and behavioral reactions. Implications for psychoeducational parent-guidance intervention are discussed.

A preventive intervention program for bereaved children: problems of implementation.

A brief, standardized intervention program to facilitate children's adjustment to the terminal illness and death of a parent posed the following implementation problems: estimation of patient life expectancy; engagement of the family in crisis; adhesion to the parental guidance model; and termination of formal clinical intervention. Resolution of these issues is described, and adaptation of such programs to other high-risk populations is considered.

Parental death: a preventive intervention.

The untimely death of a spouse and parent is extraordinarily painful and difficult. Whether a brief intervention such as the one we are exploring is enough to make a significant difference in the mourning process and future optimum survival has yet to be seen. To date we are gratified that the immediate response of most of the surviving spouses and children is that the intervention is a helpful experience.

Patterns of change in sexual behavior among gay men in New York City.

In the absence of a vaccine or effective treatment for AIDS, health education remains the most effective strategy for stemming the spread of the epidemic. Among homosexual and bisexual men, who continue to account for the majority of AIDS cases, sexual practices have been identified as the principal risk factor. Consequently, public health efforts aimed at this population have focused on raising awareness of the potential risks of HIV infection associated with certain sexual practices. A sample of 162 asymptomatic gay and bisexual men were studied to examine patterns of change and stability in sexual behavior. The data reveal that while the large majority (84%) had adopted at least modification in their sexual behavior, primarily in the form of reducing their total number of partners and their number of anonymous partners, a significant proportion (48%) continued to engage in risky sexual behavior; this, despite high levels of knowledge concerning risk-reduction guidelines. The findings suggest that the mere transfer of information concerning safer sex practices is not sufficient to induce the desired behavior changes in a substantial proportion of gay men. Alternative strategies for achieving behavior change are suggested.

Social consequences of the cancer experience.

Increasing longevity of the cancer patient has brought about the need for mental health professionals to help patients and families cope with stresses not only at diagnosis and death but throughout the course of the illness and cure when the survivor experiences late effects and societal barriers. Patients, parents, mental health professionals, physicians, and the public all have differing perspectives on problems facing the survivor. The tendency is for physicians to minimize problems in light of curing a disease that was once fatal. The public may be reluctant to acknowledge problems out of a lack of awareness that cure is possible. Differences in points of view may account for disagreements about the significance of problems associated with survival. Acknowledgment and understanding of these various perspectives are prerequisite to resolving problems and facilitating the coordination of care and support survivors require in their pursuit of a normal life.

A psychosocial assessment framework for cancer patients and their families.

This article describes four areas of knowledge for social work assessments that cover the ecological system of the patient and psychodynamics. In addition, it addresses the area of dis-synchrony, which causes stress for many patients. The author focuses on the area of dis-synchrony because she believes that social workers must be clear about the differences between reactions of pathological patients and strong reactions of psychologically normal patients to extraordinary circumstances. The literature on stress has begun to look at this aspect but is still open to a pathology bias. The social work profession needs to evolve new ways of thinking about normal people and their environments. The unique access that social workers have to the range of patients in a variety of settings creates the opportunity for them to make a significant contribution to the understanding of the full range of human experiences. Moreover, the sharing of knowledge between workers in mental health settings and those in medical settings is relevant not only in the provision of direct service, but also in the development of hospital policies and national policies regarding health care for individuals and their families.

Factors affecting coping of adolescents and infants on a reverse isolation unit.

This paper describes factors that affect the coping processes of adolescents with aplastic anemia and infants with severe combined immuno-deficiency disease treated on a reverse isolation unit. The adolescents demonstrated a rich diversity of coping styles depending on the interaction of a variety of factors. Special stresses to other family members, such as the reactions of the child donor, are also highlighted. For the infants, the dyadic relationship with the mothering figure, the feelings of the family about the fact of genetic transmission, and the impact of isolation on the infant's development are identified as important psychosocial variables in the infant's adjustment. A multidimensional perspective such as that provided within a systems framework, which encourages an appreciation of the interactive diversity of all factors, is presented as the most useful approach to interventions.